Getting reimbursed for behavioral healthcare services can be a struggle.  The complex maze of insurance rules and regulations makes submitting behavioral healthcare billing difficult and frustrating.  This problem results in only approximately 85 percent of claims being paid.  For some, using a billing service can save their businesses.

Billing Rules Explained

Any insurance healthcare billing system is set up to ensure that real claims get paid fully and efficiently while fake or inflated claims are weeded out.  Large group practices usually have a dedicated staff for billing; smaller practices often use third-party billing services. For service providers trying to get paid, figuring out how to comply with those systems is vital to staying in business and running a practice.

Differences from Medical Billing

Behavioral services billing differs from medical billing because the underlying services are so different.  A specific treatment or test is billed at a specific rate in medical settings.  In contrast, in behavioral services, billing applies to therapy, medical management of patients’ illnesses, and psychological testing.  Insurers’ rules set the reimbursable length of a session, how many sessions per week they’ll cover, and usually a maximum number of sessions that will be reimbursed.  These rules do not change based on the client’s need for longer sessions or more of them.

Most of the time, a mental health professional will wait at least 30 days for reimbursement of a submitted claim.  Also, unfortunately, service providers who contract with insurance companies usually cannot bill for the balance remaining after the insurance company pays.  The balance is simply written off.

Clients’ insurance coverage for behavioral care changes frequently.  Service providers should be sure that clients know they should inform the provider of such changes.  Often, however, even the client isn’t aware of changes.  Thus, you as the provider should check your clients’ coverage frequently to see if you need to make changes in your billing practices.  It is better to change your treatment plan than to implement it and find out it won’t be reimbursed.

When considering how to handle your client payments, think about any given insurer’s pre-approval rules and their limits for payments.  Make sure you understand the length of the session they will cover and the number during each billing period and over the life of the illness.  The more you work with given providers, the more likely you are to do things as they like them.

How a Billing Service Can Help

You can avoid many of these headaches by using a behavior healthcare billing service.  They can improve your collection rates of return and get you to nearly 100 percent successful collections.  Services they can offer include:

Tracking patient demographics, onboarding, and insurance verification

It’s not enough just to have patients.  You have to properly bring them on board, know who they are, and make sure they have insurance that covers your services.  A behavioral healthcare billing service can handle this for you, leaving you free to provide services to these new clients.

Managing accounts receivable

Behavioral healthcare billing services let you focus on treatment while they manage your accounts receivable.  As they do billing and receive revenue, the service will discover problems and remedy them before real damage to your practice results.

Obtaining physician credentialing when required

A healthcare billing service can make sure that all of your workers are properly credentialed.  They can also ensure that each service billed was performed and billed by a professional with the appropriate credentials for that service. As you add new professionals to your practice, it’s vital to ascertain that they are properly credentialed to provide those services.

Auditing codes for maximizing revenue

Proper coding is the heart of getting paid in healthcare billing.  When you have a patient in your office, you record the visit or service in the client’s file.  You include an explanation of why you gave that specific service, test, or procedure.  Your healthcare billing service will work from that record to review and document your clinical records to ensure that the file is complete and that they obtain any missing information.  The service will then apply the correct ICD diagnosis and CPT or HCPCS treatment and procedure codes to the patient’s condition and file the claim.  The billing service then compiles this information under a chargemaster capture code that sets the standard prices for services and procedures you provide.

Reporting on revenue collections

Your healthcare billing service can keep you current on the success of your collections by providing periodic reports on revenue collections.  If there are problems with particular insurance companies or patients, these reports will reveal that to you.

In sum, behavioral healthcare billing allows you, the mental healthcare professional, to concentrate on providing behavioral healthcare.  Meanwhile, someone else devotes time and effort to ensure that you are well-paid for doing so.

8 Reasons You Should Outsource Medical Billing

Medical practices of all types and sizes are tasked with helping patients feel their best. Ideally, the success of any doctor or group practice should be measured solely by the level of care received by the doctor. Still, the importance of revenue cannot be understated.

It only takes a few medical billing errors to result in an unstable revenue workflow. A disruption in cash flow can be detrimental to any size of medical practice. Because of this and the workload of medical billing, many practices outsource this service to a medical billing company. The benefits are undeniable.

A medical billing company can help the medical practice:

1. Provide the attention and expertise needed to handle the billing load.

 Medical billing companies are experts at handling billing. They know the intricacies of private insurance companies, Medicare and Medicaid. They are educated on the ever-changing coding and billing regulations. Many companies have account specialists for different types of medical practices. In short, the medical billing specialists act as the bridge between the medical practice and the insurance company, making sure the practice gets paid.

2. Keep the focus on patient care and the provision of quality healthcare.

 After all, patient care should be the top priority in your practice. Medical billing companies handle patient and payer inquiries so you can stay focused on what’s important – allowing your staff to hone in on their day-to-day functions with patients.

3. Process claims efficiently and quickly.

 Medical billing companies know the ins and outs of medical coding and insurance companies since that is their expertise. Because of this, they can process claims at a much faster and more efficient rate.

4. Maintain the biller-patient relationship in a trust-filled atmosphere.

 Because medical billing companies handle all of the inquiries from patients and payers, your focus as a medical practice can be solely on the patients’ medical needs. This creates a trust-filled atmosphere without the stress of financial worry.

5. Increase cash flow for the practice.

 Medical billing companies work with your practice to ensure consistent cash flow and optimize revenue potential. Claims are constantly being processed and filed by an outsourced service. If you have in-house billing and one employee is out on vacation or sick for any amount of time, your claims will get backlogged. Backlogged claims disrupt cash flow.

6. Increase revenue.

 The specialists can improve the practice’s overall revenue performance by bringing money that may otherwise go to collections. By outsourcing this area of work, you can have a more controlled and sustainable approach to revenue cycle management.

7. Provide peace of mind for the medical practice owner.

 The medical practice owner can feel a sense of peace once they decide to work with a medical billing company. They don’t have to worry about their in-house specialists staying up to date on medical and billing codes or insurance claims. They also don’t have to worry about staying up-to-date on software.

8. Save money on office space and salaried employees.

Outsourcing medical billing is the perfect solution for a practice that does not want to hire and maintain billing personnel. A lot goes into having your in-house billing department- from training costs, benefits, insurance, and payroll, to hardware/software installation costs. Medical practices can also skip costs on office supplies and furniture.

When medical practices don’t have to worry about billing, they can focus on what matters. Regardless of company size, medical billing outsourcing is a fantastic solution for your practice. Outsourcing medical billing can eliminate interruptions and distractions that would otherwise prevent you from reaching your potential. It also scales with your business, so growth is possible and manageable.