Billing and Reimbursement for Mental Health Billing Services

In the last few years, the concern posed by mental health has taken center stage, mainly after the COVID-19 pandemic. Despite the increase in awareness about mental health issues, the practices of the field face not only 23 percent less reimbursement than primary care but also remain under-supported and overwhelmed with the billing and reimbursement process.

Several factors make mental health billing difficult to handle for the practices. The challenging billing rules often result in therapists refusing to accept the insurance because many payers pose limitations and restrictions on the claims. That’s why mental health usually requires a nuanced plan of treatment. For instance, billing a therapy session is not as straightforward as an annual lab test or wellness check. Let’s see what all involves the mental health billing concerns:

How Is Mental Health Billing Different?

Mental health billing differs from medical health billing, impacting reimbursements for mental health providers. The field of mental health deals with the biology, emotion, and behavior of the person and how they react to certain things in their everyday life. Often psychiatrists and counselors treating mental health use different types of therapies, methods, and drugs for a varying amount of time depending on the patient’s requirements. Unfortunately, the timing provided by the payers for treatment is different from the time taken by the practitioner. The result is discrepancies in the billing, reimbursement issues, and maybe even denial or rejection of the claim.

Some of the differences that mental health billing must consider to ensure they have a successful claim, which is different from other medical billing practices, are:

• Session Length

In most primary care practices, the bill is done on services based on the CPT code. However, in mental health billing, the codes vary based on the time taken during the visit. For instance, a code for 30 minutes, i.e., 90832, can be used for a session between 16 and 37 minutes. Whereas code 90834 is used for a therapy session of 45 minutes, which can be implemented for psychotherapy that takes between 38 and 42 minutes. Typically, the closest code is used, bearing the time the patient spends in therapy.

• Limits to Appointments

Every insurer allows a limited number of sessions to an individual for mental health within a certain period. It is essential to know the number of limits set by the insurer so they do not exceed and there is no chance of claim rejections or denials.

• Different Treatment Plans

Mental health is a specific field where care plans are customized per the patient’s requirement. Often the treatment plans are more intricate, which makes the billing more complicated.

• Pre-Authorizations

A visit to a mental health facility might not need a pre-authorization. However, any testing, therapy, or medication would require pre-authorization from the insurer. The approval by the insurer varies and is based on the service required by the patient.

• Telehealth

COVID-19 has increased the provision of providing mental health services via telehealth. The bill may use the CPT codes, but the correct modifier is required to ensure service reimbursement. The modifier 95 needs to be added when the interaction is live instead of recording. 02 modifier shows the point-of-service. Apart from these, there are different codes for telemedicine billing in mental health that starts with the letter ‘G.’ Also, HCPCS telehealth codes can be used for correct billing.

• Out-of-Network Providers

At times, mental health service providers can be out-of-network. Hence, they use superbills to collect the payment. When superbills are submitted correctly, they can accelerate the reimbursement, and service providers can also use them to stay in business without joining the insurance panel.

How to Enhance Accurate Billing & Reimbursement for Mental Health Billing Services?

Undoubtedly, a mental health service provider is required to spend more time organizing better patient care. But numerous regulations and constant changes made by the governing bodies and insurers are rolling out layers of additional requirements. Having a trained and experienced mental health billing partner is always beneficial in such a scenario. There are several ways how they can be helpful such as:

1. Ensure Patient Data Safety 

In medical billing, data are sensitive, and keeping them safe is essential. Patients seeking mental health treatment needs data security, and it is of utmost importance that their details remain confidential. You can ensure that the data is protected and HIPAA compliant with an experienced mental health billing partner.

2. Better Claim Processing

While the psychiatrist, the nurse, counselor take care of the patient, the mental health billing partner can extract the necessary data from the patient’s treatment plan and other documents before submitting the claim. This ensures correct mental health billing and coding to warrant successful claims, thereby reducing denials and rejections.

3. Better Revenue Management

A comprehensive revenue management methodology is followed where the service provider can get a proper insight into the costs of the billing software. All thanks to the mental health billing company who will provide the software, the upgrades, and the training of the billing staff. They also ensure timely correct claim submissions. This indicates that the mental health service provider neither has to spend any overhead costs nor go after claim rejection or denial. Instead, they are responsible for caring for the patients and improving their practice.

4. Reduce Denials

One of the essential components in mental health billing is denial management. If there is a claim denial, then a proper system should be in place for a quick turnaround with new assessments and resubmissions. A mental health billing partner is trained in denial management while warranting clean claims to improve payer reimbursement.

5. Understanding the Complexities 

A mental health billing partner is trained to understand the nuances of mental health coding and billing. They have the knowledge base of understanding the complexities, learning the latest regulations and trends, and recognize the transitions with the much-needed experience in different insurers and their acceptable print policies. All these are of much-needed use regarding mental health billing claims and reimbursements to warrant the proper revenue collection.

Who can be Outsourcing Mental Health Billing Partner?

Did you know? Collecting the payment from the patients when they expect the insurer to pay the practice can be difficult. But that can be a worry of the past when a mental health practice has a billing partner like 24/7 Medical Billing Services. They work closely with the patients before the treatment begins and help them understand the cost of the procedures and different payment options when insurers don’t pay. Also, with proper revenue cycle management in place using the latest HIPAA-compliant software, 100% reimbursement with accurate mental health billing can be assured.

Read more: Improve Mental Health Billing Efficiencies Easily!