The complex insurance industry rules and regulations make successful claims submission difficult and frustrating. Yet, many healthcare industry leaders understand that there can be no mission without money.
That is why Mental Health billing service companies are vital to the survival of mental health service practices.
Let's dive a little deeper to explore the details.
Behavioral health
Behavioral health, also known as Mental health, is the study of emotions, biology, and mentality causing a person to behave a certain way and how that mentality impacts their daily living activities.
Mental Health billing is a complex process whereby Psychiatrists, Psychologists, Counselors, and other therapists submit insurance claims detailing the type of care given to patients enabling them to receive payment for the treatment their patients receive.
How do mental health professionals get paid for their services?
Like other healthcare services, Mental Health professionals provide a medically necessary service to their patients for the treatment of disease and illness. However, they primarily charge their patients and their patient's insurer by the time spent on treatment.
There really is no cookie-cutter approach. Mental health professionals use various treatment methods such as therapy, drugs, and meditation, which vary depending on the type of patient and their illness.
For example, patients with life-limiting behavioral issues may need job training, literacy training, and rehabilitation, while others may need intense individual or group therapy.
Proper documentation is essential to receiving payment for services rendered. Insurers follow the premise that it didn't happen if it isn't documented.
The provider, therefore, records the details of the visit, therapy, or treatment into their patient's medical record. These timely progress notes provide a written history and proof that the visit or treatment occurred and are the basis for submitting an insurance claim to the patient's insurer.
The claim is coded and submitted to the insurer. The mental health professional is paid once the error-free insurance claim receives approval for payment.
Payment typically comes in the form of co-payment from the patient and a check, accompanied with an explanation of benefits (EOB), from the insurer.
It's really that simple; insurers remit payment for error-free claims, usually within 30 days of the visit or treatment.
Not so simple, actually
Honestly, it is not that simple. As a matter of fact, it is estimated that mental health practices only collect 85% of the money owed.
Insurers often have no problem denying a claim, even for minor inaccuracies, and although they allow practitioners to fix the claim or appeal the denial, they hold payment until the claim is accurate.
Denial management is complex and wreaks havoc on a business's financial health so submitting a clean claim upfront is paramount.
The submission of a clean claim starts before the patient arrives. For instance, when a patient calls to schedule an appointment, the staff gathers their demographic and insurance information.
The required demographic and insurance information includes:
- Patient name as listed on their insurance card
- Gender
- Date of Birth
- Current mailing address
- Insurance Card Member ID
- Insurance Group number
The next step in the process requires a phone call to the patient's insurance company verifying the coverage effective dates and eligibility, practitioner network status, and active insurance benefits.
Insurers will deny payment if ANY of the demographic or insurance information detailed above is incorrect on the claim.
Other reasons for claim denial include:
- No prior authorization was obtained – Most Mental Health treatments require that the practitioner obtain authorization from the insurer before treatment. Without one, payment will be denied.
- Documentation errors – Payment of the claim means that the treatment was medically necessary as determined by the practitioner's supporting documentation. Supporting documentation includes:
- Coding Accuracy – Appropriate CPT and ICD – 10 codes were used to reflect the time spent and treatment performed
- Policy Violations – Violations include 1- Failure to record progress notes promptly 2- Billing for services without a prior authorization
Imagine operating a business where you only earn 0.85 cents on every dollar. It's not very sustainable, and you won't be in business very long.
A mental health billing services company can help prevent claim denial and ease any interruptions in cash flow. Their teams can streamline the entire revenue cycle management process keeping claim denials to a minimum and the practice financially viable.
The bottom line is that there is no mission without money.