Mental Health Billing vs Medical Billing

mental health billing for dummies

Managing your medical collections can be a major burden on your time and staff resources. The complexity of coordinating care for behavioral health patients simply adds to the work that must be done. Another thing to keep mental health billing in mind is that by outsourcing these tasks, you remove accountability from your staff. If a member of your team makes a crucial error in ICD coding or in other important data, the penalties will be your responsibility.

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. 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. The EHR you’re using probably isn’t the same one that a pediatrician’s private practice utilizes. Both EHRs serve different niche’s within the healthcare industry so they probably also have different features.

Why Is Mental Health Billing So Complicated?

After all, there are differences between the types of claims that hospitals submit compared to those coming from mental health facilities. Although the billing rules within the mental health space seem archaic, the practice sends shivers down the spine across the entire medical world…regardless of specialty. Upcoding, or overcoding, is also illegal and commonly done to receive higher reimbursement. Upcoding is when a provider uses a code that reflects a more severe diagnosis or higher-priced treatment than is accurate for a patient. However, undercoding and upcoding can easily result from an untrained employee who doesn’t have adequate coding knowledge.

Now that you know how ICD codes are relevant to insurance billing, CPT codes have a similar role. ICD codes are used primarily for diagnosing a patient, whereas CPT codes are used to support the diagnosis with the necessary medical treatment. As mentioned above, the verification of benefits (VOB) is important to confirm a patient’s insurance coverage and the service they intend to receive. In this process, you can check your patient’s policy for information that won’t often be directly on their insurance card. This step is important for making mental health billing easier, because though many patients have active insurance, your services may not be covered as a benefit. As with any mental and behavioral health industry procedure, it doesn’t hurt to double-check yourself.

Reading Payer Contracts for Key Medical Billing and Coding Details

It also usually has a series of pre-established connections to insurance organizations to streamline submission. Anyway, this section lists the industry terms used within mental health billing. This isn’t one of those industries where you dive right into it and learn as you go. If you went this route it would take you a few years to get a grasp on all of the jargon. Not to mention the fact that mental health billing is a specific niche within the space.

Finally, and perhaps most importantly, you must be assured that the provider will keep the lines of communication open. You want them to contact you immediately in case of a problem, and they should respond quickly to any inquires you have regarding bills and provider reimbursement. You can therefore move your focus from RCM tasks and devote more energy toward engaging with your patients. Insurance companies must be able to reimburse you promptly for services you rendered. When considering whether to join a network or accept payment from insurers, it’s important to evaluate their pre-approval rules and their limits for payment.