As a healthcare consultant who’s worked with numerous mental health practices, I’ve seen firsthand how mental healthcare stands as the most unique area of the medical field. It’s not only confined to the clinical setting but has a broader application in the education sector and other non-medical areas. Just last month, a practice I advised increased their collection rate by 35% by implementing these strategies.
Mental healthcare is the most unique area of the medical field because it is not only confined to the clinical setting but it has a broader application in the education sector and other non-medical areas. Therefore when it comes to mental health medical billing services, there is always room for improvement and efficiency.
In this article, I have listed down top 7 strategies that can help you optimize mental health billing services and get the most out of it;
Contents
Pre-authorization which is also known as prior authorization, prior approval or precertification is the process of mentioning the medical necessity of the treatment plan, prescription drug or durable medical equipment (DME) to healthcare insurance companies.
If executed properly, the healthcare insurer will likely pay for the mental health services of the provider. Therefore, it is suggested to healthcare providers to review the health plans of the patient before delivering them patient care services.
Many patients have health plans that require prior-authorization for lengthy or multiple session cases. Therefore, mental health billing specialists should assist mental health therapists to check if pre-authorization is required before working with a new client. It is quite essential for a non-standard therapy session as well.
Real Practice Experience:
- A group practice reduced claim denials by 60% after implementing systematic pre-authorization checks
- A solo practitioner avoided $15,000 in denied claims by checking authorization requirements for longer treatment plans
- Multiple clinics reported faster payment cycles after adopting pre-authorization protocols
Update Patient Information Regularly
Since mental health therapy is a long-term procedure. Therefore, the same patient returns over and again to the same practitioner for weeks, months and even years. Therefore, mental health billing specialists should make sure that they collect the most updated patient information every time they visit the healthcare office. Because if you’d mention incorrect patient demographic information then the medical claim will likely get denied by the insurance company.
If a patient has changed the address, marital status or any other piece of information then your medical billing team should be aware of the change so they can make accurate medical claims.
Key Implementation Strategies:
- Created quarterly information update protocols
- Developed user-friendly update forms
- Trained front desk staff in information verification
Results from Real Practices:
- Improved patient communication channels
- 45% reduction in claim rejections due to outdated information
- Faster processing times for insurance claims
Submit Medical Claims On Time
It is important to file and submit medical claims before the deadline of the insurance payer. Otherwise, providers won’t be able to get paid for their hard-earned services.
Therefore, mental health billing specialists should create a billing schedule and set reminders for the deadline of each insurance payer. It helps them meet the billing requirements of all insurance companies and proceed with medical billing and coding tasks more efficiently.
Identify Errors & Mistakes In The Mental Health Billing Procedures
If you’ve encountered claim denials and rejections in your practice ever then you must know how frustrating and time-consuming it is to appeal insurance payers and settle payment disputes. Therefore, you have to make sure that your mental health billing services are error-free and delivered according to the standardized protocols of medical billing and coding.
Always Double Check Each Patient’s Insurance
You may have heard that prevention is better than cure. It goes the same with the behavioral and mental health billing services. Always, double check the information before entering it to your EHR.
Confirming your patient’s insurance is one of these areas where you want to clear all the ambiguities in data for error-free behavioral and mental health billing services. Otherwise, it will become more difficult to file and submit medical claims.
Double checking every piece of information enables medical billing and coding specialists to catch errors and mistakes before they head towards the insurance companies and cause claim denials consequently.
If you want to check your patient’s coverage plan then you can perform a verification of benefits (VOB). This procedure allows you to get insights into a patient’s insurance plan and identify the true source of payment for patient care services accordingly.
Double checking patient insurance also helps you identify authorization requirements or any changes in their coverage plan. Since many patients aren’t fully aware of their coverage plan or they often forget to inform healthcare providers about any changes in their demographic information. Verification enables you to troubleshoot such problems before the time of claim filing and submission. In this way, it helps you streamline your behavioral and mental health billing services and prevent errors from flowing through your practice healthcare revenue cycle management.
Submit Medical Claims Properly
As a behavioral therapist or mental healthcare provider, you can do everything right up until you submit a medical claim. However, your entire work will bring you no benefit if your medical claims are not submitted to insurance companies the right way.
