In recent years, the spotlight on mental health has intensified with the social and emotional fallout of the COVID-19 pandemic, placing mental health at the forefront of healthcare. And as we are in the holiday season, we’re reminded that the season that many of us enjoy celebrating cultural traditions, family, and gratitude can be a very triggering time for others. The work of mental health workers is critically important to the well-being of our world as a whole.
However, despite increased public awareness, mental health practitioners find themselves overwhelmed and inadequately supported. A significant source of frustration lies in the intricate world of mental health billing, characterized by ever-changing coding rules that impede the claims process and have pushed many clinicians to consider not accepting insurance, which in turn, decreases the access to care for many.
Compounding this issue is the disparity in reimbursements for mental health providers. According to a Milliman study, primary care reimbursements exceed behavioral health reimbursements by over 23%. Coupled with the coding complications, it’s tricky territory for those in healthcare dedicated to an intricate and vitally important piece of health—mental health.
This article provides essential strategies for enhancing the revenue cycle for mental health care, beginning with understanding some distinctions of mental health billing.
Key differences between mental health and medical billing
A fundamental distinction between mental health billing and medical billing lies in the limits and restrictions imposed by insurance companies on behavioral health claims. Additionally, behavioral health care necessitates more nuanced treatment plans, making billing for sessions less straightforward than traditional medical services.
Take, for example, a typical healthcare procedure like a blood pressure check for a physician-requested follow-up with one clear CPT code of 99211 to quantify it. In contrast, however, mental health visits vary in duration, resulting in corresponding variations in billing codes. If a patient engages in 35 minutes of psychotherapy, CPT code 90832 is appropriate for sessions between 16-37 minutes. However, if the session went 40 minutes, the code would change to 90834, as it fits the range of 38-52 minutes. It’s clear how mistakes in billing an incorrect code for the duration of mental health services can be quite costly.
Coverage Limitations
Apart from the confusion that often arises from procedure codes that vary by duration are appointment limits. Insurers often limit the number of mental health sessions or services within a specific period or require prior authorization. Understanding these limits and prerequisites is crucial to educating patients and avoiding claim denials or reimbursement issues.
For years, accessing mental healthcare required in-office visits. However, the landscape has evolved, and many patients now opt for telehealth services, a trend significantly accelerated by the events of the pandemic. With these two service delivery options, patients now enjoy unprecedented access to care. Nevertheless, the challenge to medical billing professionals lies in the increased complexity introduced by the surge in telehealth, necessitating additional modifiers to distinguish service delivery methods.
Superbills for Out-of-Network Mental Health Services
Many mental health providers, often out-of-network, use superbills for payment collection, offering an alternative to joining insurance panels. Superbills provide the documentation a patient needs to access possible reimbursement.
Changing Regulations
The evolving landscape of mental health in healthcare necessitates staying updated on billing rules and regulations. Ignoring these changes can result in submitting incorrect claims and hindering the revenue cycle. The most critical consequence, however, is to the people we serve. Interrupted services due to not staying updated on regulations can significantly impede a patient’s progress. Maintaining a patient-centric approach serves as the driving force behind our commitment to staying informed about significant changes.
Top Tips for Improving Mental Health Billing Efficiencies
Navigating behavioral health billing’s complexity is challenging for small practices with limited staff. However, implementing the following tips can optimize billing for mental health services:
Use a Reliable Insurance Eligibility Tool
Verify patient benefits before appointments, preventing claim rejections. An automated eligibility tool streamlines this process for small practices. Efficiency means patients can access needed mental health services faster.
Maintain Detailed Documentation
Mental health providers should maintain detailed patient records. Complete notes and other documentation aid in prior authorizations, claim appeals, and gathering accurate demographic information, diagnoses, medications, and treatments.
Understand Each Payor’s Criteria
Different payers have distinct forms and criteria, necessitating an understanding of each to avoid claim rejections. Review standards for insurance carriers periodically to stay up-to-date.
Consider Partnering with an RCM Expert
4D Global offers solutions for behavioral health billing to increase efficiencies, get providers paid faster, and increase profitability by providing streamlined systems and expert medical billing support. With the most advanced software systems, integration of automation and AI, and professional billing experts, we’re equipped to help you reduce administrative costs and improve mental health billing efficiencies.
Book a complimentary consultation today. You’ll speak with one of our team members who will answer any questions and help you strategize for mental health billing success.