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Best Practices for Behavioral Health Billing


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A practice in need of behavioral health billing.

Behavioral health billing is another form of medical billing. It revolves around the services provided by mental health professionals, counselors, and substance abuse treatment centers. Behavioral health concerns include emotions, feelings, mental health and illnesses, and substance use disorders. Specifically, counselors and psychiatrists offer services such as therapy, meditation, and medications. They charge their services on a time-based code set. Behavioral health billing poses certain challenges to practices in terms of insurance companies accepting claims for these services. Additionally, these types of services have unique coverage requirements.

What is Behavioral Health Billing?

Behavioral health billing codes are based on how much time the mental health professional spends with the patient during the scheduled appointment. The billing agent uses a specialized code set for these services. First, these services must follow specific guidelines to be sure the time spent by the mental health professional will be reimbursed by the patients’ insurance companies. Second, documentation is required just as with medical claims to support the services being billed. Additionally, it must be evident in these documents that all guidelines have been adhered to.

Furthermore, the following factors must be investigated by the biller before claims can be submitted to the insurance company:

  • Insurance eligibility and coverage for behavioral health benefits
  • How many visits are allowed by the insurer
  • Establish copay or patient responsibility per visit
  • Limitations each insurer may have for behavioral health services or substance use treatment
  • Timely filing guidelines
  • Prior authorizations for services

Every insurance company has its own set of rules and regulations for billing. In order to receive correct reimbursement, it is important that the biller notes the requirements and limitations for each individual patient. Also, notations on the time of service performed are mandatory to support the billing of services. Diagnosis codes must be examined for eligibility as well. Behavioral health billing is more difficult to set into motion than regular medical billing. However, if the protocols for services are investigated before services have been rendered it can be manageable.  

Best Practices for Behavioral Health Billing

Best practices for behavioral health billing should be followed and adhered to for every patient being billed. Documentation of services including a time frame is extremely important to ensure claims can be supported should a denial be issued by the insurance company. Prior authorizations should be included on the claim to the insurance company for reimbursement to occur. Each patient for both medical and behavioral health billing has a guaranteed right to privacy and there are guidelines to follow provided through HIPAA regulations.

Insurance companies have different timely filing guidelines to follow for claim submission. Therefore, it is essential to submit claims as soon as charges can be captured and reviewed as this ensures that denials for timely filing are kept to a minimum. 

Additionally, registration staff must be educated with scanning insurance cards, gathering subscriber information and relationship to the patient, verifying the effectiveness of insurance, and checking with the insurer for behavioral health coverage with their specific requirements for these services.

Substance abuse treatment centers need to have billers experienced in billing out treatment to ensure timely filing guidelines are kept. Information for each insurance company needs to be recognized before treatment begins to be sure the requirements for reimbursement are followed. 

Choosing the Right Billing Company

Identifying the key factors when choosing the right behavioral health billing company for your practice is essential for receiving reimbursement for the services provided. Billers with coding experience in behavioral health and substance abuse treatment billing as well as using correct diagnosis coding and understanding the correct modifiers for each level of provider are essential. Because of this experience, they will keep your claims going out clean and free from errors. A consultant who is aware of the requirements for behavioral health billing can recommend reliable and responsible companies who are known for providing excellent service to providers. 

When hiring a billing company for your behavioral health practice, you should seek a company with the resources needed to maintain prior authorization practices, denials and appeals, statement generation, communication with patients, and copay collections. Professional billing consultants understand how these factors lead to a healthy revenue cycle and bring the providers the expected reimbursements. 

When choosing the right behavioral health billing company, be sure to inquire as to the electronic health records being used. This is because software can be important in utilizing the maximum benefits when maintaining a healthy and financially sound revenue cycle. Furthermore, be sure to investigate the best software for your practice.

Additionally, a behavioral health consultant can also advise what a good match would be for your needs. A good relationship between billers and providers can improve reimbursements for the practice. Documentation practices are extremely important for denials and appeals to be submitted. 

Behavioral Health Billing in South Florida

Finding the best fit for your practice’s needs is easier when you are utilizing the knowledge of our consultants. At Bloom, we look forward to helping you evaluate your needs for behavioral health billing. We also are happy to offer our assistance in finding a billing company that can keep you in business. Write down your questions and call us so that a professional consultant can steer you in the right direction. We can help with your very important financial future. Give Bloom Agency in South Florida a call or reach out through our contact form today.