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How Behavioral Health Billing Works?8 min read

behavioral health billing
In the mental healthcare industry, behavioral health billing is a powerful tool. Here are insights of the mental health billing process.

Overview

Are you a healthcare provider trying to navigate the complex world of behavioral health billing? Do you spend more time with the tiresome billing process and the missed revenue opportunities in the behavioral health industry? Submitting claims for essential services such as counseling, psychotherapy, and psychiatric care can take much effort. But fear not. Despite the numerous regulations and rules, successfully billing for these services can be challenging yet rewarding. Continue reading to explore behavioral health coding and billing practices. This blog will provide you with insights into the billing process and enable you to optimize revenue generation.

Steps Involved in Behavioral Health Coding and Billing

The steps involved in coding and billing behavioral health services are described below.

  1. Patient Eligibility Verification

The first step in behavioral health billing is to verify that the patient is eligible for insurance benefits. This can be done by contacting the patient’s insurance company and providing them with their demographic information and policy number. It is important to note that not all insurance plans cover behavioral health billing services. Some plans may only cover certain types of services, such as psychotherapy or counseling. Others may have limits on the number of sessions that are covered. It is also important to note that some insurance plans require prior authorization for behavioral health services. Prior authorization is a process in which the provider must obtain approval from the payer before providing the service. You must obtain prior authorization to ensure your claim is accepted.

  1. Coding 

Once the patient’s eligibility has been verified, the next step in behavioral health billing is to code the provided services. This involves assigning CPT (Current Procedural Terminology) codes to each service. CPT codes are specific to each type of behavioral health service, and payers use them to determine how much reimbursement to provide.

Here are some of the most common CPT codes for behavioral health services:

CPT CodeTreatment/Therapy  Time Duration 
90801    Initial psychotherapy session    45-59 minutes
90802   Subsequent psychotherapy session 45-59 minutes
90804    Crisis intervention session 30-60 minutes
90805               Family psychotherapy session 45-59 minutes
90807 Psychiatric diagnostic evaluation30-59 minutes
99214 Office or other outpatient visits for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate decision-makingTime Duration may vary       
  1. Claims Submission

Once the behavioral health coding is complete, the next step is to submit claims to the patient’s insurance company. It can be done electronically or on paper. If submitting claims electronically, the provider will need to use a clearinghouse. A clearinghouse is a third-party company that helps providers to submit claims to payers. Clearinghouses can help to improve the accuracy and efficiency of the claims submission process. If submitting claims on paper, the provider must complete a CMS-1500 form. The CMS-1500 form is a standard claim form that all payers use.

  1. Denials and Rejections

Unfortunately, it is common for behavioral health claims to be denied or rejected by payers. This can happen for various reasons, such as :

  • Incorrect behavioral health coding: If the services are not coded correctly, the claim goes into the denial phase.
  • Incomplete documentation: The claim may go into denial if the provider’s documentation is incomplete.
  • Lack of prior authorization: The claim reimbursement would be easier if prior authorization were obtained.
  • Medical Necessity: The claim may go into denial if the payer does not believe the services were medically necessary.

If a claim is denied or rejected, the provider must work with the payer to resolve the issue. It may involve providing additional documentation or submitting a corrected claim.

  1. Reimbursement

The provider will receive service reimbursement once the payer has processed a behavioral health claim. The reimbursement amount will vary depending on the payer’s contract with the provider. Most payers reimburse providers based on a fee schedule. A fee schedule lists the maximum amount the payer will reimburse for each type of service. Some payers reimburse providers based on a percentage of the provider’s usual and customary charges. The usual and customary charge is the amount the provider typically charges for a particular service.


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Improving Behavioral Health Billing Accuracy and Efficiency

Here are some tips for improving the accuracy and efficiency of your behavioral health billing:

Implement a billing software solution

A behavioral health billing software solution can help you automate many tasks involved in behavioral health billing, such as coding, claims submission, and denial management.

Use a clearing house

A clearinghouse is a third-party company that helps providers submit claims to payers. Clearinghouses can help to improve the accuracy and efficiency of the claims submission process.

