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Mental and Behavioral health billing is a uniquely challenging endeavor. It has additional challenges on top of what you face in billing for other medical specialties. Limited staff, limited time, unbundling, and pre-authorization are problem areas shared between the two healthcare types.

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Mental and Behavioral health billing is a uniquely challenging endeavor. It has additional challenges on top of what you face in billing for other medical specialties. Limited staff, limited time, unbundling, and pre-authorization are problem areas shared between the two healthcare types.

However, unlike medical specialties, mental health treatment is frequently ill-defined. A patient who comes into an office for a routine physical check-up will receive standardized care. Weight and height measurements, blood pressure checks, and heartbeat monitors are homogenous. As a result, billing is relatively repeatable from client to client.

Unfortunately, this same consistency does not apply to mental health. Each treatment plan varies with session length, therapeutic approach, age, and client willingness. So, behavioral health billers must be more diligent to avoid denials and get maximum reimbursements.

Here are six tips for mental and behavioral health billing.

Maintain Accurate Documentation

Ensure that your clients' records are up to date. These records should include personal data, insurance details, and medical history/goals. Update your client records at least once a year. Consider establishing an online system where consumers can verify their information before coming to an appointment.

Document your discussions with payer representatives. Note the time of conversation, their name, and what information they provided. This habit prevents confusion and holds payers accountable for miscommunication, should they deny claims that have pre-authorization.

Verify Client Benefits

Before scheduling any client to receive therapy, verify their benefits. This process can be tedious and unnecessary, especially for returning clients. However, insurance policies can change quickly, and clients rarely know the minutiae of their medical plan.

Verification of benefits is the process of confirming the client's insurance plan covers a service. Insurers' online portals are the easiest way to verify this information. Call the payer for more details for those who lack online portals or have limited information. Staff should also note the degree of coverage, any max limits, and whether pre-authorization is required.

Check CPT Codes

Current Procedural Terminology (CPT) codes are part of a HIPAA-regulated information system that matches services with specific codes. Medical professionals use codes to describe a procedure and detailed additional information through Modifiers. Misreading or mismatch of codes is a common reason for denials and inadequate reimbursements.

Medical coders often use Provider notes to understand the details of the service done in that session. Ensure that your Providers write in detail that can clearly distinguish similar procedures. The CPT Editorial Panel constantly updates codes, so always refer back to an official source to check the latest codes for that service.

Know E/M Codes Vs. Psychiatric Evaluation Codes

Behavioral healthcare practitioners commonly employ two types of codes. Coders use evaluation and management (E/M) codes when a physician evaluates a new medical problem. There are three documentation types E/M code users must provide.

● History: Includes the history of the illness, social and family history, and a review of systems.

● Examination: Includes the type of examination performed, the nature of the problem, and the client's history.

● Medical Decision Making: Includes the number of diagnoses or treatment options documented during the session, the complexity of the reviewed data, and the risk of complications.

By contrast, psychiatric evaluation codes are for diagnostic assessment. This assessment can include items that would typically fall under evaluation and management. However, coders must avoid using E/M codes for the diagnostic process.

Follow Insurance Guidelines

Different payers hold unique standards for how they want their claims submitted. An insurer may deny claims even with correct CPT codes if other information is required or need to be corrected. Additionally, insurers may create narrow timely filing limits by when practices can request reimbursements. Check this timely filing limit (TFL) for each payer since they vary by payer.

Review Claim Denials

Many claim denials are appealable. Document the types of denials you receive to find any patterns. Typically, insurers will delineate the error type in their report. Remember, insurers may have a limited, timely filing limit (TFL) for re-submissions or appeals.

At Plutus Health, we understand how arduous accurate billing and coding can be. That's why we provide a billing and collections service to help your practice succeed. Contact one of our representatives today to learn our plan to maximize your organization's reimbursements.

Key Takeaways

1. Maintain accurate documentation for client and insurer conversations.

2. Verify your client's benefits before providing them a service.

3. Check CPT codes to translate services accurately.

4. Know the difference between E/M codes and psychiatric evaluation codes.

5. Ensure compliance with insurers' billing standards to avoid denials.

6. Review claim denials to fix them and look for patterns.

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6 Tips for Mental and Behavioral Health Billing

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Mental and Behavioral health billing is a uniquely challenging endeavor. It has additional challenges on top of what you face in billing for other medical specialties. Limited staff, limited time, unbundling, and pre-authorization are problem areas shared between the two healthcare types. However, unlike medical specialties, mental health treatment is frequently ill-defined.

