May is Mental Health Awareness Month. Topics surrounding mental health are on the rise due to an increase in open and honest conversations across communities and on social media and a decrease in stigma resulting from advocates opening up about their mental health struggles. Television shows, movies, and the news share stories of hardship and hope as individuals persevere through depression, anxiety, addiction, and other disorders. Like with any medical diagnosis, illness, or accident, mental health concerns matter just as equally.
There are, however, significant differences between general medical billing and billing involving mental health services.
Typical medical billing can sometimes seem like a walk in the park compared to dealing with mental health billing. There are various reasons for this. Billing for mental health services is not as cut and dry as billing for a medical appointment or procedure. For example, when a patient goes to the doctor to get an x-ray, the service is obvious and specific, can be coded easily, and there is less involved in the billing process. On the other hand, if a patient attends mental health therapy sessions or ends up in a treatment facility for whatever reason, the services rendered are less objective and have a much more complicated billing process.
These difficult factors can be disadvantageous to both medical billers and the patients. Mental health services are more likely to be rejected than general medical services. Psychiatric and psychological professionals are more likely to handle their financial processes, and overall, mental health billing is less straightforward than medical billing.
Continue reading to learn about the various types of mental health billing and what makes it so much more complicated than medical billing.
What is included under the umbrella term “mental health billing?”
Four major billing categories fit underneath “mental health billing.” Each of these has its own set of CPT codes that are used to correctly bill health insurance companies.
“CPT codes are developed, maintained, and copyrighted by the American Medical Association (AMA). As the practice of health care changes, new codes are developed for new services, current codes may be revised, and old, unused codes discarded. Thousands of codes are in use and updated annually,” (VeryWellHealth).
Although they are not entirely the same, psychiatrists are more similar to medical professionals than any other mental health professional. Not only do psychiatrists need to know the mental health CPT codes, but they also need to be familiar with the psychiatric diagnostic evaluation codes. Both will be used in the billing process. Some psychiatrists who own a private practice may conduct their own billing, similar to psychologists and counselors who work for themselves, to cut down on the cost of having to hire a billing expert.
Software that medical billers use is not always adequate for behavioral health billers. Some medical programs do not take into account the intricacies of mental health sessions or residential or in-patient stays. When therapists and psychologists run their private practice, they may code and bill themselves, which can potentially increase the number of mistakes made. It is beneficial for psychologists and therapists to utilize software that is tailored to mental health billing to make their lives much easier.
Therapists must not only use common psychotherapy codes, but also CPT codes that describe a specific amount of time for each session, crisis codes, testing and assessment codes, and other add-on codes.
Behavioral health billing
This type of billing is quite similar to psychotherapy billing except it relates to social services and other forms of behavioral health, such as working with a community social worker. It can also include services when working with a behavioral specialist, for example, an Applied Behavior Analyst.
Facility Detox Billing (Substance Abuse Billing)
Substance abuse facilities have their own type of billing due to the complexities of the scenarios they deal with. Rapidly changing industry laws, regulations, and issues with insurance companies can make substance abuse billing a little tricky. Inpatient facilities have their own set of codes, which medical billers need to be aware of to ensure proper billing. The International Classification of Diseases (ICD-10) has thousands of billing codes pertaining to substance abuse and behavioral health treatment. Those who handle facility detox billing need to stay up-to-date on relevant research, codes, and regulations to ensure a successful billing cycle.
Mental health billing for non-profits
If you’re responsible for mental health billing for a non-profit, you have to deal with two types of demands — billing that involves non-traditional healthcare services, and those addressing the special needs and processes of non-profits companies. There is software available to those who work specifically with non-profits to make things go more smoothly.
CPT codes are regularly changing and the list continues to increase as the world of mental health evolves. Mental health professionals are responsible for staying up-to-date with the American Medical Association (AMA) and any changes they have made.
Common difficulties that mental health billers face
“In the mental health field, patients and insurers are billed primarily for therapy, medical management, and psychological testing services. Insurers have rules about how long a session they’ll pay for, how many they’ll pay per day or week, and often a maximum number of treatments that they will pay for. The mental health needs of the patient may exceed the services the insurer is willing to pay for, making balancing an effective treatment plan with adequate reimbursement tough for mental health professionals,” (PBA).
Among these rules and challenges, other difficulties mental health billers face include:
- Dealing with re-approval policies
- Handling rejections
- Staying up-to-date with each company’s billing methods
- Learning about policy changes
- Understanding more complex CPT codes
- Accommodating telehealth/teletherapy sessions
- Dealing with other contributing factors
There are similarities between medical billing services and mental and behavioral health billing services; however, the differences are what cause a headache for many billers. The world of behavioral health is rapidly changing and new research is being conducted, which means new types of services may be developed. Being knowledgeable and staying current on mental health topics related to services and billing is important and will help with limiting the frustration.