Behavioral health is unlike any other discipline. Mental health diagnoses are more subtle and difficult to comprehend, yet they are just as critical to a patient’s overall health. Due to the complexity of mental health, medical billing for this specialty is typically more complicated than for other specialties.
Medical Billing Tools for Behavioral Health:
Providers can simplify medical billing for mental health with the proper software. Removing yourself from one-size-fits-all software created for primary care practitioners will help you strengthen your mental health practice.
Coding by Specialty
Medical billing for behavioral health services requires the use of specialty-specific billing codes. Mental health experts do not use PCP-specific codes and should not be contacted during the billing process by them. Numerous systems stifle specialists’ productivity by clogging their billing processes with superfluous data and billing codes that will never be used. Software built specifically for mental health professionals’ medical billing includes a list of the most frequently used codes in the field, eliminating codes that your practice would never use.
Apart from the most frequently used medical billing codes in your specialty, software created specifically for behavioral health should include a specialty-specific dashboard. Tailored reports detail the status of your clinic’s billing efforts and the areas in which your practice can enhance its overall performance.
Claims Enhancement Instruments
A clean claim is the quickest path to payment. As payers cover an increasing number of mental health diagnoses for patients, medical billing for behavioral health is promoting the acceptance of insurance by more providers. High-quality medical billing software created specifically for mental health provides tools to keep your claims clean, to verify coverage prior to providing treatments, and to enable your practice to get prompt reimbursement from payers.
Managers of mental health practices face unique and difficult situations in comparison to managers of other disciplines.
Another complicating element is that many beneficiaries of behavioral health services receive medical treatment in primary care settings rather than in specialty programs where they would receive more complete care.
Factors Contributing to Delayed Reimbursements
It is critical to be aware of the factors that contribute to delayed reimbursements and denials. Several typical reasons for denials authorization in advance, or prior authorization is required for the majority of behavioral/mental health operations.
Errors in Documentation
CMS suggests particular documentation, such as timesheets, encounter notes, date and location of treatment, and proof that the plan was prepared by a professionally led care team that included the patient and their family. Establishing the medical necessity of procedures/treatments is critical, and accurate documentation will help you avoid denials.
Accuracy in Coding
Time spent in therapy is critical, as treatment is billed on a per-unit basis. Appropriate medical codes based on time spent can help minimize billing problems concerning the unit count.
Infractions of the Law
CMS outlines common policy violations that occur when behavioral/mental health treatments are billed. These include the following:
- Failure to maintain timely progress notes
- Unauthorized billing for services that require prior authorization
It is vital to bill accurately and submit clean claims for the services rendered. Outsourcing your billing process relieves you of administrative burdens and enables you to repurpose your workforce. Additionally, it has the potential to save a significant amount of money due to billing and claim filing problems. Our behavioral and mental health billers use industry best practices to maximize revenue and minimize claim denials.
Our staff is up to speed on HIPAA regulations governing behavioral and mental health billing and coding. We obtain advance authorization from the patient’s mental health insurance company to avoid denials in the long run. Our team of medical billers and coders are immediately familiar with the ICD codes for behavior and mental health, enabling us to submit accurate claims.
Swift Medical Solutions enables you to better utilize your workforce by focusing on administrative activities. Our staff is dedicated to optimizing the whole revenue cycle process in order to eliminate denials.