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Patient deductibles in the US have increased 150% between 2009 and 2018. While law makers have attempted to reduce health consumers’ burdens, their efforts have been ineffective. So, medical practices must engage with more complex accounting for patient balances. This complexity has forced billers to spend more time on each line-item of payments.

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How to Leverage Auto Posting in Medical Billing

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Payment posting is a crucial step of revenue cycle management. Here are the best ways to leverage auto posting and boost your billing efficiency.

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Understanding mental health billing and coding is a complex process. Different aspects of care require staff to follow unique codes. This blog will break down which codes your practice should use for specific circumstances.

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Understanding mental health billing and coding is a complex process. Different aspects of care require staff to follow unique codes. This blog will break down which codes your practice should use for specific circumstances.

Here are the top elements to keep in mind to maintain accurate mental health billing services.

Billing for Diagnostic and Treatment Services

Practices use the International Classification of Diseases (ICD) coding system to bill for diagnoses. Treatment billing has two code options: Current Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System (HCPCS).

ICD 10 Overview for Mental Health Diagnosis

The ICD-10-CM model provides a classification system for diseases and injuries. Practices report diagnoses using this model to both private and public insurers.

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CPT Overview for Mental Health Treatment

The American Medical Association developed CPT codes. This system has numbers associated with each service a physician may provide. Insurers use these numbers to determine how much reimbursement to provide a practice.

The procedural codes for mental health (codes90785-90899) are found in the Psychiatry section of the CPT code set. Codes originating from this section can be delivered by clinical psychologists, licensed professional counselors, licensed marriage and family therapists, and licensed clinical social workers.

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HCPCS Overview for Mental Health Treatment

Coders use HCPCS codes when dealing with Medicare and Medicaid.( The Centerfor Medical Services (CMS) monitors this code set. Both programs use Level 1and Level 2 codes. Medicaid typically uses Level 2 codes, and Medicare typically uses Level 1 codes. Medicaid has exclusive access to some Level 2codes.
Most mental health Providers code only Using Level 1 Codes. Medicaid required to use Level 2 alphanumeric codes that are provided by non physicians HCPCS Code range from H0001- H2037
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Billing For Counseling

Physicians spend significant time counseling patients and coordinating patient care. These actions fall under Evaluation and Management (E/M) services. It's easier to justify high levels of E/M compared to other services. Therefore, they frequently receive higher reimbursement levels.

As defined by CPT codes, counseling must involve a discussion with a patient, and/or their family, or another care giver. This conversation must involve one or more of the below categories.

● Patientand family education

● Recommended diagnostic studies

● Diagnostic results

● Impressions

● Risks and benefits of management (treatment) options

● Management (treatment) instructions

● Follow-up

● Significance of complying with chosen management (treatment) options

● Riskfactor reduction

Documenting Medical Records

When documenting services, your staff must maintain consistent standards. Failing to accurately record procedures is devastating to long-term stability. To avoid this destabilization, your medical records should support codes you included in an insurance claim.

Ensure that your physicians are writing legibly and including all necessary treatment details. These details include:

● Reasonfor visit

● Relevanthi story

● Examination findings

● Priordiagnostic test results

● Clinical impression

● Assessment

● Planfor care

● Date

● Identity of observer

Unless easily inferred, physicians must document the reason for ordering ancillary services and diagnosis. Also, identify appropriate health risks, patient's progress, response to change, and revisions to diagnosis.

Coding complexitie scan overwhelm an Mental Billing. Consider hiring a professional coding company to reduce the stress your staff endures. Plutus Health offers an expert team that excels at accurately coding services and billing quickly. Talk with a representative to hear how we'llimprove your practice's financial processes.

