Mental and behavioral health billing is a challenging endeavor to nail down. The reason for this complication is that charges for different services vary, as do the credentials of the professional delivering the therapy. Before we know it, the practice or RCM staff may face a never-ending pile of behavioral health billing specialists to manage with limited resources and time. Let’s streamline Streamlining the behavioral health billing best practices for success.
Another area that presents a concern is the issue of correctly processing pre-authorization. Due to the differences in the types of treatments and procedures associated with mental and behavioral health facilities, pre-authorization for these facilities is separate from that for other specializations. This makes it difficult for RCM workers to unbundle and improve the claims submission process.
Billing consistency in mental and behavioral health facilities differs from that of other medical specialties. In some facilities, a consistent method is followed when a patient walks in, beginning with a height and weight check, blood pressure, and so on, resulting in a recurring pattern when billing for one patient to the next.
Treatment plans in mental health facilities vary from patient to patient, depending on the session length, therapy, and the patient’s consent. This makes it difficult for mental and behavioral health personnel and requires them to be far more cautious when processing bills to minimize maximum denials and improve reimbursements.
However, these difficulties can be significantly simplified in order to achieve a more suitable approach. Let’s have a look at a few of the best practices for success while streamlining behavioral health billing:
Stay on Top of the CPT codes
A HIPAA-compliant system aligns rendered services with appropriate medical codes by using Current Procedural Terminology (CPT) codes. Coders utilize modifiers to specify the details of a certain operation or treatment for more detailed information on the given codes. Making errors, even in the most minute code, can have severe consequences for claims.
The most typical occurrence of coding errors has been owing to the re-occurring of identical procedures. As a result, it is critical to ensure that coders successfully differentiate comparable procedures. The CPT code Editorial Panel is regularly updating the regulations and codes. As a result, mental and behavioral health practices must revisit the source and modify it accordingly.
Psychiatric Evaluation Codes vs. E/M Codes
Mental and behavioral healthcare practitioners may bill for psychiatric evaluations and Evaluation and Management (E/M).
The E/M codes include:
- The patient’s medical history, such as illness history, system reviews, family and social history, and so on, followed by
- Examination, which includes the type of procedure, test, and examination that needs to be performed, the nature of the patient’s issue, and so on, and
- Medical Decision Making includes the number of treatments needed and documented, the risk factors, and complexities associated with reviewed data.
The psychiatric evaluation codes, however, are only used for diagnostic purposes and may also fall under the E/M code umbrella. However, coders must understand which codes to use to generate clean claims.
Check the Patient’s Benefits
Before starting the sessions, the first and most important step must be to verify the patient’s benefits. Although this process is time-consuming, it is not impossible, especially for returning patients. This procedure may appear needless, but it is unavoidable as patients will be unaware of their treatment plans, even if they change.
Benefit verification confirms the patient’s current insurance coverage for the practice’s services. Online verification is once again the most effective and simple option to complete this verification process. Even yet, there are several limitations to online processing, and to compensate, the practice staff may contact the payer for additional information, such as the extent of insurance coverage, pre-authorization requirements, and maximum limit.
Outsourcing to 24/7 Medical Billing Services
Even with a streamlined approach, claims may be denied for various reasons. Although these claims are appealable, practice personnel must identify patterns and find strategies to eliminate the unusual denial. As insurers may have a short time constraint for re-submissions, timely and regular evaluation of prior denials must be done effectively and promptly.
Mental and behavioral health practices must be linked with best practices to guarantee effective billing and coding clear claim submissions. We at 24/7 Medical Billing Services are aware of the challenges associated with appropriate behavioral billing and coding company. We provide a billing and receivables solution to help your practice succeed. Speak with one of our specialists to learn how we expect to enhance payments to your healthcare organization.