Behavioral health is the study of emotions, biology, and mentality causing a person to behave a certain way and how it affects their day-to-day life. Behavior & mental health billing is complicated due to the type of care offered to patients and the funding provided for the treatment.

The current epidemic of opioid abuse, involving both prescription pain relievers and heroin, has a significant impact on the US healthcare sector. Services for the prevention and treatment of substance misuse and substance use disorders have traditionally been delivered separately from other mental health and general health care services.

Counselors & Psychiatrists treat patients using various methods such as therapy, drugs, meditation, etc. These treatment methods take varying amounts of time based on the type of patient and the illness. A patient with disabling behavior issues needs additional job training, literacy training, rehabilitation, etc. Unfortunately, insurance providers’ timing for each treatment method differs from the actual time taken, causing discrepancies while billing for the services. It is essential to be conscious of the issues that cause delayed reimbursements and denials. Some of the common causes of denials are:

• Prior Authorization. Most Behavioral/Mental Health procedures require that the provider obtain prior authorization before the treatment.
• Documentation Errors. CMS recommends specific documentation, including timesheets, encounter notes, time and place of service, and evidence that a professionally led care team that included the patient and their family developed the plan. It is essential to establish the medical necessity of the procedures/treatment, and detailed documentation can help you reduced denials.
• Coding Accuracy. Time spent on therapy is an essential factor as billing for treatment is based on the number of units. Appropriate medical codes based on the time spent can avoid errors involving the number of units billed.
• Policy Violations. CMS specifically identifies typical policy violations that occur in billing for behavioral/mental health treatments. These include:
  • Failure to record progress notes promptly
  • Billing for services that require prior authorization without receiving prior authorizations

Benefits of Accurate Billing and Outsourcing for a Profitable Practice

It is necessary to bill accurately and submit clean claims for the services provided to run a profitable practice/billing operation. Outsourcing your billing process takes the load off your back and allows you to use your staff for better purposes. It can also save a large amount of money lost to billing & claim submission errors. Our team of behavior & mental health billers implement best practices to increase your revenue and decrease claim denials.

Medical Billing Services Expertise in Behavioral & Mental Health

Our team of behavior & mental health billers & coders have trained specialty specifically and can offer data-driven solutions for improving your revenue cycle. We have a client base that extends over 50 states covering a wide range of hospitals, physician practices, and medical billing companies. Our coders are proficient in ICD-9/10, CPT, HCPCS coding based on CMS and AMA guidelines and are certified by the American Academy of Professional Coders (AAPC). 

Applying best practices for Behavioral & Mental Health Billing

Our team stays updated on the HIPAA regulations for behavior & mental health billing & coding. We ensure prior authorization of the patient’s eligibility & benefits with mental health insurance to avoid denials in the long run. Our team of medical billers & coders instantly know the ICD codes for behavior & mental health, which allow us to submit clean claims. We recommend the following best practices.

• More information is better. Our team obtains full information from the patient, including their alternate phone numbers, addresses, insurance type, social security number, etc. Ensuring that we have all information before calling an insurance company saves the time it takes to check on claims.
• Specialty specific solutions. Our team’s experience in handling the nuances of Behavior & Mental health billing helps you avoid unwanted complexities or delays.
• Claim Follow Up. Our team keeps a regular track of submitted claims to catch and resolve denials’ issues without exceeding the time limit.
• CPT & HBAI codes. We stay on top of the yearly changes in the CPT codes and have a deep understanding of HBAI codes’ usage while billing for mental health services offered to reduce impact while treating a physical health problem.

Our Value

We have a track record in helping Behavioral & Mental health practices manage and improve their income. Our team focuses on streamlining your entire revenue cycle process to keep it denial free. Medical Billing Wholesalers help you utilize your staff in improving patient care, as we focus on your administrative functions. We bring you a team of specialists that are:

• Certified by the American Association of Professional Coders (AAPC) and has received training in most common Medical Coding Software
• Successful in processing medical claims with most standard commercial insurance companies including UHC, WellPoint, Aetna, Humana BCBS, and Anthem, and government payers such as Medicare
• Successful in working with Medicare and understand state-specific Medicaid Policies
• Experts in reducing costs and helping you achieve improved clinical and operational efficiency
• Strong prior authorization team to ensure detailed patient information collection