The treatment of long-term conditions such as anxiety, depression, substance use disorders,
bipolar disorder, or schizophrenia is the focus of behavioral health medical billing. The essential
element of billing for behavioral health services is the limitations placed on facilities and
patients, such as limiting the number of visits in a week or month and the length of the actual
visit. In fact, pre-authorization is sometimes required before visits are covered. Some insurance plans do not cover behavioral health services, and some providers are not in a
network with a patient’s plan. Therefore, behavioral health providers must be prepared for
patients who pay for services out of pocket. Consequently, you must be aware of the tips and
best practices involved in medical billing for behavioral health:
● Know about Coding Regulations:
Billing for behavioral health services entails more than just diagnosis and CPT codes. There are
significant differences that can be perplexing for billers unfamiliar with this type of medical
billing. Submitting claims may differ from one payer to the next, so it’s vital to concentrate on
the regulations and codes that adhere to the services rendered and the patient’s plan
● E&M codes are not as simple as medical billing codes
.● Time spent on a visit is allotted for psychotherapy.
● Certain codes may be required by payers when submitting claims.
● Billing format is critical and varies by payers, such as CMS1500, UB-04, or electronic
billing via the electronic health record (EHR) system of your facility.
The coding regulations imposed on behavioral health claims ensure services are accurately
captured and reimbursement is paid.
● Verify Patient Benefits:
Verify any patient’s benefits before scheduling them for therapy. This procedure can be time-
consuming and unnecessary, particularly for returning patients. However, insurance policies
can change rapidly, and patients need to be made aware of the specifics of their medical plans.
The process of confirming that the patient’s insurance plan covers a service is known as benefit
verification. The easiest way to verify this information is through the online portals of insurers.
For those who need access to online portals or have limited information, contact the payer for
more information. Employees should also take note of the extent of coverage, any maximum
limits, and whether pre-authorization is required.
● Maintain Accurate Documentation:
Verify to see if your patients’ records are up to date. Personal information, insurance
information, and medical history/goals should all be included in these records. At least once a
year, update your patient records. Consider establishing an online system where patients can
confirm their information before attending an appointment.
Record your conversations with payer representatives. Keep record of the time of the
conversation, the person’s name, and the information they provided. This practice avoids
confusion and holds payers accountable for miscommunication if they deny pre-authorized
● Understand How to Submit Claims Properly:
To receive reimbursement from a claim, you must not only file the correct code with the
correct insurer but also submit the claim in the correct billing format, which varies depending
on the insurance company. Ensure you understand the insurance company’s preferred filing
method and file within the time frame specified in the insurance policy.
The UB-04 form is the claim form utilized by many major insurance companies for specialized
health centers such as mental health and rehabilitation clinics, so you should become
acquainted with it. The UB-04 can be completed on paper or electronically, with numerous
software programs loaded with the most recent version of the form and filing instructions.
Third-Party Behavioral Health Medical Billing!
A significant amount of work is involved in correctly filing claims for behavioral health providers. As a result, it is expected that many providers prefer to use a third-party behavioral
health billing company so as to focus on core patient treatment while handling claims successfully.
24/7 Medical Billing Services works with providers to provide pre-authorization, claims
follow-up, and assistance with insurance claim appeals. We want you to utilize your time
where it matters most: on patient health, not insurance company disputes.