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mental health billing guide

How to Bill for Mental Health Services: A Beginner’s Guide

Mental health services aim at ensuring the personal well-being of patients on a more emotional level.  At the end of the day, a healthy mind equals a healthy body.  Practices that render mental health services must incorporate several treatments and a huge variety of components in order to ensure smooth processing of both patient care and billing. If there are any errors in the billing process, it can critically hinder the treatment process, thereby largely affecting patient care.

Mental health insurances are very stringent when it comes to reimbursing the mental health services. On top of that, medical insurance for mental health will only have coverage up to a certain extent which makes it very hard for the medical professional.

A lot of time, mental healthcare professionals find it difficult to juggle between rendering patient care and filing claims. Mental healing requires a lot of collaboration between the medical professional and the patient.  Partial or incomplete coordination of care will have adverse impacts and will only bring in several inconveniences and discrepancies for both practice and patients.

Therefore, it is important for everyone to understand what mental healthcare billing is right from its basics.

What are the types of mental health services?

The provider of the mental health services plays a crucial role in the mental health billing process. The services will be charged based on the type or qualification of mental health provider rendering them. Depending on that, the insurance covers a part or in some cases the whole of the coverage.

The primary types of mental health services and the insurance coverage offered for them include:

1. Group Therapy

A group of patients is chosen to get interactive treatment in an effort to alter behavioral patterns. If their diagnoses are curable, health insurance ought to pay for them.

2. Family Therapy

Immediate family members or caregivers attend therapy sessions to learn about the disease and how to care for a family member who has a particular ailment, diagnosis, or other mental health difficulties. This service may be provided with or without the patient’s presence and is occasionally reimbursed.

3. Diagnostic Review by Psychiatrist

The psychiatric diagnostic evaluation, also known as a psych evaluation, is typically performed to evaluate patient’s medical and mental health.  The patient’s behavior, thought process, cognitive skills etc will be examined, and provider will devise a treatment plan based on the patient’s readiness and capacity to react to treatment.

4. Therapeutic Services by Psychiatrist

Psychotherapy also known as individual therapy is where the patient would interact with the therapist to discuss emotional or behavioral issues such as anxiety, stress, and addiction etc. with an aim of changing the quality of life, bring about positive behavioral changes and enabling self confidence in dealing with difficult life situations.

Tips for Improving Mental Health Billing

1. Ensure that the patient information is true. Double check!

“Get clarity about the patient information way ahead of time, preferably even before the patient visits the clinic.”

It never hurts to look over something twice just to make sure everything is in place, and being a mental healthcare professional, it is always important to ensure that the patient information stays correct at all points. In fact, it is important to endorse double-checking in the billing process. If not, the billing process will get tougher to handle than ever, errors will accumulate and the claims might get rejected even. With the level of patient frustration that may rise along with the inaccuracies, practices also might encounter significant deterioration in their efficiency.

You can run a verification of benefits (VOB) to see if your patient is covered. You will have a greater understanding of your patient’s insurance program after this process enabling you to treat and serve them appropriately.

Since many patients could fail to keep the practices informed on the updates, double-checking the patient’s insurance coverage could also assist in identifying prior-authorization needs or any modifications in their insurance coverage program. You can discover how to appropriately bill insurance for treatments rendered by verifying this crucial element.

2. Undergo Verification of Benefits

“Leverage technology to do the VOB for you!”

As already mentioned in this article, Verification of Benefits is a crucial aspect to ensure the patient’s insurance coverage details and the kind of services that they have intended to encounter.

During this approach, practices can look up details about your patient’s coverage that aren’t frequently listed on the insurance card. Even though many patients possess active coverage, the services might not be reimbursed as a benefit, so this step is essential to make mental health billing smoother.

You can figure out the insurance coverage for the services by running a VOB. Through the patient’s account number, contact the insurance company to learn more about their coverage.

Having said that, it isn’t necessary that this step must be done manually. The digital systems have been really kind to us with the new advancements. Mental health practices can leverage the technology to carry out the VOB process. Even though there are limitations to these options, this might save up a lot of time for the medical staff.

A VOB can assist in eliminating denied claims and unpaid bills for the services that are rendered to the patient.

3. Submit the claims the proper way

“Make sure that the billing process has been done correctly before it goes for submission.”

You can work hard to submit your claims, and go above and beyond for it as well. But all the work will be in vain if the billing isn’t done properly. For any service rendered, it is indisputable to receive reimbursement but it is detrimental to the practice if the services are not reimbursed and particularly frustrating when the staff had put in all the efforts to address the patients’ issues.

The billing format before submission should be aligned to the terms of the insurance company that the practice is filing for. To make things even easier, they may follow the particular insurance company’s filing methods and file the claims within the claim window. It is always best to communicate with the insurance provider on this to keep ahead of this and get to know about their preferences associated with the filing and submission guidelines.

The insurances accept CMS-1500 or UB-04 based on the place of service. If the mental health practices could familiarize themselves with this, they can be more confident about their claims and get away from feeling intimidated once the claims get submitted.

4. Know your CPT code

“CPT codes are employed to support the services rendered and the required medical care.”

Common Procedural Technology (CPT) codes play a very critical role in billing, especially when it comes to therapists because these codes denote the type of mental healthcare service and the coverage depends on that.  It is equally important to determine and document the medical necessity based on which the ICD codes are assigned. 

Using the wrong CPT code could result in a significant impact on the claims submission process. Therefore it is important to make sure that no mistake is made even accidentally.

Ensuring clear CPT codes will bring in reimbursements according to the coverage of the given mental health service. They are often time-based associated with the time taken for the session or the presence of the patient in family therapy, like for instance the CPT 90832 is used to denote 30 minutes of patient-centered psychotherapy, family or couple therapy of 50 minutes with the patient present is coded as 90847, while group therapy other than of a family group is coded as 90853.

Apart from the confusing ICD Codes with CPT code assignment errors, the other kind of mistakes that could occur include undercoding or upcoding.

When a CPT code represents a less serious diagnosis or a less expensive therapy than was actually provided to a patient, this is known as undercoding.  Upcoding refers to the assignment of a code by a provider for a patient that represents a more serious diagnosis or more expensive treatment than is actually the case.  Both undercoding and upcoding are strictly illegal as they do not accurately represent the services rendered and could be construed as fraud by the payers.  However, if not intentional, these could also happen due to an untrained or inexperienced coders without much process knowledge.

It is very important to ensure that attention is paid to differentiation within the CPT codes and the apt usage of codes to avoid any repercussions.

Last Thoughts

For mental health providers, the billing process can be challenging but not impossible. If you dig into the points mentioned in this article, you will get where you want to be – having your practice receive the deserving reimbursements on time.

We at Practolytics process medical billing for Mental and Behavioral Healthcare including Ketamine and Esketamine (Spravato®). We help our clients be more precise with their coding, documentation, and billing and save up quite a lot of time for the practice so that you can fully concentrate on patient welfare.

 Reach out to us to learn more about us!


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