Top 5 Common Errors With Mental Health Billing

Navigating the insurance claim can be challenging for mental health practitioners, mainly if you are into individual or small facility practice. While most large medical facilities have an entire dedicated department trained in researching, submitting, and following up on the billing and the claims, you might be 'winging it. It is because mental health billing is more complex and complicated than other medical billing. In fact, there is a lack of uniformity in the billing process.

In most medical practices, standardized tests and services are performed. However, in mental health, the practitioner has to undertake various procedures to treat a patient. Adding to this, the different approaches in mental therapy make the billing and coding process quite convoluted.

Knowing how the different services and procedures is a must to warrant an error-free billing and submission. Failure to understand or follow the correct billing and coding procedure would mean losing out on revenues.

It is a must that any mental health practitioner would know the five common errors with mental health billing to ensure they can avoid them and get the payment for the services rendered.

Top 5 Common Errors In Mental Health Billing:

Billing and coding mistakes can doom your practice financially; hence, while you take care of the patients, you need to take care of the billing. However, if you thought you were the only one struggling with billing as a mental health practitioner, you are wrong. So, to warrant your revenue flow is regular with the reimbursements, here are the top five mistakes any mental health practitioner must avoid.

1. Wrong CPT Code Usage

It would help if you were quite specific with the procedure codes in mental health billing, mainly when it has to be recorded for the time spent in a session. In most cases, if you are using the auto-pilot mode, you will be using the same code for every session. Therefore, it runs the chance of overbilling for a shorter session or under billing when you have provided some other billable services. In addition, if you are offering any new service, you have to dig into the code descriptions for these services you provide each time, which can be pretty time-consuming.

The lack of knowledge about CPT codes means either you are leaving the money for the services you offer or overbilling, which can bring you under scrutiny by the authorities. The only way to fix it is by knowing the CPT codes and understanding them as per the procedures.

2. Mentioning Outdated Codes

ICD and the CPT codes are being updated continually, so as a mental health practitioner, you need to know the latest codes and the changes. There is a grace period when the code sets are changed. However, the payers expect the biller to use the most recent codes during the submission. Therefore, after the grace period, any codes that have been changed and not used by you would mean claim rejection or denial.

The mental health practitioner thus must ensure that they do not use the old code during the claims.

3. Unbundling Codes

In mental health billing, using multiple codes to raise the payment is called unbundling codes. In unbundling codes, the practitioner uses various codes when there is a single code available for the service, which can be used to reflect the procedure accurately.

Any mental health practice should avoid unbundling because it is a red flag for the audit team. In addition, unbundling is often associated with fraud or abuse. It is vital to know what is included in the code description, and when a single code is available, you should be using that.

4. Using Up-coding

Even up-coding is used for getting higher claims, and once again, it is a red flag. Unlike unbundling, where multiple codes are used instead of a single code to increase the payment, up-coding uses a single code that offers higher payment than the service provided. For instance, when a psychotherapy session is for thirty minutes, and the code 90837 is used for sixty minutes, you are doing up-coding.

Up-coding can again trigger an investigation for fraud, so knowing the correct codes while tracking the time accurately for the therapy session is a must. It is also vital that you learn the aspects included in the codes that you are unfamiliar with so you don't do up-coding.

5. Using Incorrect Modifiers

Modifiers are used to provide additional information to the payer. For example, a two-digit code is added at the end of the CPT code. It can suggest where and how the service was offered. But a practitioner cannot just randomly use the modifiers. There are rules for it that need to be adhered to.

Failure to abide by the rules and use the correct modifier can result in claim denial or rejection. Also, the misuse of modifiers can bring the practice under scrutiny by the authorities due to fraud or abuse if it is done regularly. Hence, unless you are sure about the modifiers and the rules that come with them, please don't use them.

How to Mitigate these Issues?

One of the best ways to overcome mental health billing errors is using good ERM software. It can help you with the proper coding and reduce errors. Also, it can help you go paperless, and by digitizing the process, you can stay organized easily by attaching the intake forms and insurance cards to the clients' files. In addition, adding session notes and comments and collecting them for billing becomes easy.

ERM software also helps in monitoring the practice's health by providing comprehensive reports regularly. But if you are wondering where to find the right ERM software and how to operate it for your mental health practice, the solution is 24/7 Medical Billing Services. We work with all the latest ERM and other revenue management software to ensure a scalable and profitable practice while reducing billing and coding errors. We are one of the best mental health billing and coding outsourcing company that can help you flourish without worrying about making any billing mistakes.

Read more: Can Mental Health Billing Improve Through AI?