iPatientCare Blog - Quick Billing Guidelines for Behavioral Health Services

Quick Billing Guidelines for Behavioral Health Services

The connection between behaviors and the health and well-being of the body, mind, and spirit, which includes how eating habits, drinking, exercising have an impact on physical and/or mental health; is what Behavioral Health implies to. It includes both mental health and substance use, encircling prevention, intervention, treatment and recovery support services.

It is important to remember that behavioral health is a blanket term where mental health is included. Behavioral health watches out for the impact of behaviors on one’s health – physically and mentally. For instance, a behavioral health professional may see what may contribute to a person’s obesity – individual’s behavior, family, community and changes in their thinking patterns.

How does behavioral health integrate with primary care?

A gateway for many individuals with behavioral health and other primary needs is primary care settings. There is integration of depression treatment into primary care settings, that has proved to be twice more effective than traditional depression care. It has shown improvement in physical and social functioning and patients’ quality of life. It has also shown a reduction in overall healthcare costs. Moreover, this integration has proved to be effective even in treating diabetes and cancer.

What behavioral health billing services consist of?

A strong understanding of various codes that behavioral health treatments comprise of is required to be able to successfully bill the claims. If the billing software does not consider psychotherapy or psychology; then the practice might face some challenges during the billing process.

It is important for practices to bring in reliable and expert vendors to handle their billing, to overcome challenges related to non-traditional healthcare service, and other special needs and processes. The software should be able to find and input codes easily, according to the needs and concerns of the patients being treated.

Usually, behavioral health practices operate under unique circumstances. It comes across with severe disabling behavioral problems, which may require additional services such as – support programs, rehabilitation programs, and other specific programs when it comes to more comprehensive care.

Some other challenges faced by behavioral health practices are – they have to spend more resources, and time for coordinating patient care, instead of attending to their patients’ needs. Secondly, most behavioral health services are provided to the patients in primary care facilities where they miss getting treatment through specialty programs, which are more beneficial for the patients.

Why practices should outsource the billing process?

Outsourcing the billing services can reduce practices’ overhead costs, increase in reimbursements, decrease in claim denials and rejections. This can enable practices to focus more on their patients rather than spending hours on constructing and interpreting the billing reports.

The medical billing providers provide dashboards that easily show the issues with the medical accounts. The practice can easily check and maintain patient volumes, procedure mixes, collections, days in AR and major denials. All this makes it easier for practice to handle their patients’ financial matters and in a less time-consuming manner.

An in-house billing software and hardware costs are high. In addition, to train the front office staff to be able to use this software in and out, can add to the expenses. Further, if the employee operating the in- house system quits the job or is on leave then this can lead to more denials and pending claims.

By outsourcing to the highly experienced behavioral health experts, there will be accuracy in correct codes, terminologies, etc.

When should the practice consider outsourcing?

  • When the practices’ billing process is insufficient
  • When the staff and practitioners’ are not technologically sound
  • When the practice has high staff turnover
  • When the provider is new

Outsourcing to an expert billing company will supply the practice with comprehensive performance reports that are automatically generated or given upon request. This helps the providers’ to know where the practice stands financially. There will be enhanced consistency without worry about staffing and rejected claims.

Related Article: Healthcare Revenue Cycle Management: Is it cheaper to embed it than it is to outsource it?

When it comes to mental or behavioral health billing, there could be frustration due to the type of services offered. Most psychiatrists provide therapy sessions and related services rather than performing an x-ray or an eye-exam. The insurance companies want to know, how much time the treatment continued for, and this can be difficult for the mental healthcare providers to balance adequate treatments and their timings, along with successful billing plan.

The practices have to be updated on healthcare billing codes, changing regulations and each insurance companies’ billing practices; otherwise, the rejection rates will be high. To process the claim successfully without consuming much time, the practice should:

  • Apply the appropriate code for the treatment.
  • Include the appropriate policy number along with the claim.
  • Be able to limit the bill’s total, to the fees allowed by the patient’s insurance policy.
  • Receive the pre-approval for the treatments when needed by the insurance plan.
  • Using the required billing format for each insurance company.

Thus, behavioral medical billing is much more complicated than regular medical billing, which is straightforward with fewer pitfalls. Some other concerns that behavioral practices can overcome easily are:

  • To stay updated with preferred filing methods of the insurance company.
  • To encourage cash payments from the patients who have no insurance coverage.
  • To check thoroughly, the policies and coverage lapses.

Most of the behavioral health practices face challenges that are unique when it comes to billing. If the practices operate at multiple locations and are at a stage of overall growth, then it is beneficial for the practices to outsource to the expert third party, since they will know all the intricacies that go with it. The practices can streamline the process better by using a behavioral health practice-oriented revenue cycle management.

Behavioral health revenue cycle management is a specialized application developed for the practices that deal with behavioral issues. It simplifies billing and collection cycles, helping practices generate more revenue and process the payments quicker. It serves as a perfect bridge between electronic health record system for behavioral health and billing systems, thus allowing the providers to stay more committed to their patients and quality of the treatments given to them.


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