Billing Behavioral Health Services: A Comprehensive Guide

Billing for Applied Behavior Analysis (ABA) services in the mental health field differs in several ways from billing for other mental health-related services. It emphasizes comprehensive assessments, individualized treatment plans, and meticulous data collection for behavioral interventions. We call and ask for specific people to submit claims to, reps that can receive faxes on a call, or setup systems to ensure claims are successfully submitted and processed by each insurance company. We recommend using one EHR software, mental health billing ideally custom built only for mental health providers, to manage all your clients in one place, and to submit all your appointments through one website. You have all the necessary patient and session information to file claims.

Chapter 3:  Filing Claims

Although these claims are appealable, practice staff must determine the patterns of this and devise solutions to eliminate the denial reoccurrence now and then. For this, timely and regular reviewing of the existing denials must be done effectively and promptly as the insurers might have a short timely filing limit for re-submissions. It has a good practice management system, good customer support, and great functionality needed by larger practices. But, some users have found out that it is complex to use as it has only a few customizable features. There is room for additional users which costs $41.70 monthly and part-time users cost $14.95 per month.

What are the types of mental health services?

These codes, which are always five digits, pertain to mental health testing, assessment, psychiatry evaluation and management (E/M), case management and telehealth. Take advantage of reporting features in your billing software to track trends and spot recurring issues. Regular quality checks prevent claim denials, save time, and improve overall billing accuracy. Stay on top of your revenue cycle by tracking claims from submission to approval.

Step 7: Recording and Reviewing Denials

Remember, the DSM-IV is used by all mental healthcare practitioners to help in the diagnosis of clients/patients with mental health ailments. Post-COVID-19 pandemic, the adoption of telehealth in mental health practice has received significant attention from patients. Integrating telehealth services into the practice of mental health billing requires a nuanced understanding of both traditional and virtual care. Proper mental health billing ensures that healthcare providers are compensated for their services while adhering to legal and regulatory requirements. Also perform a new eligibility and benefits check for that client from Chapter 2 of this mental health billing for dummies guide.

Simplified billing equals better care

Someone’s last name was spelled wrong or they changed addresses or that “0” was actually an “O” (zero vs the upper cased letter ‘o’). If you don’t know which CPT codes to use, what diagnosis to use, the number of units to use, consider seeking professional expertise. Submit appointment dates with the requisite CPT codes and diagnosis codes. IF YOU MUST bill claims via paper, ask about their claims address as well. Once you have gathered all of this information, save it in a secure location for future processing.

• Therefore it is important to make sure that no mistake is made even accidentally.
• This process might seem unnecessary but is indisputable as the patients will have little to no knowledge about their medical plans, even if a change occurs.
• Providers should ensure their billing software is updated to reflect these changes and train their staff on new code usage to minimize errors and improve claim accuracy.
• A more recent survey from 2021 determined that 85% of denials are preventable.
• If you aren’t sure how to submit the claim accurately, consider asking a colleague or hiring an expert.

Mental health practitioners must be familiar with these aspects to ensure proper billing for remote services. Our mental health insurance billing staff is on call Monday – Friday, 8am-6pm to ensure your claims are submitted and checked up on with immediacy. He co-founded a mental health insurance billing service for therapists called TheraThink in 2014 to specifically solve their insurance billing problems.

Now it’s time to check eligibility and benefits to ensure they have coverage that will reimburse you. Our Beginner’s Guide to Mental Health Billing is for the brand new and having-no-clue outpatient therapist looking to learn how to bill insurance companies. You will learn what client information you need, how to verify mental health benefits, create and submit claims, and account for EOBs. By following these insights, you’ll traverse the landscape of mental health billing with confidence, ensuring that financial procedures align seamlessly with the quality of care extended.

The billing procedure can become even more complicated if incorrect codes result in payment delays or denials. It is essential to consult the CMS behavioral health billing guidelines and payer-specific policies to ensure compliance with who can bill for what services. A clearinghouse is an in-between service between you as a mental health service provider and an insurance company. So, in this case, you would choose and pay the clearinghouse to check your work and verify everything is correct before send them through. So they’ll take a bit of the heat off and check for errors and to make sure that the codes you’ve put down are correct. If your claim isn’t quite right, the clearinghouse will send it back to you, highlighting the errors.

Every mental health insurance claim will require a large amount of information, but that information needn’t be overly complicated. Whether you’re coding for telehealth sessions, prolonged family therapy, or collaborative care consultations, precision and consistency are key. With the right tools and knowledge, you can simplify administrative tasks and dedicate more time to helping clients thrive. Payers, regardless of which country you live in and who is responsible for settling the invoice, have a very limited scope for receiving and remitting claims from mental health practices. Often there are conditions that have to be met related to diagnosis, number of treatments, and style of intervention. One thing that’s worth keeping in mind is that you’re not alone in this, and there are procedures you can do that will help future-proof your practice.

Once a claim is submitted, it often goes through a clearinghouse, which reviews the claim for errors before forwarding it to the insurance company. Clearinghouses check for issues such as incomplete information, incorrect CPT codes, and eligibility problems. If a claim is rejected by the clearinghouse, it must be corrected and resubmitted.