As we step into 2024, it becomes paramount for behavioral health providers to stay abreast of the impending billing updates that will significantly influence their financial operations.
Not only this but statistics from the National Institute of Mental Health (NIMH) reveal that approximately 20% of adults in the United States experience a mental illness each year, highlighting the increased demand for effective and accessible behavioral health services.
With such high demand, providers should also align their billing practices with the latest regulations to ensure optimal reimbursement, maintain financial viability, and, most importantly, continue providing essential mental health services to those in need. Let’s have a look at the behavioral health billing updates in 2024:
Behavioral Health Billing Updates for Medicare in 2024
Direct Billing by MFTs and MHCs
A significant change set to take effect on January 1, 2024, is the ability of marriage and family therapists (MFTs) and mental health counselors (MHCs) to bill Medicare for their services directly. This shift aims to enhance accessibility for Medicare beneficiaries, addressing potential financial barriers to behavioral health services. Given the anticipated increase in demand, providers should prepare to capitalize on this opportunity while ensuring compliance with billing guidelines.
Telehealth Payment
The extension of telehealth-related flexibilities through the Consolidated Appropriations Act 2023 will continue to impact behavioral health billing in 2024. Services delivered via telehealth to individuals in their homes will be reimbursed at the non-facility Physician Fee Schedule (PFS) rate. This alteration is especially significant for expanding access to behavioral health services, a critical consideration in rural and underserved areas.
Extension of Telehealth Flexibilities
The extension of telehealth service payment for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) is extended until December 31, 2024. This extension is crucial for maintaining access to behavioral health services in rural and underserved areas, offering continued flexibility in service delivery models.
Delay of In-Person Requirements
In 2024, there will be a delay in the in-person requirements for mental health visits furnished by RHCs and FQHCs. This delay offers providers additional flexibility, ensuring continued access to necessary services without compromising compliance.
Behavioral Health Billing Updates for Commercial Payers
Adoption of New CPT Codes
A noteworthy change anticipated in 2024 involves the adoption of new Current Procedural Terminology (CPT) codes by private payers. These codes are expected to provide greater specificity and accuracy in billing for behavioral health services. Therefore, this will ultimately enhance claims processing and reimbursement. Providers should familiarize themselves with these codes and update their billing systems accordingly.
Increased Focus on Value-Based Care
Another notable trend among commercial payers is the continued shift towards value-based care models for behavioral health services. This approach rewards providers not merely for the volume of services but for achieving positive patient outcomes. As this trend gains momentum in 2024, providers must prepare to align their practices with these value-based care models to ensure sustained financial success.
Proactive Measures for Providers
Review the New CPT Codes
Familiarize yourself with the new CPT codes for behavioral health services and ensure your billing system is updated to accommodate them.
Update Billing and Coding Policies
Ensure that your billing and coding policies are current and reflect Medicare and private payer rules changes to avoid compliance issues.
Enroll for Training
Attend training sessions or webinars on the new billing updates to equip yourself and your staff with the knowledge needed for a smooth transition.
Consult with Billing and Coding Specialists
Seek professional guidance from billing and coding specialists to navigate the complexities of the new rules and maximize reimbursement.
According to a Medical Group Management Association (MGMA) report, hospitals face an average claim denial rate of around 4–8%.
Consulting with specialists helps mitigate such denials by ensuring that behavioral billing codes are accurate, compliant with the latest regulations, and reflect the specified complexities of different payers.
Behavioral health billing and coding specialists like 24/7 Medical Billing Services possess the expertise to interpret and implement the challenges of behavioral health billing updates, such as changes in Medicare policies or the adoption of new CPT codes by commercial payers. Their knowledge helps providers avoid common pitfalls leading to claim denials, delays, or reduced reimbursement. Additionally, specialists are well-versed in optimizing documentation practices, aligning them with billing requirements to enhance the likelihood of successful claims.
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