FAQs on Mental and Behavioral Health Billing: Part – 2

Mental and Behavioral Health Billing, as we have already discussed in our previous articles, is a very tedious process as it contains several procedures that aren’t standard for all respective services. However, these aren’t impossible to carry out. All it requires is the right partner who can take charge of all the mental health billing tasks.

Practolytics offers mental and behavioral health billing services for our clients who choose to focus on patient care and want to leave the Billing process in the hands of an expert partner.

Having said that, let us go ahead with the most frequently asked questions on Mental & Behavioral Health Billing, along with their solutions.

1) In the event that a patient doesn’t have the pre-authorization required for a session, what should be done?

It is always the provider’s responsibility to gain all the authorizations from the payers. It is mainly because most of the patients aren’t aware of the critical requirements and the need for prior authorization to carry out their treatment, procedure, or medication. If the patient doesn’t already have prior authorization and the encounter has been conducted, it is always the best option to communicate the same with the payer and convince them for backing the authorization for the given date. It requires diplomacy and convincing as insurers never encourage this step.  When properly handled they might make an exception, especially in the case of a new patient with almost no information on the PA process.  If you aren’t already enrolled with the insurance company, it is always best to ask the patient to pay out of pocket as the insurance company will not cover the services.

2) Can I charge my clients for many sessions each day?

Although there is a stringent rule for this stating one session per patient per day, under certain circumstances mental health practices can attain approval to bill clients for more than one session per day. For instance, if a psychiatrist and a counselor are both employed by the mental or behavioral health practice, the psychiatrist may provide one service while the counselor provides another, and the insurance would cover both services, provided that the practice had attained authorization for the same.

3) What is the deadline for filing a claim?

The deadline for filing a claim varies from one insurance provider to the other. Some insurance companies are way more stringent with the timelines while some are way more lenient. For instance, typically Medicare permits providers to submit claims between a year and 18 months after treatments are rendered. You can prevent having claims refused due to late submission by being aware of the payer rules regarding claim submission.

4) Does insurance cover teletherapy?

There are currently many challenges to getting compensated for teletherapy, despite the Affordable Care Act’s requirement that insurance companies make some accommodations for the treatment.  For instance, according to Medicare, the patient must reside in a region classified as a Health Professional Shortage Area (HPSA). The Provider requires a license to work in the state the patient resides in.

Only a teleconferencing system that complies with HIPAA regulations is permitted, and it has to be arranged in a licensed medical facility or institution. Simply put, a treatment conference must not be conducted on facetime or skype at the client’s home.

Even while teletherapy is technically possible, it’s still challenging to get compensated for it. Before beginning teletherapy treatment, we would need to confirm the prerequisites specific to the payer.

5) Would it be acceptable to submit claims using the name and NPI of some other provider?

This is a very common tendency in most group practices as all the providers might not be enrolled with all the insurers. If such a therapist encounters a patient whose plan does not cover him, then he will charge the patient for his services under a different provider’s name and NPI number within the same group practices.

During some instances when the provider is not enrolled, we may use the Q6 billing modifier which implies that the provider delivering care as a substitute provided for another provider in the same practice.  It is imperative to have a close watch on the payer contracts while billing for providers who aren’t credentialed for insurance plans. If the insurance health plan only bills for credentialed providers and the given provider is credentialed or isn’t a replacement, then the reimbursement will not occur for the rendered service. If carried out for non-credentialed providers for the same insurer, then the practice would be against the terms of their agreement with the health plan

Depending on the mental and behavioral health insurance plan, some providers, including mid-level providers may merely be required to be enrolled while others must be credentialed and obligated to the insurance contract.

6) Is ‘cash only’ good to go?

Charging cash only totally depends on the kind of practice and the market. There are insurance companies with promising reimbursement rates while there are insurance companies with extremely low rates, making it challenging to cover services rendered by the practices. A small percentage of the community’s patients might possess better coverage in some locations where low-paying insurance companies are predominant.

It’s crucial to assess the pre-approval policies and payment restrictions of insurers before deciding to either engage a network or receive insurance payments. In some circumstances, switching to a cash-only structure or accepting reduced contributions from the patients is more profitable due to the low payouts and also there are several issues associated while working with insurance companies.

Behavioral health practices can increase their collection rates by collaborating with a mental health billing company, which enables practices to recover the amount owed to them.

Practolytics delivers mental and behavioral health billing services that help mental health organizations, psychologists, therapists, and psychiatrists streamline their billing process and bring order to the chaos. Our services include claims processing, payment posting, patient billing and engagement, claims follow-up for unpaid instances, benefits and eligibility verification, credentialing, prior authorization, and more.

Practolytics’ billing staff always has the most up-to-date understanding of insurance policies, legal requirements, and coding compliance specifications.  The business is tech-focused and gives customers 24/7 access to data on payment status and prior authorization status among other things.

Timely, efficient, and accurate mental and behavioral health billing services are crucial to the financial stability of your mental health practice. For your practice’s billing and collections to go as smoothly as possible, Practolytics offers the knowledge, experience, and innovation need for your practice.

To learn more about us and our services, email us at [email protected] or call us at (803) 932-9624

ALSO READ – FAQs on Mental and Behavioral Health Billing: Part – 1