Before we dive in to discuss mental health billing, you need to understand the duties of behavioral health providers. Mental health deals with a person’s psychological, emotional, and personal well-being. They also explain how we determine and handle stress and anxiety and how to make healthy choices. We face health issues in every phase of life, from childhood to old age.
In today’s age, people are suffering from poor mental health and mental illnesses. A person who is dealing with poor mental health doesn’t mean he/she is dealing with mental issues; both are not the same. Mental and physical health are both essential components of our health. Mental issues can create many health problems, one of which is depression, which increases the risk of cardiac arrest.
Around 50 million people in America suffer from mental issues; the numbers are staggering yearly. Psychiatrists deal with various mental illnesses such as changes in feelings, loss of interest, unusual sleeping patterns, fatigue, social anxiety, weight loss, and uncontrollable emotions. Mental health providers are already dealing with many stressful conditions, so they are already frustrated and don’t have time to deal with complex mental health billing. Reimbursement in psychiatric medical billing is usually lower than in other healthcare medical billing. One case study shows primary care reimbursement is 23% higher than mental health reimbursement.
Difference between behavioral health billing and other primary care medical billing
The main difference between primary health care billing and behavioral medical billing is the restrictions imposed by insurance companies on mental health claims.
Behavioral healthcare has a different approach and it has 40-45 minutes of therapy sessions that are not as straightforward as billing for primary medical care; some other differences are mentioned below:
Length of the session
Behavioral health visits vary over time, which also shows psychiatric health code changes. After every visit, codes vary depending on the duration of the session. I.e.
- The 90832 code is for a session of 30 minutes of individual psychotherapy.
- The 90834 code is for the session of 45 minutes of individual psychotherapy.
- The 90837 is for a session of 60 minutes of individual psychotherapy.
- The 90846 code is for a session of 50 minutes of family psychotherapy.
Appointment limits
There are limits from the insurer on how many sessions or services mental health providers can provide in a specific period. It is imperative to realize the limitations of insurance companies.
Customized plan for treatments
Every patient’s mental health is different, so mental healthcare plans vary from patient to patient. However, not all treatments fit into one size plan. Other customized plans are made. These customized plans are more complicated than simple medical billing.
Pre- Authorizations
Sometimes insurance providers need prior authorization before approving behavioral health care.
Change in Regulations
Billing rules and regulations keep changing. Many mental health care codes were added during Covid -19 pandemic. Medicare and Medicaid simultaneously updated new codes and regulations.
Outsourced Mental Health billing
Mental health billing is a very complicated and complex procedure that is difficult for psychiatric providers to deal with properly, so the third party comes forward and lessens the stress on the providers. The outsourced mental health billing providers carry the burden on their shoulders, trying to maximize revenue and minimize denials.
Outsourced Behavioral medical billing companies take essential steps:
Patient Information and check-in
This is an essential step; at check-in, detailed patient information is required. It helps in insurance verification and reduces further errors. Different billing software such as EMR and EHR is used to gather information such as personal details, names, phone numbers, insurance IDs, demographic details (addresses), etc. are kept in the software.
Insurance Eligibility verification:
This step plays a vital role, as insurance coverage and policies change with time, which affects mental health billing and leads to rejections. So, it is crucial to double-check eligibility verification by checking patient coverage benefits, documents, and benefits details.
Medical coding:
Mental health coding is an essential step in psychiatry medical billing; it involves different codes for different sessions, as mentioned above. A single coding error leads to rejection and non-payments.
Submission on claims:
The submission of medical bills on time results in payments. Outsourced mental health billers and coders not only focus on rejections and denials but also ensure timely submission. Each billing period is different in psychiatry medical billing, so it is important to take care of each time limit provided by insurance companies.
How can Medcare Helps mental health providers:
Medcare MSO provides behavioral health billing services as it has all the essential experience and technology to deal with mental health billing procedures. Medcare takes care of medical coding as per insurance companies and state-specific guidelines, also, it is HIPAA compliant. The professional and skilled medical billing and services team makes sure that the bills are paid within the given time frame, assists in patient eligibility verification, provide follow-up services, and receives advance patient collection by checking patient coverage details.
For further details, Contact Medcare MSO via email at [email protected].
