The Future of Medicaid Billing in Community Behavioral Health

Medicaid changes in 2022 repositioned behavioral health’s significance within the program — and the value of behavioral health to the business. Medicaid is the nation’s single largest payer of mental health services. Changes to the public health plan for vulnerable people may further alter the commercial landscape. Navigating Medicaid billing in the context of Community Behavioral Health is a complex and vital task.

Medicaid, a partnership between the federal government and states, has increased its focus on behavioral health this year. Medicaid, for example, will pay a significant increase in the number of certified community behavioral health clinics (CCBHCs). The all-in-one behavioral health facilities were previously limited to a few states, but the Bipartisan Safer Communities Act passed in June, funded a countrywide expansion of CCBHCs.

Since the epidemic, Medicaid enrollment has shot up by around 26%, reaching approximately 90 million adults and children.

About 27% of the American population is covered by the health plan.

About 29% of those receiving Medicaid have a mental illness or a substance use disorder (SUD).

For fiscal year 2023, no Medicaid program in the state has restricted behavioral health services. Therefore, a few trends may have an impact on behavioral health in Medicaid in the future, such as:

  • Medicaid IMD Exclusion

Medicaid has primarily excluded institutes for mental disorders (IMDs) since its inception in 1965.

Facilities with more than 16 beds dedicated to behavioral health treatment may be denied Medicaid funding. The exclusion applies to Medicaid enrollees over the age of 21 but under the age of 65. Enrollees under the age of 21 are exempt from receiving compensation for inpatient psychiatric services.

The federal government has made many efforts to increase access to behavioral health services for Medicaid and Medicare beneficiaries. In reality, the Centers for Medicare & Medicaid Services (CMS) recently implemented Medicare payment guidelines affecting behavioral health.

  • Other Trends: Medicaid Technologies

Several issues for Medicaid enrollees living with mental illness could be addressed by technology. This is especially true for patient engagement and healthcare access.

Telehealth holds an exclusive position in the mental health industry. Behavioral health providers have embraced telemedicine more thoroughly than other disciplines. Due to the pandemic, many providers were forced to adopt a broad but temporary, all-in approach. Telehealth will have facilitated nearly half of all behavioral health encounters by 2020.

Legacy technology may have a significant impact in dealing with mental health problems. In fact, it increased the number of mobile behavioral health units available. Medicaid expressly funds the latter. These new tools, when combined, create an interesting prospect. In fact, those who provide Medicaid insurance must use technology to provide more proactive care.

A Shift from Managed Care to Wellness

With more knowledge and data regarding the risk factors contributing to illness progression, healthcare will focus on prevention rather than therapy. To facilitate this change, Medicaid-based technology must transform from systems that monitor and analyze treatments and treatment results to strategies that can manage various other program types.

Custom Healthcare

Custom therapies range from medical to behavioral treatments and are a tiny but rising part of the healthcare industry. Combining behavioral data, artificial intelligence, and other technologies will pave the way for personalized support programs with therapies suited to each patient’s personality and health situation. These programs will assist patients in making positive behavioral adjustments to attain long-term health benefits. Of course, managing these programs will necessitate considerable modifications to Medicaid-based technologies to facilitate their management and assessment.

Adoption of Smart Devices

Smart devices are planned to be available to all Medicaid recipients in the future. These devices provide patients with real-time data on their health status, enabling them to take a more active role in their health management. Furthermore, as one of the most critical components of the Medicaid program is measuring the quality and impact of service delivery on patients’ health, the data provided by these devices will become a crucial part of program evaluation and payment.

Outsourcing Medicaid Billing in Community Behavioral Health for Trends Implementation

Undoubtedly, there is a need to be aware of and keep updated on the latest trends in Medicaid billing for community behavioral health centres. That’s why it is recommended to outsource Medicaid billing  to professionals. However, outsourcing is not always an easy decision. As with any significant decision, it’s critical to research the best options and verify potential partners. Finding a highly specialized and experienced billing and coding partner can make a world of difference for you, your community behavioral health centres, your patients, and your financial line, whether you’re looking for a short- or long-term engagement.

The most optimal solution is 24/7 Medical Billing Services, which has improved the financial health of private practices, health facilities, and medical groups throughout the United States. Our highly trained and experienced Medicaid billing specialists work together to ensure maximum reimbursement for your centres. Contact the team right now to avail the benefit.

See also: Billing For Community Behavioral Health Clinics  


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