September 25, 2023

Best Practice Guidelines for Behavioral & Mental Health Providers

In a world where stress, anxiety, and life's challenges loom, the significance of behavioral and mental health is undeniable. Yet, billing for mental and behavioral health poses a unique puzzle.

Unlike standard medical billing, this realm is a complex landscape where charges vary significantly based on service nuances and therapist credentials. Each patient's journey is distinct, with therapy sessions varying in length, approach, and individual agreements.

But it doesn't end there. Processing pre-authorizations in mental and behavioral health is a challenge of its own due to the diverse treatments offered.

And here's the twist — mental and behavioral health billing isn't a checklist like standard medical settings. There's no routine form with checkboxes. Instead, each patient's treatment plan is unique, covering session length, therapy approach, and personal preferences.

There's a lot on your plate!

Nevertheless, take heart, for there is a way to master this puzzle. Let's explore some effective practices that streamline mental and behavioral health billing, ultimately leading to optimized reimbursement.

1. Comprehensive Documentation

Comprehensive documentation is indispensable when billing for mental and behavioral health services. Beyond the administrative necessity, it's a solid groundwork that proves the medical necessity of the care provided. It ensures that patient encounters are meticulously recorded, accurately detailed, and promptly documented, all pivotal for continuous patient care and significant in insurance reimbursement decisions.

Moreover, it supports accurate coding and billing. When all relevant details are documented, assigning the appropriate diagnostic and procedural codes becomes easier, avoiding claim denials or payment delays.

For example, in psychiatry, thorough documentation would include capturing critical information such as the visit date, service type, session attendees, referral source, examination results, diagnostic findings, patient history, ongoing therapies, medical background, care coordination, person-centered observations, progress tracking, and treatment plans.

Furthermore, comprehensive documentation acts as a protective shield in the face of claim challenges or audits, offering a clear view of patient condition, treatment plans, and progress achieved, solidifying the justification of billed services and safeguarding against potential audits.

2. Insurance Coverage Verification

Ensuring a seamless and efficient billing process for mental and behavioral health services begins with thorough eligibility verification. This practice is essential for both healthcare providers and patients, as it plays a pivotal role in avoiding billing discrepancies, claim denials, and financial burdens.

Here's why insurance coverage verification is a vital step in the billing process:

  • Accurate Billing — Mistakes in this step can lead to claims being sent to the wrong insurer, resulting in delayed or denied payments.
  • Patient Transparency — Informs patients about insurance benefits and potential costs, managing expectations.
  • Preventing Claim Denials – Identifies specific payer prerequisites, such as pre-authorization or referrals, reducing the risk of claim denials.
  • Efficiency in Claims Processing — Reduces the need for back-and-forth communication with insurance companies, speeding up claims processing and leading to quicker reimbursements.

3. Prior Authorization

Prior authorization is essential for most behavioral and mental health procedures in the reimbursement process. Providers must know the ins and outs of various payer guidelines and adhere to specific formats to obtain treatment approval.

While not typically needed for initial or basic mental health sessions, some health plans may mandate it for extended or multiple sessions. Therefore, verifying pre-authorization requirements before beginning treatment with a new client is crucial, particularly in non-standard therapy sessions. This proactive step helps ensure a smooth billing process, avoids claim denials, and maintains financial transparency for providers and patients.

4. Accurate Coding

Precise procedure code selection is paramount in mental health billing, especially when accounting for session duration. In many cases, automatic code repetition may lead to overcoding for shorter sessions or undercoding when additional billable services are provided.

Understanding the specific requirements for assessment, treatment, and evaluation and management (E/M) codes is essential, especially for psychiatrists offering E/M alongside psychotherapy.

Furthermore, as mental health's significance rises, billing regulations undergo frequent updates, including annual revisions to ICD and CPT codes. An example is the introduction of telehealth codes during the COVID-19 pandemic.

Staying well-informed about these changes can be particularly demanding for smaller practices. However, failing to do so could result in inaccuracies in claims and subsequent reimbursement challenges.

Moreover, it's worth noting that conventional billing software may not be tailored to mental and behavioral health practices' unique needs, potentially adding complexity to the claims process.

5. Claim Review and Denial Management

Effective claim review and denial management are integral to a well-functioning healthcare revenue cycle. Those who have experienced claim denials understand the frustration and time consumption involved. Despite implementing a streamlined approach, various reasons can lead to claim denials.

When faced with a denied claim, it's essential to investigate the explanation provided by your insurance company carefully. By understanding the cause of denial, you can rectify the issue and resubmit an accurate claim, increasing the likelihood of approval.

Analyzing patterns in your billing process from previously denied claims can reveal areas for improvement, leading to more successful future submissions. Additionally, it's imperative to address and correct any issues for resubmission within the designated window provided by the insurance carrier to avoid further delays and complications in reimbursement.

Boost Practice Efficiency with Customized Billing and Coding

Things can get tricky in the world of mental and behavioral health billing. The challenges in this field, including accurate coding, regulatory compliance, and claim denials, demand dynamic and customizable solutions to each practice's unique needs.

With Glenwood's software (GlaceEMR and GlaceRCM), mental health practitioners can confidently pick the correct billing codes, stay up-to-date with the latest coding changes, and handle claims efficiently. Glenwood's integrated EMR and RCM software is highly adaptable, evolving seamlessly as your practice grows and as billing rules change. It's like having a trusted partner to simplify the complexities of mental health billing.

GlaceRCM/EMR - Billing Service For Private Practice

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