Behavioral medical billing can be frustrating at times, as it tends to take up a significant amount of time, and its arcane nature can sometimes get in the way of the time you would otherwise spend treating or recruiting new patients. At the same time, a lot of insurance carriers are also prone to using incongruities in the mental health industry to deny certain claims or submit a reduced underpayment.
Whereas conventional billing practices are strictly codified. Many of the codes and modifiers used in conventional medical billing are well-established and objectively assigned. Great care has been put into streamlining the process for convention providers.
The Challenges of Convention Medical Billing
For all its strengths there are some challenges in the realm of conventional medical billing. This includes:
- Staffing for billing
- Support staff for collections
- Increased prior authorizations
- The risk of claim denials
- Increased need for documentation
- Credentialing issues
Though these are still minor compared to the complexities of behavioral medical billing.
Why Is Behavioral Medical Billing Complicated?
One of the biggest obstacles in behavioral medical billing is the fact that there is no current standardized process. A lot of mental health practices have to account for a wide range of variables when it comes to the various services and therapies they offer. This means that a lot of time is lost in behavioral healthcare that could otherwise be spent on therapy sessions, research, or other avenues that improve patient treatment outcomes.
Of course, insurance companies note of the duration of all treatment sessions as well as tracking just how many of these sessions can take place in a day. This leaves counselors, therapists, ABA specialists, and psychiatrists having to meter out the way they dispense their services.
Many mental health professionals find it very challenging to balance their treatments with an adequate billing system. At the same time, mental health billing differentiates from other conventional billing plans in that the problems are amplified by office budgets.
The Different Types of Behavioral Medical Billing
There are four distinct types of behavioral medical billing.
- Psychotherapy Billing
- Psychiatric Billing
- Behavioral Health Billing
- Substance Abuse / Facility Detox Billing
The Dangers of Handling Your Own Medical Billing
A lot of small practices and solo providers will attempt to process their own bills in hopes of cutting down on operation costs. Unfortunately, the lack of dedicated staff to update billing codes for behavioral health, and staying abreast of changing regulations, and billing practices often translates into increasingly high rejection rates. Ultimately, the attempt to save money on operational costs ends up costing more money in unpaid claims.
Ways to Improve Behavioral Medical Billing
There are a few things you can do to improve your behavioral health billing practices. This includes things like:
- Always stay within the time allotted by the patient’s insurance policy
- Only use the billing format required by your patient’s insurance company
- Use the correct code for the delivered treatment
- Make sure to always use the correct modifiers with a clearly documented reason for doing so
- Limit the bill’s total to the fee allowed by your patient’s insurance policy
- Set an in-office protocol to always double-check the accuracy of the policy number for the bill claim
- Verify that each claim is sent to the correct address
- Receive pre-approval for treatment as needed by the insurance plan
- Outsource your medical billing services to an expert third-party agency
Tips for Improving Claim Approval Rates
Statistically, only around 80 to 85% of behavioral medical billing claims get full approval from a patient’s insurance provider. Despite massive efforts within the industry, improving these approval rates still remains one of the biggest challenges facing behavioral healthcare providers today.
Seek Pre-Approvals and Check Insurance Plans In Advance
Taking the time to always double-check your client’s insurance plan before each visit will help improve the claim approval rate for your practice. Sudden policy changes and/or unknown lapses in coverage are all too common in the world of health insurance. Especially when it comes to the ever-changing landscape of behavioral medical billing.
This means you have to take a proactive approach to be able to stay up-to-date and stay ahead of the game for your own benefit. As well as the benefit of your patients that rely on your care.
Oftentimes these pre approval checks will also reveal other treatment options that might be available within the patient’s coverage. Even if your original treatment modality wasn’t or is no longer available.
Stay Aware of Insurance Company Filing Methods
The ever-changing landscape of behavioral medical billing often has insurance companies changing their preferred filing methods. Unfortunately, they rarely take a proactive approach to informing all the providers in their panel. Instead, they often expect providers to be proactive about knowing what their new filing methods are. So, it’s best to make it a company policy to stay in touch with all the insurance companies you are paneled with.
This proactive approach is the only effective way to make sure you’re aware, every time they change their billing method. Failing to stay up to date will likely lead to a higher percentage of unpaid, rejected, or denied claims.
Consider Outsourcing Your Medical Billing
Whether it’s behavioral medical billing or conventional medical billing, all practices find that they benefit from outsourcing their medical billing services to an expert agency like Operant Billing Solutions. Our expert coders are well-versed in convention and behavioral medical billing intricacies, and we take a proactive approach to staying fully informed on insurance companies’ formatting changes.
Our intimate knowledge of both industries ensures that all your claims are being thoroughly scrubbed, and properly coded before they are transmitted to the patient’s insurance company. This includes things like updating policy reviews and asking clarifying questions before the claim is submitted.
A lot of small practices and solo practitioners find that they have more time to spend with patients or grow the scale of their business when they outsource their medical billing services. Not only does this mean a more consistent revenue stream, but it also boosts the robustness of your income by being able to treat more patients.