What Makes Mental Health Billing So Difficult?

Health & Fitness

  • Author Lauren Lau
  • Published November 10, 2020
  • Word count 1,935

Vexatious Aspects of Mental Health Billing

Let’s face it, the healthcare industry is vast and complex, even more so for mental health providers. This is especially true when it comes to the billing process.

The variety in the types of services, the time, scope and restraints put on mental health treatments make the billing process quite demanding. If a patient visits his or her medical doctor, the doctor will likely perform standard tests and services, such as measuring a patient’s height and weight, checking blood pressure and perhaps drawing blood. Such tests tend to be standardized across patients, differing only slightly among patients and all taking nearly the equivalent amount of time. As a result, billing is also repetitive and standardized.

With mental health providers, however, services vary way more extensively. The length of the session, the approach to therapy and the willingness of the patient to partake make it far more difficult to standardize treatment and billing.

Moreover, the manner in which insurance companies look at mental health is noticeably unlike the way they look at more traditional medical practices. For example, insurance companies can determine how long treatments are allowed to take and how many sessions can take place each day, making it challenging for mental health clinicians to balance effective billing with adequate patient treatment.

Additionally, the requirement of pre-authorization has resulted in more difficulty and complexity for mental health billing.

The differences between medical billing and mental health billing are also magnified by office budgets. A large group practice might hire dedicated employees to focus wholly on medical health billing, but with mental health, it’s more commonplace to have small group or solo practices with limited administrative support for billing and other office duties. Some providers will even try to do the billing themselves but sooner or later, this will become overwhelming and produce time management problems, not to mention lost income.

All this makes the billing process quite demanding for mental health professionals. They need to make sure that they can keep income levels high while also assuring that each and every patient gets the utmost quality care.

Truth is, no one gets into the mental health field because they enjoy wading through insurance industry bureaucracy. People become mental health professionals because they want to help others. However, providers cannot help others unless they collect sufficient funds to run their practices and pay themselves.

It’s rather predictable, without a dedicated staff member to keep up-to-date on healthcare billing codes, changing regulations and the billing practices of each insurance company, rejection rates will climb.

Put simply, there are fewer pitfalls involved in medical billing versus mental health billing because medical health billing is more straightforward.

Avoiding billing issues is vital to the well-being of your business

As a mental health clinician, being paid for the services you provide to patients is paramount. Unfortunately, due to the frequency of insurance claim denials today, payment is not always assured for your services. Payer sources use denials and rejections as tools to force clinicians to hand over hard-earned dollars.

Let’s briefly look at some of the more common billing pitfalls.

Seeing Patients Too Often.

Serving and billing a larger number of patients than you could credibly see during a typical workday is one billing pitfall. For instance, seeing and billing 50 patients and using the same code for these patients could be a red flag to an insurance company. Similarly, if you work in a psych hospital for half of your workday and then are at a clinic for the second half of your workday where you claim to see 50 patients, this also is not considered feasible.

Clients Seeing Multiple Therapists

Another billing pitfall happens when a client is visiting multiple therapists. This can occur if a client must see a therapist in the same facility as his or her doctor, but he or she is also meeting a private therapist or counselor for personal reasons, such as the client prefers sessions with the private therapist. A payer source will not want to pay for two different therapists for a single client.

Frequently Using the Same ICD-10 Code

Using the same ICD-10 code too often is another common billing pitfall for mental health professionals. Variety is key in billing to avoid audit risk. When you bill the same diagnosis code for all of your patients, such as anxiety disorder, this is considered a red flag.

Specific Codes That Raise a Red Flag

Another billing pitfall surfaces from the use of specific codes in mental health billing that can raise red flags. Billing too many specific codes for your services can create problems for your practice. Three of the codes to be aware of are billing code 90837 (individual psychotherapy); billing code 99215 (established patient visit); and billing code 90853 (group psychotherapy).

Treatment Plans

The final billing pitfall for mental health professionals lies in treatment plans for patients. Not completing a treatment plan is a definite way to not receive payment or to be required to pay back money to a payer source after an audit.

Documentation and billing errors can also occur when a claim is missing progress notes and does not include a plan for the patient’s long-term care.

The bottom line is that billing issues for mental health professionals can lead to reduced revenue, unproductive time and further stress.

Maybe it’s time to get help with your mental health billing

Okay, it’s been demonstrated that billing for mental health differs greatly from billing for medical services. We’ve also determined that mental health professionals often operate on a smaller budget than medical facilities and many offices employ a small staff.

As a result, taking on the billing needs of patients can stretch counselors and staff members thin, which can ultimately impact client service.

