mental health billing for dummies

Both EHRs serve different niche’s within the healthcare industry so they probably also have different features. That shouldn’t be a roadblock to integrating with a clearinghouse provider. It’s likely that the bulk of the solution provider’s clients are doctor’s offices. A telltale sign that who you’re evaluating isn’t a leading mental health clearinghouse is if they don’t have experience integrating with the EHR your organization’s using. However, you’re in a unique scenario within the mental health space where you have to deal with MCOs, mental health EHRs and state-level government ordinances. Thus, if you don’t have a clearinghouse that has specific processes in place to help you with each of those mental health billing-related aspects, you should seek a new one.

Don’t delay the billing process.

  • The doctor will usually perform the same exams and tests for many patients, such as checking blood pressure, height, weight, listening to your heart or getting blood samples.
  • Filling out all this information can result in an exhausting experience for providers.
  • Each taxonomy was designed to create a common way to communicate treatments, diseases, procedures, and evaluations for mental and healthcare providers.
  • Repeated coding mistakes could cause your practice to be flagged for fraudulent practices.
  • This requires intimate knowledge of behavioral health coding, as well as access to comprehensive resources on the subject.

The process includes confirming insurance coverage, accurately categorizing services, submitting claims, and managing complex reimbursement processes. A multifaceted procedure is required to ensure the financial viability of mental health practices and maintain quality treatment for patients. By understanding the basics, navigating challenges, and staying informed about legal and ethical considerations, mental health practitioners can optimize their billing processes. Remember, staying proactive and informed is key to ensuring that the financial aspect of mental health services aligns with the dedication to patient care. Billing in mental health services is new for most mental health practitioners, so what do the terms eligibility and benefits mean? Well, eligibility refers to the process where a patient or client is determined to be eligible for health care coverage through their insurance or healthcare plan.

The different kinds of codes used in mental health billing

Find key CPT codes that physicians and care teams can use (as appropriate) when administering behavioral health screening, treatment, and/or preventative services. Ideally, your EHR will have a built-in coding database to help simplify the process. If you have questions, contact the insurance provider directly to see what coding they accept for various telehealth treatments.

How to Read Mental Health Eligibility Verification Data

  • After all, there are differences between the types of claims that hospitals submit compared to those coming from mental health facilities.
  • You want to understand how to bill claims online, digitally, because it’s the fastest way to submit claims and the easiest to track.
  • After this process, you have all of the information required to file claims, what to charge your client when they come in for a visit and how to file their claim via online or otherwise.
  • Some software solutions include the option to receive alerts on aging or rejected claims, an invaluable feature for busy practices.
  • At the heart of mental health billing is the use of accurate CPT (Current Procedural Terminology) codes.

If you submit a claim and it doesn’t meet all of the requirements, the payer won’t accept it and deny it. Usually, you receive a notification of the claim denial through your practice management (PM) system and your clearinghouse. Luckily, we’re going to learn together by breaking down the essentials of mental health billing in this definitive step-by-step guide. You can run a verification of benefits (VOB) to see if your patient is covered. You will have a greater understanding of your patient’s insurance program after this process enabling you to treat and serve them appropriately. If your claims require appeal, speak to a customer support representative about obtaining the necessary forms to file your appeal.

mental health billing for dummies

Minimum Required Patient Information

If you aren’t enrolled to receive the status of your submitted claims electronically, you’ll receive an explanation of benefits (EOB) via the mail. If you’re enrolled with your payer to receive the status of the claims you submit through your clearinghouse or by other computerized means, you’re receiving electronic admittance advice (ERA). Essentially, you submit your claims to a clearinghouse, it runs your submission through a series of automated tests and alerts you to any errors. It also usually has a series of pre-established connections to insurance organizations to streamline submission.

mental health billing for dummies

Least Ideal: Mail Claims to Payers

On the service end, you have to include CPT codes to prevent claims from being rejected or bounced back to you unpaid. All of this comes in addition to actual services that your office or clinic is providing on a day-to-day basis. In the mental health billing mental health billing for dummies process, there’s no such thing as gathering too much information. Request as many facts as possible, including the patients’ full legal names and current addresses. We must pay more attention to those factors for seamless mental health billing.

  • Family medical psychotherapy service is beneficial for family members of insurance holders.
  • Double-checking with patient insurance is helpful for providers to know about more benefits and coverage.
  • A comprehensive mental health EHR system empowers you to mix and match resources to meet the communication, billing and administrative needs of your practice.
  • The process of submitting your client claims to your clearinghouse and/or insurance payer.
  • The psychiatric diagnostic evaluation, also known as a psych evaluation, is typically performed to evaluate patient’s medical and mental health.
  • If your claims require appeal, speak to a customer support representative about obtaining the necessary forms to file your appeal.
  • Double-checking with patient insurance assists in identifying authorization requirements and any changes in the patient’s coverage.

Acknowledging these differences is essential for accurate reimbursement, effective treatment, and continued progress in destigmatizing mental health care. In the healthcare domain, mental health billing takes center stage as a vital link between compassionate service and accurate financial processes. Let’s embark on a transformative journey through the detailed world of skillfully managing mental health billing services. Changes in the mental health billing landscape happen on what seems like a daily basis. You can’t expect to stay “in the know” regarding everything that happens…you have clients to care for.

UWorld Medical frequently asked questions

mental health billing for dummies

Explore the role of AI in psychiatry and its impact on diagnosing, treating, and managing mental health issues effectively. Our secure platform & features empower therapists to guide families & promote emotional well-being. To sweeten the deal, the form that you sent came with a return envelope and form for the payer to fill out and resend to you about the claim’s status.

Make and store copies of insurance cards.