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Key Takeaways

1. Know the distinction between diagnostic and treatment services.

2. Learn the ICD and CPT overviews.

3. Understand nuances in HCPCS codes.

4. Study when a conversation falls under Evaluation and Management.

5. Keep accurate and detailed medical records.

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Key to Efficient and Accurate Mental Health Billing Services

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Understanding mental health billing and coding is a complex process. Different aspects of care require staff to follow unique codes. This blog will break down which codes your practice should use for specific circumstances. Here are the top elements to keep in mind to maintain accurate mental health billing services .

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Key performance indicators KPI's are an essential component to improving an ASC's financial performance. By consistently monitoring specific items, a practice can streamline its operations. To discover what factors may harm specific KPI's and potential solutions, visit this article from Surgical Notes.

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Key performance indicators KPI's are an essential component to improving an ASC's financial performance. By consistently monitoring specific items, a practice can streamline its operations. To discover what factors may harm specific KPI's and potential solutions, visit this article from Surgical Notes.

Here are the most integral key performance indicators to track.

Payer Type Trends

ASCs need to understand their projected revenue. Knowing what payer types are trending can help determine this estimate. A financial category boom or dip should modify income expectations. Even if your practice meets its predicted patient volume, failing to account for payer type can misalign your calculations.

To determine payer classes, compare the charges you send each agency to the reimbursements you receive. Payers that trend towards high charges but low payments may cause long-term financial problems.

Specialty Services Trends

Revenue per case is crucial to understanding future income. Check how much each specialty service nets. If your physicians are comfortable comparing peers, do this same process with them. A monthly revenue decrease for a physician or specialty may be worrisome. However, a spike in income should also cause concern as it may indicate upcoding.

Once you know how much each specialty nets, calculate the number of specialty visits you receive each month. A shift towards a lower revenue-generating service may significantly harm your financial predictions.

Days to Bill/Pay

On average, ASCs should send bills less than 48 hours after a service. If your practice takes significantly longer, address this problem immediately. Billing delays can increase days sales outstanding, denials, and even result in unnecessary lost payments.

Monitor days to pay to review how long it takes insurers to settle a claim. Different agencies have unique timelines. A reliable overall standard is 45 days. Medicare may take on average18 days, and workers' compensation may take around 55 days.

Note the average number of days it takes each insurer to pay. If you find that time to pay is increasing, examine the cause. Payment delays can oftentimes be avoided and if the claim is unnecessarily delayed may cause a rise in imply denials, billing issues, or payer miscommunications.

Cases and Days in AR

Patient financial responsibility is increasing. As such, tracking the number of days and cases in patient AR is critical. Numerous cases may indicate that most insurers have paid, and your practice billed many patients. However, a high number of days in patient AR may imply poor collection habits.

Note how many cases have surpassed 90 days in total AR Collection typically becomes impractical after this date. A general industry standard is less than 15% of AR should reach 90 days. Exceeding this standard points to revenue cycle issues that can easily be rectified with the right RCM processes and expertise.

Write Off Percentage

Write-offs can indicate denials, bad debt, timely filing, and other factors your staff failed to consider when billing and managing the total AR. Timely filing write-offs should never happen. Denial and bad debt write-offs are acceptable in low, consistent numbers. If your practice exceeds your maximum write-off goal, rethink your RCM processes and seek expert assistance to correct your RCM performance.

Clean Claims and Denial Reason

Calculate clean claims by measuring the percentage of claims a payer rejects. Clean claims show a successful professional coding and billing process that avoids denials. The industry goal for this metric is 98%. If your ASC receives a high rejection volume, it can imply a major claims or clearinghouse problem.

Denial reason is a critical indicator. While this reason is often a one-time fluke, it may highlight operating procedural issues. Record denials by which payer reported them. A high rejection volume from an payer can imply miscommunication of standards.

Yearly Financial Changes

Compare a period of one year with the same period the next year. Understanding long-term changes can help expose positive growth or worrisome decline. However, this metric on its own is too vague. Many factors may have contributed to shifts over the past year. Use this metric as part of a complex system designed to narrow down problems and lead you to viable solutions. ‍

Plutus Health understands how complex revenue cycle management is. That's why we provide services that alleviate ASCs' burdens. Our professional billing and coding team relentlessly pursues an increase in reimbursements and a shorter turnaround time to get your reimbursements into your bank account speed. Talk with a representative today to begin your financial improvement journey.

