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.