Behavioral health is the study of emotions, biology, and mentality causing a person to behave a certain way and how it influences their everyday life. It looks at how behaviors impact someone’s health — physical and mental.When differentiating between behavioral health and mental health, it is important to learn that behavioral health is a blanket term that includes mental health.
Behavioral & Mental health billing is complex due to the type of care provided to patients and the funding given for the treatment. Medical billing for Behavioral and Mental health services brings a set of unique challenges. By understanding the process for behavioral health billing, providers can spend more of their time and energy focusing on what truly matters—their patients.
The spread of sedative abuse, involving both prescription pain relievers and heroin, has a significant influence on the US healthcare sector. Services for the prevention and treatment of sedatives misuse and substance use disorders have generally been delivered separately from other mental health and general health care services.
Various methods such as therapy, drugs, meditation, etc are used by counselors & Psychiatrists to treat patients. A patient with behavior issues needs additional training, rehabilitation, etc. Unfortunately, insurance providers’ timing for each treatment method varies from the actual time taken, causing disparities while billing for the services.
Denials in Behavioral and Mental Health Billing
So, it is crucial to be aware of the issues that cause deferred 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.
- Coding Accuracy
Time spent on therapy is a key factor as billing for treatment is based on the number of units. Correct medical codes based on the time spent can avoid errors involving the number of units billed.
Documentation Errors
CMS recommends specific documentation, including timesheets, encounter notes, time and place of service, and evidence. It is crucial to establish the medical requirements of the procedures/treatment, and detailed documentation can assist you reduced denials.
Policy Violations
CMS categorically analyzes 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
It is essential to bill correctly and submit clean claims for the services provided to run a profitable billing process.
Outsourcing the billing process takes the load off your back and allows practitioners to use their staff for better purposes. It can also save a huge amount of loss to billing & claim submission errors.
Medical Billing Services Expertise in Behavioral & Mental Health
Zee Medical Billing team of behavior & mental health billers have trained specialty specifically and can offer data-driven solutions for improving your revenue cycle. Our team stays updated on the HIPAA regulations for behavior & mental health billing. To avoid denials in the long run we ensure prior authorization of the patient’s eligibility & benefits with mental health insurance.
We recommend the following best practices.
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.
Experience in handling the nuances of Behavior & Mental health billing helps you avoid unwanted complexities or delays.
Our team keeps a regular track of submitted claims to catch and resolve denials’ issues without exceeding the time limit.
ZMB has a track record in helping Behavioral & Mental health practices manage and improve their income. Our team focuses on streamlining the entire revenue cycle process to keep it denial-free.
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