Billing for Community Behavioral Health Clinics  

Billing for Community Behavioral Health Clinics  

Did you know?

206 community mental health centers (CMHC) received an estimated $218.6 million in 2010 for delivering partial hospitalization program (PHP) services to roughly 25,000 Medicare beneficiaries with mental and behavioral disorders. Certain investigations have discovered flaws in Medicare payments to CMHCs for PHPs. Furthermore, a few of the practices were convicted of fraudulently charging Medicare roughly $200 million for medically unnecessary PHP procedures from 2002 to 2010. 

That’s why it is always recommended to know about the billing for community behavioral health clinics in detail to avoid fraud and low reimbursements. Or, you can also avail of community behavioral health services to enhance your revenue. 

Let’s have a look at a few of the crucial aspects of community behavioral health clinics billing and coding: 

Overview:

Certified Community Behavioural Health Clinic (CCBHC) is a community-based behavioral health care paradigm that strives to increase service quality and accessibility. It performs the following functions:

  • offer the complete range of CCBHC-required mental health, substance use disorder (SUD), and primary care screening services 

  • Provides integrated, evidence-based, trauma-informed, recovery-oriented, and person-and-family-cantered treatment.

  • Have formed collaborative ties with other physicians and healthcare systems to ensure care coordination.

General Billing Guidelines:

  • All mental health CCBHC services should be billed as a professional claim in the MN-ITS 837P electronic claim format.

  • Outpatient substance use disorder service claims should be billed as an institutional (MN-ITS 837I electronic format) or professional claim (MN–ITS 837P electronic claim format).

  • Non-CCBHC services provided by CCBHC providers must be submitted separately from CCBHC service claims.

Billing Requirements:

Minnesota Health Care Programs (MHCP) providers who offer or oversee services are liable for MHCP claims:

  • Only submit claims after providing one or more MHCP-covered services.

  • Except in the case of Elderly Waiver (EW) or Alternative Care (AC) for environmental accessibility adjustments, the bill is only for the dates of service when services were given. 

  • Payments for EW or AC environmental accessibility adaptations must be prorated over several months due to EW or AC budgets to be stated on the service authorization Bill.

  • Only one calendar month of service is billed per claim.

  • Claims must be submitted electronically.

  • Provider's usual and customary charges should be billed.

Billing Timing:

One should implement the following guidelines to ensure prompt billing:

  • Submit claims accurately, including Medicare crossover and third-party liability claims, to ensure Minnesota Health Care Programs (MHCP) receives them within 12 months of service.

  • Submit replacement claims within six months of the date of the wrong payment, or 12 months of the date of service, whichever is later.

  • Submit non-automatic Medicare crossover claims to MHCP within 12 months of the date of service, or within six months of the Medicare determination or adjudication date whichever is later.

  • Resubmit claims that were incorrectly refused by the MHCP within 12 months of the date of service or up to six months from the date of county correction, whichever is longer.

Electronic Billing:

MN-ITS is MHCP's free, web-based, HIPAA-compliant system for health care claim submission, inquiry, and other transactions. Submit claims using the following methods:

  • Individual, direct data entry claims must be submitted through MN-ITS Interactive.

  • Submit your transactions using MN-ITS Batch if you use HIPAA-compliant billing software or if you are a community behavioral health billing company.

To execute any of the following functions, providers must register with MN-ITS:

  • Check and verify the status of active provider enrolment.

  • Verify program eligibility for one or more MHCP members.

  • Request authorization for medical or dental treatments or supplies.

  • Request service agreements (SAs) for home care services.

  • Retrieve your authorization and service agreement letters.

  • Make a claim (including claims with Medicare and other insurance)

  • Copy previously filed MN-ITS claims or replace paid claims that were wrongly submitted.

  • Determine whether a claim has been paid or denied.

  • Submit a Payment for Performance Results.

Outsource Community Behavioral Health Billing!

Community behavioral health billing outsourcing encompasses the mechanisms that behavioral health systems utilize to charge for treatments and earn revenue. It records all time and services supplied to all patients, creates process for each step, and accepts the final payment from the payor. 

Outsourcing community behavioral health billing to 24/7 Medical Billing Services ensures managing all the aspects - a streamlined procedure that includes medical billing, coding, and other non-provider-related responsibilities. This will help you in precise coding, increased cash flow, timely revenue collection, and financial viability. It allows for more emphasis on patient care and practice expansion. 

Read more: Community Behavioral Health Billing Services