Reducing the time for billing and coding procedures can, however, be harmful to offices focusing on mental health services as insurance companies will quickly deny a claim that is not filed or coded accurately.

Such is the dilemma faced by mental health professionals today!

Okay, what are the benefits of outsourcing your billing process?

Most healthcare providers don’t possess the time or know-how to manage the billing process. Plus, very few have the means to take on an in-house billing team. This especially holds true for the mental health provider.

By outsourcing such things as your statement preparation, data entry, filing and follow-ups to a third party, your practice benefits in the following ways.

Reduction in unpaid claims

We get it. Nothing is more wearisome than disputing with the insurance company over unpaid claims. When you work with a billing service, not only will the number of unpaid claims go down, but they’ll also contest the ones that get rejected. Billing services take the irritation of dealing with insurers off your plate. That involves looking into claim rejections, tracking full payment of partly reimbursed submissions, and keeping up on approved claims that have not yet been paid. In short, third party billing services help you take command of your receivables once and for all.

A billing service will submit your claim accurately the first time

You’re clearly aware that proper coding is vital if you hope to be reimbursed promptly. The traditional therapist billing software utilized by a third-party billing service starts by authenticating the client’s insurance coverage. Next, they accurately code the claim and submit it straightaway. Not only will claims be clean the first time they are submitted but as mentioned above, you’ll witness a dramatic drop in rejections and partial payments. This will increase cash flow and help keep your focus on your patients.

Offer cost-effective solutions

With outsourced billing, your organization can free up in-house resources substantially. Rather than tasking your employees with time-consuming billing duties, they can work on things such as quality assurance and improving patient care.

Help to reduce your expenses

Mental health providers can reduce their office expenses by using the services of a third-party biller as well as the existing software. All you need is a PC and access to the internet. The majority of practice management software is all-inclusive, even over the internet and is part of the service provided. No costly software updates or support fees. No hidden costs or added charges.

Improved communication

When you work directly with insurance companies, you’ll most likely be able to work with them only during their specified business hours, which may not even be in the same time zone as your practice. It’s also to be expected that you’ll end up talking with a different agent each time you call, obliging you to describe your circumstances again and again. When you use a billing service to help push through your claims, you’ll do away with these aggravations.

More time to provide direct care

Every minute spent tracking down claim information in the course of your business day is a minute you’re unable to devote to providing direct care. This disruption forces you to miss out on would-be income opportunities. Let’s say you charge $100 per hour and devote one business hour every day on billing. In this instance, you may be losing up to $500 every week. When you recoup this lost time by employing a billing service, you’ll be growing your income potential and, in many cases, producing added revenue that exceeds the cost of the billing service.

When should you consider outsourcing?

When your practice’s billing process is inadequate

When your practitioners and staff are not technologically sound

When your practice has excessive staff turnover

When your practice is new

Or, putting it another way, the real cost of billing is not the payroll expense. It’s really all the charges that were not billed in the first place or were not followed up after billing.

An expert billing service would pay for itself.

Conclusion: Outsourcing mental health billing can allow offices to focus on patient services while realizing higher returns for services provide.

What should you look for when searching for a mental health billing service?

It pays to take your time and be discerning when assessing possible providers for your outsourced mental health billing. Before you make your decision, make sure to find out if the provider has the following capabilities and the wherewithal to do the job.

Ensure they offer specialty-specific mental health solutions. Failing to identify and understand the complexities of billing for this specialty can lead to needless holdups.

By all means, verify that the company has substantial experience and the necessary know-how in the medical billing industry plus a demonstrated track record of improving the revenue cycle for their current customers.

Your provider ought to have a policy of keeping up with industry trends as a means to ensure your practice is constantly making use of cutting-edge technology.

Another crucial issue is that the company provides suitable staff training. Inadequate training leads to added mistakes, further slowing the revenue flow to your organization.

Finally, and perhaps most important, you need an assurance the provider will keep the lines of communication open. You can expect them to contact you straight away in case of a problem, and they also need to respond promptly to any inquiries you have concerning bills and provider reimbursements.

In the long run, outsourcing provides so many benefits, you can visualize expanding your practice more rapidly than your business plans called for at the outset, since a third-party billing expert will be taking care of your revenue cycle management while you focus on patient care.

Medwave Billing & Credentialing is located in Cranberry Township, Pennsylvania. We are dedicated to providing the best medical billing and credentialing services. Our team of experience professionals do the job right and provide medical practices the peace of mind they deserve. Find us at https://medwave.io.

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