Mental Health Billing Services: Explained


Mental Health Billing Services: Explained

Filing claims for any type of insurance is supremely frustrating as the credit goes to the slow process involved. But if we talk about behavioral and mental health billing services then certainly the frustration bar has got no limits. With the pre-authorization services, books, consultancies involved, you’re definitely at a disadvantage if we compare it with other professional health services. Lack of proper knowledge makes a person vulnerable to irreplaceable debts and losses. So let’s have a brief look at these services and try to figure out why it is much more difficult to claim insurance in mental health billing services than any other one. 

What are Behavioral and Mental Health services?

It is a study of human emotions, biology, and the basic mentality of a person that causes him/her to behave in a certain way and how it affects their day-to-day life. Psychiatrists and counselors treat patients in a variety of ways like therapy, drugs, meditation, etc. These methods take different amounts of time depending upon the process of healing of a patient and the doctor’s process involved. Services for preventing and the treatment of a substance abuse patient also involve a traditional process that lies in a different mental health bubble that is different from other general health services. Several companies tabulate the treatment time and the maximum sessions that can take place in a day, but if it involves the complexity of the brain and how it reacts to the treatment, nobody can tell a specific time that will be taken in the healing process. This makes it extremely difficult for mental healthcare providers to balance out sufficient treatments with a suitable billing plan. 

Insurance providers’ tabulated time for each treatment usually differs from the actual time that is taken by the patient that causes discrepancies at the time of billing. Some common issues that cause billing denials are:

Documentation errors:

Specific documentation, that includes session timesheets, encounter notes, place of service, and evidence of a professional needs to be submitted correctly. Failing to present detailed documentation or other important treatment documents can lead to denials.

Advance Authorization:

Most of the mental health treatment insurance companies require prior authorization to be taken from them before availing any of the services that build a pretty miserable situation for any patient. 

Coding Accuracy: 

The billing is done with the help of unique codes that denotes that particular service. Mistakes in mentioning the exact codes over the insurance document can lead to denial at the time of claims.

Policy Violations:

An insurance company can identify the policy violations that occur in billing for mental health treatments. It can involve faults in mentioning the progress reports or mentioning those services that require prior authorization. 

So it is necessary to create, bill, and submit crystal clear documents to achieve smooth insurance claims. Here are some tips and suggestions that can turn out to be supremely beneficial for any mental health billing services organization and will provide them huge returns in the long run. 

Double-check each patient’s insurance and coverage

One should ensure that each patient’s insurance plans and benefits are thoroughly checked from time to time. This can turn out to be a bit time-consuming, and surely it is, but it leads to a larger return in the end. A process known as Verification of Benefits (VOB) should be done before each patient’s visit. This will give much more information to the service providers that they are not going to get from the patient’s policy card. By checking a VOB, one can ensure that a patient is covered for the services they are seeking or not, and get to know how much the insurance company would provide. 

Understanding of the CPT codes

These are the ‘common procedural technology’ codes that are used by the insurance providers to determine the amount of reimbursement that is to be given to a particular patient for the healthcare facilities he’s availing. If you’re dealing with mental health billing or any other type of billing, you need to have services that are offered and the codes associated with them. Different codes vary from patient to patient and that is why these codes are a very integral part of the mental health billing services.  

These codes are of two types, the E/M codes, and the psychiatric evaluation codes. The E/M codes are basically for any new medical issue of a patient that also has some sub-sections like the patient’s history, examinations, and medical decision-making. 

Psychiatric evaluation codes are for diagnostic assessments. A psychiatric session can have E/M services, but the time involved in E/M services cannot be counted in the psychotherapy services.  

To reduce rejections, it is very important to know which CPT code is to be used where and how to use it.

 Proper submission of Claims

To receive reimbursement from a claim, the submission process holds the same amount of importance as using the correct code for the correct insurer. The process of the submission of claims can vary from company to company and according to their respective policies as well. It is better to cross-check the procedure of the insurance company within the time allowed by the insurance plan respectively. 

As you can see, there’s a large amount of work and effort that goes into the filing process for any mental health provider. So it is better to have brief and thorough knowledge about the industry and the technical details involved within, to prevent future debts. 


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