Overview

Mental health billing adds another layer of complexity to the already challenging and time-consuming medical billing process. It is no wonder that many psychiatry practices struggle to navigate the complexities of psychiatry medical billing. In addition, psychiatric medical practices face a 20% higher claim denial rate compared to any other medical specialties. Psychiatric billing services typically differ in various critical aspects, such as the clinical approach, session size, required visit frequency, patient age considerations, and level of therapy preparation. In this blog, we will explore the intricate challenges confronting psychiatric practices while providing you with essential steps to overcome these complexities with expertise and ease.

Complexities of Medical Billing for Mental Health Practices

To standardize and control costs, insurance companies have introduced guidelines for mental and behavioral billing, focused on restricting the duration and frequency of sessions conducted by psychiatrists. As a result, many mental health practitioners find themselves grappling with the complexities of billing procedures, leading many to opt for the convenience and expertise of outsourced mental health billing services. Whether you choose the outsourced billing option or the in-house billing route, ensuring the following steps are part of the process is crucial. Here are ten essential actions that mental health practices must undertake to successfully bill for medical services:

Intake Details

When beginning a new patient record, it is crucial to implement meticulous billing procedures right away. Why? Because even seemingly minor errors, such as misspelled names, incorrect patient insurance ID numbers, or missing fields, can lead to claim rejection. Achieving precision in these details is the key to generating a “clean claim.” Among the essential components that demand utmost accuracy is the recording of the patient’s complete legal name. Intake details lay the groundwork for seamless and precise billing practices from the very start.

Date of Birth

In psychiatric medical practice billing, the accuracy of patient information is an indispensable pillar that upholds seamless billing procedures. As we delve into the essential steps to simplify your billing challenges, the significance of capturing the patient’s date of birth cannot be underestimated. This seemingly essential detail holds tremendous weight in the billing process, as it serves as a crucial identifier for insurance verification and claim processing. Moreover, precise patient information facilitates streamlined communication between the psychiatric practice and the insurance company.

Insurance Eligibility Verification

It is crucial to confirm insurance eligibility before invoicing for mental health services. Each patient’s insurance coverage and policies may differ, and failing to verify this crucial information beforehand could lead to claim rejections, delayed payments, or even potential financial setbacks for your practice. Therefore, it is crucial to verify eligibility by checking the supporting documentation, and patient coverage benefits information. Confirming insurance eligibility at the outset can mitigate potential obstacles and streamline the billing process.

Medical Coding

As we continue our journey through the steps to simplify your billing challenges for psychiatric practice, we arrive at a pivotal stage: medical coding. In the intricate world of psychiatric billing, accurate and comprehensive medical coding serves as the key to unlocking precise reimbursements and ensuring a seamless revenue cycle. Medical coding translates complex patient information, diagnoses, and procedures into universally recognized alphanumeric codes. Any errors or omissions in coding could lead to claim denials, delayed payments, or underpayments, potentially impacting the financial health of your practice.

Charge Input

Accurate charge entry is necessary for psychiatric medical billing. It determines whether or not a doctor will be paid for his services. It is carried out in accordance with the provider’s policies on the duration and frequency of the services given. It involves recording and entering the charges for each patient encounter based on the provided services and the duration and frequency of therapy sessions. Therefore, pre-installing pricing structures for different services into the systems is crucial. Along with accurate coding to prevent any erroneous charge entry from leading to claim rejection or denial.

Patient Copay

Patient copayments are the predetermined fixed amounts that patients are required to pay at the time of their appointments. Once your patient has left the facility, your chances of collecting that money decrease. Collecting copayments upfront not only supports the financial health of your practice but also fosters transparency and trust with your patients. In short, by paying the copay upfront, you’ll gain more money and steer clear of unpleasant surprises.

Claims Production

The medical biller will then use the superbill to create a medical claim that will be sent to the patient’s insurance provider. The biller must carefully review the claim once it has been produced to ensure that it complies with payer and HIPAA compliance criteria, including those for medical coding and format.

Submission of Claims

The next step is submission after the claim has been examined for accuracy and compliance. The claim will often be sent electronically to a clearinghouse, a third-party business that serves as a point of contact between healthcare providers and health insurance. High-volume payers like Medicaid, who take claims directly from healthcare providers, are the exception to this norm.

Track Claim Resolution

Tracking claim resolution involves monitoring the status of your submitted claims with insurance companies. This process helps you promptly identify any claim delays, rejections, or denials, allowing you to take proactive steps to address issues and expedite payment processing. Consider the following essential measures for effective claim resolution tracking in your psychiatric practice:

• Claim Status Reports: These reports provide insights into the progress of each claim, indicating whether they are in the processing stage, pending, or have been settled.
• Claim Denial Analysis: Analyze claim denials to identify recurring patterns or common reasons for rejection.
• Claim Follow-Up: Implement a systematic follow-up process for outstanding claims. Regularly contact insurance companies to inquire about claim status and expected resolution timelines.
• Appeals Management: Timely and well-documented appeals increase the likelihood of claim reconsideration and approval.
• Denial Trend Identification: Identifying trends helps you implement proactive measures to minimize future denials.
• Automated Systems: Utilize automated claim tracking systems to streamline the process and efficiently manage claim resolution.

Statement Follow-Up

Making sure that bills are paid is the final step in the medical billing process. Statement follow-up involves communicating with patients after billing to ensure they receive and understand their statements. It is an opportunity to address any questions or concerns they may have regarding their charges, copayments, or insurance coverage.

Conclusion

In conclusion, we have delved into the essential steps to simplify your billing and help you overcome common billing hurdles. Focusing on meticulous intake details, insurance eligibility verification, accurate medical coding, and efficient charge input can pave the way for timely reimbursements and financial stability. Amidst all these complexities, it’s natural to feel overwhelmed, but fret not! Transcure is here to alleviate that burden for you.