Mental health is a complicated part of the healthcare industry, and endeavors to handle it. Practices that deal with mental health services must align several treatments and a vast variety of services and components. It is complex because all service charges contrast with each other.
Mental health caregivers face distinct disadvantages when compared to other healthcare providers. They not only give exceptional client care but also keep an eye on the bottom line. They face the challenges of pre-authorization, convoluted billing procedures, changing insurance policies and funding providers, and many more.
It is an uphill battle for behavioral health providers to get reimbursement from clients and insurers for services. According to the survey, it is estimated that mental and behavioral health professionals only get 85 percent of the amount they invoice. This puts pressure on mental health providers’ sustainability because 15 percent of total revenue is lost and can’t get back.
Let’s discuss a few common mistakes and their remedies in mental health billing services.
Common Mental Health Billing Errors
There are several factors that are the reason for errors in the psychiatry medical billing process. Since mental health is very different from others, it is more crucial than other medical billing processes. It requires highly trained professionals who understand how to submit claims properly. Typical errors that arise during mental health medical billing process:
Missing Information
It is easy for billers to overlook essential details, such as treatment dates or the date of onset of the incident. However, excluding important information can lead to reimbursement delays for psychiatry medical claims. To expedite the procedure, ensure all relevant details are included in the mental health billing.
Ill-timed Submission
Every claim must be submitted in a timely fashion in accordance with the rules of the insurance providers. If a valid claim is submitted but not in the given time frame, it may face denial. Moreover, all claims must have provided all the necessary supporting documentation before the deadline.
Inaccurate Patient Identifier Details
While submitting each claim, it’s vital to provide the correct patient data, including their name, date of birth, and gender. If they have a health insurance plan, it’s essential to include a group and policy number that match their personal data.
When a patient has multiple insurance plans, the primary insurance should be specified. Once the primary insurance is submitted and processed, the remaining balance due can be sent to the secondary insurer for further reimbursement.
Inaccurate CPT or REV Code
Psychiatry medical billing claims must have the accurate Current Procedural Terminology (CPT) or Revenue (REV) code for each service provided by a healthcare facilitator. The numbers are assigned to each service, such as medical, surgical, and diagnostic services. Once the insurance company receives claims with a CPT code, they review it to ensure alignment with their policies and the accuracy of the CPT code. Incorrect CPT codes may lead to claim denials.
Employing Outdated CPT Codes
Each year, the American Medical Association (AMA) revises CPT codes. If psychiatry medical billing software does not include updated codes, it may lead to errors during the billing process. Behavioral healthcare providers must verify that they have the most recent CPT code set and that their claims correctly incorporate these codes before submitting them to insurance companies for reimbursement.
Engaging In Upcoding
Upcoding is a manipulation of medical codes to inflate the reimbursement amount from an insurance provider. Sometimes, medical billers deliberately or accidentally include code that leads to additional physician payments.
In the psychiatry medical world, one instance might be applying codes for a 48-hour facility, even if they were only staying there for 36 hours. Psychiatry medical billers make sure that they use the correct codes that precisely transmit the patient’s treatment and its duration.
Challenging in Documentation
While submitting a claim to the insurance company, it must contain all relevant documentation. Common types of documentation include:
- Purpose of the treatment or visit
- Date of the treatment or visit occurred
- The patient’s case history
- Description, prescriptions, and copies of test results
- Clinical assessment and final diagnosis
This documentation plays a crucial role in assisting the health insurance provider in determining the appropriateness of the treatment or visit in the given case. Missing documents can result in being denied or experiencing delays in reimbursement.
Duplicated Billing
Sometimes it happens that medical billers accidentally submit a claim to an insurance company for the same patient’s visit twice. In some scenarios, there may be minor discrepancies in the claim that may go uncaught by billing software, leading to duplication of claims.
In other cases, the patient portal is not updated properly, or an appointment may be entered twice, which causes the submission of two identical claims. Whatever the reason, insurance companies commonly reject duplicated billing.
Lack of Prior Authorization
In some cases, insurance companies mandate the facilitation of prior authorization or referrals before particular services or procedures are performed. A referral must be issued by the patient’s primary care for treatment. Prior authorization is essential to give health insurance company before treatment is given.
Taking Measures to Avoid Psychiatry and Mental Medical Billing Errors
It is essential to follow a strict set of procedures every time they see or treat a patient. Ensuring the smooth management of the medical billing process involves various steps that providers can put into place:
Establish Pre-Authorization Process
All insurance companies do not mandate pre-authorization. Employ a pre-authorization process to confirm that the facility can use it to ensure the patient’s insurance covers services or treatments offered. This is a simple step in which a brief phone call to the insurer to confirm the validity of the patient’s insurance and its coverage for the intended treatment.
Make sure Patient information is up-to-date
When a patient visits for a session or treatment, it is essential to check that their personal information has not changed. Request for their current identification, including their address and phone number. Create a form that can be filled out by patients that indicates changes in personal details. Most healthcare providers encourage patients to update such forms at least once per year.
Look out for the Reason for Claim Denials
If a mental healthcare provider receives notification of a claim denial from the insurance agency, take the initiative to determine the cause of the denial. Understand that it is important to make sure any errors in the medical billing process are caught and corrected.
By finding the cause of claim denials, it is the biller’s duty to prevent its occurrence proactively.
Timely Submission of Claims
Each insurance company follows different guidelines for medical billers when submitting a claim. Ensure that all medical billers are well-informed of each provider’s claim submission window. Late claim submission is the most common reason for a claim to be denied.
Take Aways
To ensure the efficiency of billing and clear claim submissions, mental health practices must follow given essential tips:
- Maintain precise and detailed documentation of discussions for patients and prayers.
- Before providing services to a patient, check for their benefits
- Confirm appropriate CPT codes that accurately present the provided services.
- Distinguish between psychiatry evaluation codes and E/M codes.
- Follow the billing guidelines set by the insurance companies to reduce claim denials.
- Examine claim denials to rectify errors and search for recurring patterns.