Key Takeaways

1. Monitor payment volume trending.

2. Keep a close eye on specialty services income and volume.

3. Calculate days to bill and track reimbursements by the payer.

4. Track days and cases in total AR.

5. Manage write-off percentages.

6. Observe clean claims and denial reasons.

7. Compare year-to-year changes.

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Key Performance Indicators to Monitor in ASC Revenue Cycle

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Key performance indicators KPI's are an essential component to improving an ASC's financial performance. By consistently monitoring specific items, a practice can streamline its operations. To discover what factors may harm specific KPI's and potential solutions, visit this article from Surgical Notes. Here are the most integral key performance indicators to track.

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CMS is reinstating its ASC coverage criteria from 2020. Following the review of 258 procedures, CMS removed 255 from the ASC Covered Procedures List. Here are the three CPT codes CMS allowed to remain on the list

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2022 CPT Changes: The Codes ASCs Should Know

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CMS has modified its ASC Covered Procedures List. Learn what CPT changes affect the ASC payment system and its reimbursement relationship with CMS.

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A 2018 report showed that U.S. medical practices leave approximately 125 billion dollars on the table annually. The report attributed this loss to poor billing habits. Studies like these impress the importance of accurate financial transactions.

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A 2018 report showed that U.S. medical practices leave approximately 125 billion dollars on the table annually. The report attributed this loss to poor billing habits. Studies like these impress the importance of accurate financial transactions.

Patient statements are the backbone of medical billing. Here are the best ways you can produce accurate patient statements.

Switch to Digital Invoices

Sending physical bills is more time-consuming and expensive than digital. Digital billing users can copy information from stored data seamlessly into a statement. This precision helps keep invoicing flawless.

Some financial systems will automatically alert a sender when a receiver opens a bill. This notification circumvents the arduous task of determining if a physical copy reached the target.

Most patients have access to and prefer online options. 72% of responders said they wanted e-statements for health plan premium bills in a recent survey. By shifting to digital invoicing, practices will boost efficiency and increase patient satisfaction.

Consistent Detail Verification

Ideally, the statement sending process should not include extensive information checks. If your team prioritizes critical details, your staff should trust their documentation's accuracy. Here are a few essential items your team should consistently monitor.

● Contact Details: Practice standards must support patient communication. Ensure that the patient agrees to receive messages and that their contact details are accurate.

● Insurance Eligibility: Even after insurers provide practices with an explanation of benefits (EOB), billers fail to catch problems. Confirm that the coverage insurers have given is adequate given the circumstances. After establishing sufficient coverage, accurately charge based on the insurer's report.

● Early Collection: Ask for co-pays up-front. This will help avoid future instances where billers have to track down this information during a later stage. Also, a patient is less likely to pay for a service the longer you fail to collect.

Avoid Confusing Statement Information

Patients frequently misunderstand their medical bills. A survey reports that 70% of consumers claim their medical bills confuse them. This confusion can lead to delays, time-consuming customer service, and disgruntled patients.

Avoid including balance aging. Balance aging is useful for billers in categorizing late payments. However, consumers may misinterpret this information as optional due date extensions. Also, when possible, use the full name of a procedure instead of abbreviating it. Shortening titles can befuddle non-medical experts.

Contact Agencies Over Unclear Insurance Denials

For online claim submissions, insurers may not provide an EOB. Instead, they will return the claim number and denial codes. Teams often fail to catch fixable errors in this stage and will send an overpriced invoice.

Train your staff on standard denial codes and how to research others. Note recurring codes to help identify and fix these errors. If your team is struggling to understand the problem, contact the insurer for more details.

Outsource to a Professional Billing Service

High-quality revenue cycle management is easy in concept but complex in execution. Many practices pride themselves on their involvement in coding and billing. Often, financial gains would rise if a professional billing and coding service handled invoicing. However, understand your team's limitations.

At Plutus Health, we prioritize statement accuracy while maintaining quick return time standards. Our expert team takes meticulous steps to maximize a service's reimbursement. Learn how we will boost your practice's revenue cycle performance by contacting a representative today.