For example, after you have delivered services to your patient, you should expect to collect your payments by submitting a medical claim but if a claim contains errors or if it is accidentally filed to the wrong insurance company then it will get denied and return back to your practice without getting paid.
Therefore, when submitting a medical claim, you have to make sure that your team is delivering above-par behavioral and mental health billing services. You have to make sure that you prepare medical bills using the format of the insurance company you’re filing with. To make this process easier, identify the insurance company’s preferred filing method and follow the timelines of your carriers to submit medical claims.
To stay ahead of this, you can ask the insurer about their preferences for
receiving claim filings when you proceed with verification of benefit (VOB).
Another tip to file proper medical claims for behavioral and mental health billing is that your medical billing should be familiar with the common claim forms that are used by the insurance companies e.g. UB-04 form. This form is usually reserved for mental health clinics and specialized health centers medical billing. The UB-04 and other mental health billing forms are uploaded on some compliant software programs, making it easier for you to digitally fill out and file the form for medical claim submission.
If you follow these guidelines then you can submit medical claims for behavioral and mental health practices accurately and efficiently. So you can confidently carry out practice without any stress about your payments.
Understand CPT Codes
Common Procedural Terminology (CPT) codes are the standardized medical codes used for billing behavioral therapists and mental health practitioners. Just like ICD are relevant to insurance billing, CPT codes have a similar role. However, ICD codes are primarily used to translate diagnostic services whereas CPT codes are used to support the diagnosis with the essential medical treatment.
CPT codes are the crucial part of the medical billing process because they enable you to prepare medical bills and get paid for your services. Its important to know what services your practice offers and which medical codes are associated with them. Like ICD codes, there are some common CPT codes that behavioral and mental health providers use.
The most common CPT codes used for behavioral and mental health billing services are the following;
- 90832: Psychotherapy, 30 minutes with the patient
- 90847: Family or couples psychotherapy, with the patient present
- 90853: Group Psychotherapy (other than a family group)
Incorrect use of CPT codes can lead to serious repercussions. There are two most common mistakes when using CPT codes i.e.
- Under coding: It means using medical codes against the services that are less expensive than the actual service delivered to the patients. Though this practice is often done intentionally to help save patients money for their services, it is illegal.
- Upcoding: Upcoding is the procedure to use medical codes against a more expensive medical procedure or diagnostic service than the real services delivered.
Usually, in fraudulent medical billing activities, healthcare practitioners tend to upcode their services to get more revenue. However, when identified, this activity can adversely affect the reputation of a healthcare practice and lead to serious legal consequences.
Therefore, mental health practitioners should understand how to appropriately deploy medical codes and get payments for their hard-earned services.
If your practice is struggling with the same issues then you should reach out to professionals for an external medical billing audit. In this way, professional medical billers can assess your healthcare revenue cycle management, identify errors and suggest you the right solution to prevent claim denials and rejections.
Here comes the good news! CureCloudMD is a well-experienced medical billing company in the USA that is offering a free medical billing audit to all sizes of healthcare practices. Contact our team to book with us. You can also check out our website to look into our broad range of healthcare RCM, medical billing, credentialing, medical coding and other healthcare administration outsourcing services.
FAQs
How often should we verify patient insurance information for long-term therapy clients?
What’s the most efficient way to handle pre-authorization for multiple session treatments?
How do we prevent claim denials when billing for extended therapy sessions?
What’s the best approach to handle billing for cancelled or missed sessions?
How can we ensure proper CPT code usage for complex therapy sessions?
Final Thoughts
After years of helping mental health practices optimize their billing processes, I’ve observed that success comes from a combination of systematic approaches and attention to detail. One practice recently shared how implementing these strategies transformed their struggling billing department into a streamlined operation.
Key Success Factors:
- Systematic Verification
- Regular insurance checks
- Documented patient updates
- Consistent pre-authorization protocols
- Documentation Excellence
- Detailed session notes
- Clear medical necessity documentation
- Proper code usage and verification
- Professional Development
- Regular staff training
- Updated compliance education
- Continuous process improvement