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Billing Challenges in Mental and Behavioral Health and How to Handle Them

As a provider for mental and behavioral health services, it is important that you have an organized billing process which will save you time so you can focus on what is most important – patient care. Below are some billing challenges you might find yourself faced with, some tips to manage these challenges and how ShareNote’s billing solutions can help.  

Challenge #1 
Patient Insurance Changes and Pre-Approvals 

Patients seeking mental or behavioral health services are likely to have regular appointments and services. Some may have had the same insurance for years, making billing for services rendered fairly straightforward. Any change in insurance can cause your claim to be denied – leaving payments owed to you uncollected. Likewise, if you provide treatment for a patient who has not received that pre-approval, the insurance company will not pay for the necessary treatment. This could ultimately mean that a patient cannot afford those services—leading to cancelled appointments and missed revenue opportunities.  

Verify Insurance Coverage and Requirements 

When a new patient makes an appointment for the first time, verify that treatment with the insurance company and ensure that they do not require any special steps for approval.  Continue to verify your patients’ insurance and their coverage at every visit, and let regular patients know that they need to notify you quickly if they have any changes to their insurance.  

A premier EHR platform like ShareNote can make it quick and easy to determine whether a patient still has the coverage they need to complete an appointment. If your patient does not have the necessary coverage for the appointment, or if you cannot verify insurance, you may need to reschedule for another time.  

If you have been an in-network provider in the past but have shifted out of network, or to a different network tier for a specific provider, you may need to notify your patients about those changes. Make sure this happens well in advance of their appointment to allow them to sort out potential insurance or payment changes ahead of time.  

Challenge #2  
Insurance Company Filing Preferences  

Today’s insurance companies have mostly shifted to a digital billing model. That does not necessarily mean, however, that every company will prefer the same filing method. Your staff may feel it necessary to keep up with an ever-changing array of preferences–and if you file incorrectly, you could find yourself struggling to collect payment through that insurance company. 

Work with a Dedicated Billing Specialist 

Utilizing a dedicated billing specialist can help keep up with the ongoing changes in the insurance industry, including the changes made by various companies. As your practice grows and changes, your billing specialist will keep up with those changing needs, ensuring that insurance claims are filed correctly so you can collect those payments more efficiently.  

Challenge #3 
Coding Bills Correctly  

Coding for mental and behavioral health can be more detailed, especially if a patient has more than one condition. Mistakes in coding can lead to significant delays in claim approval or even prevent the claim from being approved altogether. Often, traditional billing software isn’t designed for mental and behavioral health practices. This can make it more difficult for you to move your claim through the system.  

Use Wiley Treatment Plan Builder and Note Builders 

Using Wiley Practice Planners can help you streamline your process when it comes to creating patient treatment plans, notes, and submitting the claim to insurance. Wiley includes DSM-5 diagnostic suggestions and ICD-10-CM codes so that you can easily create and submit insurance claims with limited denials.   

Challenge #4:  
Delayed or Denied Claims 

Sometimes, it can prove incredibly difficult to collect payment owed for the services rendered. The more insurance companies delay those important payments, the harder it can prove to collect the funds you need. Fortunately, there are several steps you can take to ensure that you continue to receive the claims you deserve in a steady, ongoing stream, rather than regularly facing claim approval challenges.  

Identify Delays and How to Avoid Them 

Get to know potential claim delays, including those that are most common with insurance companies. For example, many insurance companies will delay a claim that exceeds the maximum allowable amount of the policy. If you know this could represent a challenge, you may want to check how you bill the insurance company to ensure that you do not go over the maximum. Avoiding coding challenges–which can most readily be prevented by working closely with a dedicated billing specialist–can also help streamline approval and ensure that you get paid on time. Finally, consider taking cash payments from patients who do not have insurance or who work with specific insurance companies, which could help streamline payments and ensure that your practice can keep operating efficiently.  

Using an EHR Built Specifically for Mental and Behavioral Health 

While these tips can be super helpful to streamlining your existing billing process, ShareNote, an EHR built with your specific mental or behavioral health practice in mind, can take your billing to the next level. Our team can help you implement all of these solutions in one place – positioning you for success, and your patients for positive outcomes. Fill out the form below to learn more today!