Key Takeaways

1. Digitize your invoicing to increase efficiency and satisfy consumers.

2. Regularly verify details so billers can send statements quickly and accurately.

3. Avoid including information in a bill that will potentially confuse patients.

4. Train your staff to identify denial codes and contact insurers when confused.

5. Opt to hire a professional billing and coding service when invoicing pushes your limits.

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Accurate Patient Statements for Better Customer Satisfaction

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A 2018 report showed that U.S. medical practices leave approximately 125 billion dollars on the table annually. The report attributed this loss to poor billing habits. Studies like these impress the importance of accurate financial transactions. Patient statements are the backbone of medical billing. Here are the best ways you can produce accurate patient statements.

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Medical science is advancing exponentially. New services, devices, and medicines are entering the field quicker than ever before. Unfortunately, the American Medical Association (AMA) may take 18-24 months to modify CPT codes to reflect these advancements. In these circumstances, unlisted codes meet the crucial task of expediting the process of coding and billing.

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Medical science is advancing exponentially. New services, devices, and medicines are entering the field quicker than ever before. Unfortunately, the American Medical Association (AMA) may take 18-24 months to modify CPT codes to reflect these advancements. In these circumstances, unlisted codes meet the crucial task of expediting the process of coding and billing.

The AMA demands that practices use a CPT code when the code accurately describes a provided service. A code that is an approximation of the service is unacceptable. Unlisted codes are necessary in such cases.

Payers review unlisted codes more thoroughly than regular codes, so the chances of denial are higher. As such, practices must have well-defined strategies to receive quick coverage approval.

Here's how to handle unlisted codes while avoiding rejections, denials, and audits.

Reviewing the Initial Provider Suggestion

When a provider suggests using an unlisted code for a service, examine the details. Instruct your coders to review the service carefully. Ensure no standard code exists that meets the service's description. Occasionally, coders will need to inspect the physician's records for missing information.

Meeting the Technical Requirements

Submit an initial description of an unlisted service as part of Item 19 on the CMS-1500 claim form. Unfortunately, the electronic equivalent of this form only offers 80 characters. Use these characters to include a concise description of the unlisted procedure code.

Some physical submissions are unable to describe everything in Item 19. In such cases, attach a document with additional details. If you submit two or more of the same unlisted CPT code, report the unlisted code just once.

Submitting an Unlisted Code

Payers will want answers to a few key questions in an unlisted code submission.

● Service Description: What is the service, why was it necessary, and to what extent was it performed?

● Extenuating Circumstances. Were there any extenuating circumstances that notably affected the procedure?

● Surgical Details: Were other service providers involved in the operation? Was it performed through the same surgical opening and at the same surgical location?

● Technical Specifications: How long did the procedure take? What equipment and effort were needed to perform it? How many times was the service provided?

Coders must submit clear supporting documentation with the unlisted codes. They must mark what parts of the documentation reference the service or other critical information. Specialty providers must submit specific supporting documentation.

Using Code Modifiers

Practices use modifiers when a CPT code is inadequate to describe the details of a provided service. Many procedures require modifiers to note service changes the physician deemed circumstantially necessary. So, modifiers are a critical part of a typical medical billing and coding cycle.

By contrast, unlisted codes do not require modifiers. Unlisted services, by definition, do not match any fixed described procedure. Therefore, the AMA expects practices to clearly describe services without using modifiers.

Preventing Insurance Claim Denials

As with all coverage standards, insurance payers hold unique rules regarding unlisted codes. Payer websites may give relevant submission information. However, you'll likely still need to contact payers more frequently when claiming unlisted services.

Insurers won't say whether they cover an unlisted procedure until they receive relevant codes. Because of their uniqueness, payers must extensively review unlisted claims before determining coverage status.

(Exception: Unlisted codes for DME, orthotics and prosthetics require appropriate NU, RR or MS modifier.

Claims submitted with an unlisted procedure code will be denied if determined that a more appropriate procedure or service code that most closely approximates the service performed is available.

Unlisted codes provide a denial hazard to all practices. At Plutus Health, we've developed a service that combats this hazard in a quick, efficient manner. Our expert team of coders and billers accurately submits claims and gets high reimbursements. Contact us today to learn how we'll bolster your revenue cycle efficiency.

