Mental health billing adds another layer of complexity to the already challenging and time-consuming medical billing process. Medical billing is somewhat standardized and varies from patient to patient only a little, with the fundamental tests and parameters being the same. This is why mental health practices billing services differ from medical billing.
However, the sorts of services offered in mental health or psychiatric billing differ in terms of the clinical approach, session size, frequency of visits required for a patient, age, and level of preparation for therapy, among many other aspects.
Complexities of Medical Billing for Mental Health Practices
In order to standardize and reduce fees by limiting the length and frequency of sessions delivered by psychiatrists, several insurance companies have created various guidelines for mental and behavioral billing.
Due to all of this, the majority of mental health practitioners struggle with billing procedures and opt for outsourced mental health billing services. If you are going for the outsourced billing option or the in-house billing option just ensure the following steps are in their process. The following are ten crucial actions that mental health practices need to do in order to bill for medical services:
The minute you start a new patient record, you should start using good billing procedures. Why? Because most billing errors such as misspelled names, errors in patient insurance ID numbers, missing fields, etc. lead to insurance companies rejecting claims. You’ll require exacting precision on details like these to produce what the billing industry refers to as a “clean” or error-free claim:
The complete legal name of the patient
Date of Birth
The ID number for the insurance member’s current address
Sorting and entering detailed patient data at check-in is crucial as it facilitates insurance verification and reduces additional errors. Some clinics and mental health billing businesses utilize specialized software for mental or behavioral health billing. Which secures patient data such as personal details, demographic data, etc., online.
Insurance Eligibility Verification
As coverage and policies may differ in such circumstances, which in the long run may result in rejections. It is crucial to confirm insurance eligibility before invoicing for mental health services. Therefore, it is crucial to verify eligibility by checking the supporting documentation and patient coverage benefits information.
Verify the accuracy of the new patient information by checking it again. Additionally, as soon as possible, you should confirm their insurance coverage of mental health services. One simple way to avoid such headaches is to confirm coverage in advance.
Because mental health billing comprises several codes for therapy, referral, and diagnostic services, any coding error could result in the claim being rejected or not paid. A new or missing code for a certain therapy is updated in the system. To reduce errors, medical coders use ICD-10 and CPT assistance to check and verify the codes for a procedure.
Accurate charge entry is necessary for medical billing and should be done as such. 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.
Therefore, it’s crucial to pre-install pricing structures for different services into the systems. Along with accurate coding to prevent any erroneous charge entry from leading to claim rejection or denial.
Wherever possible, take the patient’s copayment at the time of the appointment. Once your patient has left the facility, your chances of collecting that money decrease. Additionally, invoicing for many copays later could result in an unexpectedly high cost that the patient needs to prepare to pay all at once.
In short, by paying the copay upfront, you’ll gain more money and steer clear of unpleasant surprises.
The superbill will then be used by the medical biller 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
The process through which payers assess medical claims to decide if they are legitimate and compliant and, if so, what amount of payment the provider would get, is known as adjudication. The claim may be approved, rejected, or refused during this process. According to the insurance company’s agreements with the provider, a claim that is accepted will be reimbursed.
Making sure that bills are paid is the final step in the medical billing process. Medical billers must contact patients after billing.
Still, do they sound too much to handle? You always have the option to hire mental health billing services since it has the necessary expertise and equipment to handle the procedure. Medical coding is handled by Transcure in accordance with payer and state-specific regulations and is HIPAA compliant. It has a devoted group of medical billing professionals who make sure that the bills are paid on time, assist with the eligibility verification of new patients, follow-up services, and advance patient collection by examining the coverage information.