Stay up-to-date on coding and billing regulations

Behavioral health billing regulations are constantly changing. It is essential to stay up-to-date on these changes to ensure that your claims are being submitted correctly.

Hire a behavioral health coding expert

If you are not comfortable coding your own claims, you can hire a coding expert to do it for you. Coding experts are familiar with the latest coding and billing regulations and can help you ensure that your claims are being coded correctly.

Get prior authorization

If prior authorization is required for a particular service, obtain it before providing it. This will help to prevent your claims from being denied.

Submit claims electronically

Submitting claims electronically is more efficient than submitting claims on paper. Clearinghouses can help you to submit claims electronically.

Track your claims

Tracking your claims to identify any denials or rejections early on is essential. This will give you time to work with the payer to resolve the issue.

Behavioral Health Billing for Specific Services

In addition to the general tips above, there are some specific tips for billing for specific behavioral health services.

Psychotherapy

When billing for psychotherapy services, using the correct CPT codes is essential. The CPT codes for psychotherapy services depend on the length of the session and the type of psychotherapy.

For example, an initial psychotherapy session lasting 45-59 minutes would be coded as CPT code 90801. For a subsequent psychotherapy session lasting 45-59 minutes, behavioral health coding will be 

90802.

It is also important to provide clear and concise documentation for psychotherapy services. The documentation should include:

  • The patient’s presenting problem
  • The treatment goals
  • The interventions that are in use
  • The patient’s progress.

Psychiatric Care

When it comes to behavioral health billing for psychiatric care services, using the correct CPT codes is essential. The CPT codes for psychiatric care services are based on the service type, such as a psychiatric diagnostic evaluation or a medication management visit.

For example, in a psychiatric diagnostic evaluation lasting 30-59 minutes, the behavioral health coding is CPT code 90807. A medication management visit lasting 30-59 minutes would be coded as CPT code 99214.

Providing clear and concise documentation for psychiatric care services is also essential. Documentation should include:

  • The patient’s mental health diagnosis
  • The treatment plan
  • The prescribed medications. 
  • The patient’s response to treatment.

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Conclusion

Behavioral health billing can be complex, but it is essential to get it right. By following the tips above, you can improve the accuracy and efficiency of your behavioral health billing and ensure that you receive the full reimbursement you are entitled to.

FAQs Answered by the Transcure Team

Can BHI codes be billed in the same month as CCM?


Yes, BHI codes can be billed in the same month as CCM. However, there are some restrictions. For example, the same provider cannot bill for both CCM and BHI services for the same patient on the same day. Additionally, the services provided must be distinct and not redundant.


Can other nonface-to-face care management services be billed in the same month as CCM?


Yes, other nonface-to-face care management services can be billed in the same month as CCM. However, there are some restrictions. For example, the same provider cannot bill for both CCM and another nonface-to-face care management service for the same patient on the same day. Additionally, the services provided must be distinct and not redundant.


How many Medicare Part B billing codes are available?


There are over 7,000 Medicare Part B billing codes. These codes are used to report a wide range of medical services, including physician visits, laboratory tests, and imaging procedures.


How can behavioral health billing associates help your mental health practice?


eClinicalWorks EMR offers an interface that can be tailored to meet the needs of your practice. You have options to:

  • Accurately coding and submitting claims to payers.
  • Following up on denied and rejected claims.
  • Managing your billing records.
  • Providing you with reports on your billing performance.

Can BHI codes be billed for the same patient in a month?


BHI codes can be billed for the same patient in a month. However, there are some restrictions. For example, the same provider cannot bill for the same BHI code for the same patient on the same day. Additionally, the services provided must be distinct and not redundant.


Can the behavioral health care manager bill for psychotherapy and other similar codes separately from BHI?


Yes, a healthcare manager can do behavioral health billing of psychotherapy and other similar codes separate from BHI. However, the services provided must be distinct and not redundant.


Darren Straus
Darren Straus
Leverages expertise in RCM, medical billing, and coding to navigate the complexities of healthcare IT. I like to write about simplifying complex healthcare processes and empowering providers with efficient solutions.

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