Behavioral Health Billing 101

Behavioral health billing is a beast to navigate, especially for providers who are new to the process. For many years, the industry leaned toward self-play billing, where clients would pay for mental and behavioral health services out of their own pocket. This made sense at the time for quite a few reasons. The first was that not very many private insurance payers covered mental health services and the ones that did were not worth the hassle. Now, providers should be surprised if they encounter a payer that does not cover the services they offer, at least to some degree. 

With more payers covering these services, the bulk of clients search for providers that accept insurance. While providers may have some that prefer self-pay, the majority of financial opportunity lies in the hands of patients with coverage. For this reason, providers need to work on their understanding of behavioral health billing so they can maximize their reimbursement from payers and grow their bottom line.  

Getting Started with Behavioral Health Billing

There are steps that providers should take when navigating behavioral health billing. Following these steps can better prepare providers for the billing process and reduce the number of mistakes along the way. 

Deciding Whether or Not to Accept Insurance

It is not a requirement for providers to accept insurance. As mentioned earlier, for providers who want to increase their patient volume or expand the number of patients in their area are willing to partner with them, working with a few different payers is not such a bad idea. For providers who do not want to accept insurance, there are still options for you!

Getting Credentialed

If you have decided to accept insurance at your practice, then the next step is to get credentialed. During this process, insurance companies (panels) review you or your practice to decide whether or not they will approve you as an “in-network” provider. When clients contact their insurance to see what providers are covered in their area, in-network providers show up first. While there are still ways to accept insurance as an “out-of-network” provider, it is not your best option to streamline your claim and billing process. Getting credentialed for behavioral health billing can take anywhere from 3-6 months depending on the payer and their requirements.  

Learning Billing Requirements

Speaking of billing requirements, one of the most frustrating and complicated aspects of behavioral health billing is each payer’s rules. Every payer has different requirements, or regulations, for their billing cycle that have to be followed explicitly if a provider wants to maximize their reimbursements. Behavioral health billing software is a great tool for navigating confusing payer requirements. This way, you can focus on your patients and less on the complicated aspects of billing. 

Memorizing Billing Codes

Billing codes are used to “code” a claim that is sent to the payer for reimbursement. Billing codes help identify the type of service that was rendered during a visit. These codes have to be 100% accurate on every claim if a provider wants to receive an on-time and in full payment. 

Filing Claims

The claims process is the most detailed and time-consuming aspect of behavioral health billing. Each claim needs to be filed accurately the first time in order to be paid on time. This is referred to as a clean claim. Today, providers absolutely need the right electronic tools and billing services in order to maximize the process without distracting from the quality of client care. 

The Challenges of Reimbursements

Reimbursements, while the fastest way to payment, present several challenges that providers have to navigate. For example, the number one cause of a denied claim is an error in billing codes. With providers not being experts in behavioral health billing, errors happen relatively frequently. If not a billing error, then a claim might be rejected due to an error in patient information (date of birth, name, etc). While there are dozens of reasons why a claim is denied, behavioral health billing solutions can prevent errors from happening. 

Benefits of Behavioral Health Billing Solutions: 

  1. Claim Correction – checkpoints in your billing workflow prevent errors from ever being submitted to payers. This makes sure you get paid after the first submission. 
  1. Denial Reconciliation – If claims do get denied, it is important to act fast and submit them again. The right billing software can help providers stay on top of denials if they happen so they can still get paid on time. 
  1. Real-Time Eligibility Checking – Sometimes clients think they are covered and they’re not. A good behavioral health billing software will make sure your clients are covered before services are rendered so you don’t risk a delayed payment. 
  1. Billing Snapshot – Get a birds-eye view of your billing processes so that you can pinpoint areas that need improvement and work toward streamlining your bottom line. 
  1. EHR Integration – Move easily between processes with total EHR integration. Billing software should work in tandem with your other technology to improve your workflow and help you work more efficiently. 

To learn more about an EHR that can help you streamline and organize your practice management, click here.

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