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Complete Guide to Behavioral Health Practice Medical Billing

The wellbeing and emotional healing of so many people depend on behavioral health treatments. These services and treatments cover a broad spectrum of essential elements required to guarantee a seamless process. However, if there are systemic flaws, incomplete or inaccurate data, and pre-authorization problems. Paying for behavioral health services can frequently impede the course of therapy.

It may be challenging for mental and behavioral health professionals to run their practice effectively due to one or more of these issues, as well as numerous additional factors. Patients’ time is lost since it takes a lot of effort and time to submit a claim for medical billing for mental health care. Knowing more about the billing procedure for mental health services might help you focus more of your time and attention on your patients and less on annoying inconsistencies. Think of this as a mental health billing crash course for beginners.

Types of covered Mental Health Services

For your patients who might have various insurance or medical coverage. It’s crucial to be aware of the kinds of covered mental health therapies. For instance, some insurance plans will only pay for mental health care provided by a certain group of professionals, including doctors, psychiatric professionals, clinical psychologists, and clinical social workers. Additionally, because insurance does not pay for the actual treatment. Some are independent mental healthcare professionals can merely label the patient as having a mental condition.

The diagnosis and treatment of a mental disorder by doctors and psychiatrists will almost certainly be paid for by insurance if you work in a private practice. These services frequently involve counseling in some way, such as:

  • Family medical psychotherapy: If a family member has a particular illness, diagnosis, or other mental and behavioral health problems, close relatives or caregivers attend therapy sessions to better understand the condition and how to care for the person. This service may be provided with or without the patient’s presence and is occasionally reimbursed.
  • In group psychotherapy, several patients are selected to receive interactive treatment in an effort to alter behavior patterns. If their diagnoses are curable, health insurance ought to pay for them.
  • Psychiatric therapeutic services: This is a type of individual therapy with a patient who can interact with and comprehend queries from a provider as well as the treatment they get. Treatment options for this therapy include addressing behavioral patterns, emotional issues, and exams.
  • A patient’s medical and mental health history is gathered during a psychiatric diagnostic review, also referred to as a psychiatric diagnostic interview examination. The patient’s mental health will also be examined. A provider will assess the patient’s readiness and capacity to react to treatment.

Important steps to take when using medical billing for mental health services

Mental health billing adds another layer of complexity to the already challenging and time-consuming process of medical billing. Medical billing is somewhat standardized and varies from patient to patient only little, with the fundamental tests and parameters being the same. This is the main reason why mental health billing services differ from medical billing.

The sorts of services offered in mental health or psychiatric billing. However, differ from one another in terms of the clinical approach, session size, frequency of visits required for a patient, age and level of preparation for therapy, among many other aspects. Because it is challenging to standardize these variable aspects, mental health billing becomes a challenging process to handle.

Additionally, in order to standardize and reduce pay by limiting the length and frequency of sessions delivered by psychiatrists. Several insurance companies have created various guidelines for mental and behavioral billing. Due to all of this, the majority of mental health practices choose the outsourced services provided by mental health billing firms. Because they find it difficult to manage the billing processes.

The following are 5 crucial actions that a mental health practice needs:

  1. Patient Check-in: In order to verify insurance and reduce further errors. It is crucial to organize and enter complete patient information while checking in. Some clinics and mental health billing businesses utilize specialized software for mental or behavioral health billing. Which secures patient data such personal details, demographic data, etc. online.
  2. Eligibility Verification: Verifying insurance eligibility is crucial for mental health billing because coverage and policies may differ in certain situations, which in the long run may result in rejections. Therefore, it’s crucial to conduct eligibility verification early on by cross-referencing patient coverage benefit information with primary and secondary payers.
  3. Medical Coding: Billing for mental and behavioral health treatments requires specific medical codes for therapy, referral, and diagnostic services, and any errors in coding could result in rejection or non-payment. A new or missing code for a certain therapy is updated in the system. To reduce errors, medical coders use ICD-10 and CPT assistance to check and verify the codes for a procedure.
  4. Charge Entry: Charge entry is a crucial part of medical billing and should be done carefully. It determines whether or not a doctor will be paid for his services. It is carried out in accordance with the provider’s policies on the duration and frequency of the services given. Therefore, it’s crucial to pre-install pricing structures for different services into the systems along with accurate coding to prevent any erroneous charge entry from leading to claim rejection or denial.
  5. Submission of Claims: Only when bills are submitted on time do they become payable. Experts in medical billing pay close attention to accuracy as well as timely submission. Different insurance companies have different billing periods, so it’s critical to research each insurance company’s specific deadlines. Submit your claim on time to avoid rejection or denial.

How are mental health services billed?

  • Recognize the differences between CPT and ICD-10 codes

ICD-10 (International Classification of Diseases, 10th revision) and CPT (Current Procedural Terminology) codes must be used for both medical and mental health invoicing. The latter is more significant since CPT codes describe how you are treating the disease. Whereas ICD-10 numbers describe the patient’s diagnosis. Although you can charge patients for your therapy services, you cannot charge them for a diagnosis.

More than 200,000 codes are present in the ICD-10 book. Even though there are more CPT codes, mental health professionals choose to use the ones that begin with the number 9. These codes, which are always five digits long, are used for telemedicine, case management, psychiatry evaluation, and testing and assessment of mental health. Some telehealth codes start with G rather than 9.

The length of a patient interaction, in contrast to normal medical billing, affects the CPT codes you’ll utilize. The CPT code 90834 designates a 45 to 55 minute session. While the CPT code 90837 is used for sessions that last longer. An easier invoicing procedure results from properly classifying your services depending on length.

  • Learn the codes for mental evaluation and E/M.

There are two groups of CPT codes that you should be familiar with:

E/M codes: When assessing a new patient concern, utilize these codes in your invoicing. The three documentation components listed below are needed for each E/M code.

History: Include the patient’s present diagnosis, a system overview, as well as any relevant family and societal history.

In this section, you’ll describe the patient’s history, the current problem, and the exams you’ve done.

  1. Medical decision-making: In this section, you’ll list the number of diagnoses and treatments that were applied during the patient contact. You should also describe the complexity of the patient’s data and indicate any potential issues.

2. Psychiatric assessment: If your psychotherapy session also has psychiatric components, you must separately bill and code these components. Notably, any time spent receiving a psychiatric evaluation cannot be deducted from the time you spend offering psychotherapy. For instance, you would use CPT code 90834 rather than 90837 if you spent 50 minutes on psychotherapy and 10 minutes on a psychiatric evaluation.

3. The patient’s insurance benefits should be confirmed.

You can formally start the billing process once you are familiar with the ICD-10, CPT, E/M, and psychiatric evaluation codes applicable to your services. Before each patient’s initial visit, a verification of benefits (VOB) is carried out. Obtain a copy of the patient’s insurance card in order to do this. After that, log in to the provider site of the insurer to see if the patient has insurance that will pay for your services. If there isn’t a gateway, contact the insurer.

4. Select the appropriate billing form.

You will probably come across two billing forms in both medical and mental health billing: UB-04 and CMS-1500, often known as Form HCFA. If you have front-office employees, they will complete the UB-04 form; doctors will complete the CMS-1500.

Your tax identification number (TIN) and national provider identifier (NPI) should be on hand in either scenario. Considering that various payers may want various information, you should also be aware of the kinds of information needed in each area of the form.

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