Medical billing for mental health services is more complicated than in other areas of healthcare due to the types of services, time, scope, and restraints placed on mental health treatments.
For instance, if a patient visits a doctor for a routine check-up, they will almost certainly go through a standard series of tests and exams. This typically includes measuring the patient’s height and weight, taking their blood pressure, listening to their heart, and possibly drawing blood. These exams, for the most part, are standardized across all patients, take the same amount of time, and differ only slightly from patient to patient.
Similarly, when providers bill routine check-ups to health insurers, the billing is standardized, repetitive, and frequently bundled into a single overall charge. However, the same cannot be said for mental health treatments.
That’s why you must have a well-organized mental health billing process as a provider of mental health services that allows you to focus on what is most important – patient care with the best treatment process. Here are some mental health billing challenges that might hinder your treatment process, along with well-proven tips for dealing with them.
Challenge #1: Denied or Delayed Claims
It can be extremely difficult to collect payment for services rendered at times. The longer insurance companies delay important payments, the more difficult it can be to collect the funds you require. Fortunately, there are numerous moves you can take to ensure that you continue to receive the claims you deserve in a consistent, ongoing stream, rather than facing claim approval challenges regularly.
Solution: Identifying Delays and How to Avoid Them
Learn about potential claim delays, including those most commonly encountered with insurance companies. Many insurance companies, for example, will deny a claim exceeding the policy’s maximum allowable amount. If you anticipate this will be a challenge, you should review how you bill the insurance company to ensure you do not exceed the maximum. Coding issues, which are most easily avoided by working closely with a dedicated mental health billing specialist, can also help streamline approval and ensure that you are paid on time.
Finally, consider accepting cash payments from patients who work with specific insurance providers or do not have insurance, which could help streamline payments and keep your practice running smoothly.
Challenge #2: Patient Insurance Changes and Pre-Approvals
Patients seeking mental health services are likely to schedule appointments regularly and services. Some people may have had the same insurance for years, making mental health billing for services rendered relatively simple. Any insurance change can cause your claim to be denied, leaving you with uncollected payments. Similarly, the insurance company will not cover the necessary care if you provide treatment to a patient who has not received that pre-approval. This could eventually lead to a patient being unable to afford those services, resulting in missed appointments and revenue opportunities.
Solution: Verify Insurance Coverage and Requirements
When a new patient makes their first appointment, check with their insurance company to ensure that they do not require special approval steps. Continue to verify your patients’ insurance and coverage at each visit, and remind regular patients that they must notify you immediately if their insurance changes.
A top-tier EHR platform can help you quickly and easily determine whether a patient has the necessary coverage to complete an appointment. If your patient lacks the coverage of insurance required for the appointment, or if you are unable to verify insurance, you may need to reschedule for another time.
If you were previously an in-network provider but have moved out of network or to a different network tier for a specific provider, you may need to notify your patients. Make sure this happens well before their appointment to give them time to sort out any potential insurance or payment changes.
Challenge #3: Insurance Company Filing Preferences
Nowadays, most insurance companies use a digital billing model. However, this does not imply that every company prefers the same filing method. Your staff may feel compelled to keep up with an ever-changing set of preferences—and if you file incorrectly, you may struggle to collect payment from that insurance company.
Solution: Collaboration with a Dedicated Medical Health Billing Specialist
A dedicated mental health billing specialist can assist in keeping up with ongoing changes in the insurance industry, including changes made by various companies. Your mental health billing specialist will keep up with changing needs as your practice grows and changes, ensuring that insurance claims are filed correctly so you can collect payments more efficiently.
Outsource Third Party Mental Health Medical Billing
As you can see, a significant amount of work is involved in correctly filing claims for mental health providers. Thereby, it is not surprising that many providers prefer to use a third-party mental health billing company to handle claims so that they can focus on patient care and treatment.
24/7 Medical Billing Services works with mental health providers to offer pre-authorization, mental health medical billing and coding, claims follow-up, and assistance with insurance claim appeals. Check out our mental health billing and coding services, and contact us immediately if you believe this is the best option for your facility.