Key Takeaways

1. Review unlisted code suggestions to ensure no standard CPT codes match the services.

2. Meet technical submission criteria to avoid denials.

3. Include critical information in an unlisted code and its supporting documentation.

4. Never use modifiers when submitting an unlisted code.

5. Learn payers' unlisted code standards.

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Handling Unlisted Codes: Strategies to Avoid Rejections, Denials, and Audits

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Medical science is advancing exponentially. New services, devices, and medicines are entering the field quicker than ever before. Unfortunately, the American Medical Association (AMA) may take 18-24 months to modify CPT codes to reflect these advancements. In these circumstances, unlisted codes meet the crucial task of expediting the process of coding and billing.

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Underpayments occur when a health insurance fails to reimburse a provider the full requested/contracted amount. This failure can result in long-term financial problems for ABA agencies. Therefore, ABA practices must develop a clear understanding of underpayments and how to handle them.

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Underpayments occur when a health insurance fails to reimburse a provider the full requested/contracted amount. This failure can result in long-term financial problems for ABA agencies. Therefore, ABA practices must develop a clear understanding of underpayments and how to handle them.

Here's what to do when you receive underpayments for ABA services.

Know Reasons Underpayments Occur

Insurers are always looking for a reason to deny claims. Careless billing makes it easy for the Insurance to spot errors and either deny or make a partial payment. As such, ABA agencies must be wary of common underpayment causes:

● Missing information: Billers sometimes leave out critical information that supports the claims. Early in the scheduling process, note what documentation is needed to receive full reimbursement.

● Insurers miscalculating payment: Insurers may come to different monetary conclusions when reviewing a therapy service. Maintain detailed notes regarding the sessions and also segregate billable vs. non-billable hours.

● Overbilling: Ensure your billers are using appropriate codes/modifiers to bill for services. Failing to accurately record provided services and translate them into codes with correct modifiers may result in overbilling. Hold internal audits to verify your agency's procedural consistency.

● Contract misinterpretations: Confusing contract language in healthcare legal agreements can lead to differing interpretations. During contract disagreements, legal intermediaries may be the only viable solution.

Maintain Consistent Standards

Underpayments happen mainly for two reasons: practice mistakes and insurer mistakes. To prevent the former, you must have clearly defined standards that your staff consistently uphold.

Keep a clear record of sessions with all required details. Your therapists must know what items are integral to the session notes. Once the therapist has completed a note set, assess the notes to find the appropriate CPT codes. Ensure that your workers are familiar with CPT standards and what variables influence the usage of correct modifiers.

Review your contracts with insurers to clearly understand how much they have agreed to pay for each service. Finally, match the codes you have provided with the agreed-upon compensation amount.

Contact Insurers When Appropriate

You may need to contact an insurance agency to determine prices. Medicaid has online resources that makes this process simple. Unfortunately, many private insurers are less well equipped. Have knowledgeable contacts at these insurance companies to streamline the information-gathering process.

File an Underpayment Claim

While most underpayments can be filed for reprocessing, practices rarely do so. Many health providers struggle to fix past errors while sending current bills. However, a well-trained billing team can recoup significant funds through either reprocessing or a quality appeal.

Insurers may describe why they provided less than the requested amount. In such cases, review their report to identify and handle the issue. Contact the insurance if they've failed to describe the underpayment reason and a further review shows an accurate claim.

Use Legal Support

Occasionally, insurers will refuse to fully compensate an appropriately priced claim. In this scenario, legal options may be necessary.

Using legal means to protect your finances is expensive and time-consuming. Plutus Health offers billing and coding services that protect your practice from underpayments. Our experienced team accurately codes and bills, then follows up on late payments. Contact us today to learn how we'll improve your revenue cycle.

Key Takeaways

1. Understand the reasons underpayments commonly occur.

2. Maintain consistent billing and coding standards.

3. Contact insurers to gain agency-specific information.

4. File an underpayment claim once you've determined the underpayment was unwarranted.

5. Use legal aid when appropriate.

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What to Do When You Receive Underpayments for ABA Billing

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Underpayments occur when a health insurance fails to reimburse a provider the full requested/contracted amount. This failure can result in long-term financial problems for ABA agencies. Therefore, ABA practices must develop a clear understanding of underpayments and how to handle them. Here's what to do when you receive underpayments for ABA services.