How Behavioral Health Agencies Can Make Billing Easier

These simple suggestions will make billing much easier for your agency, saving you valuable time and money!

Billing is Complex, Even for Experts!

Mental health billing is complex, even for experts. Billing codes change and insurance providers don’t cover every service but understanding what insurers need can help agencies navigate this complicated landscape.

While it’s up to agencies to choose what codes to bill for, it’s also important to have a streamlined billing process and be working with billing experts to make sure that your claims are processed in a timely manner.

Continue reading to learn more about codes and billing.

How Insurers Use CPT Codes

Every service a provider does for a patient, be it medical, surgical, or behavioral, has a Current Procedure Terminology (CPT) code associated with it. This code is mandated under HIPAA to be used by both providers and payers and provides a standardized way of billing for these services across the United States. 

Insurance companies take this CPT code and, typically, cross-reference it with the Centers for Medicare and Medicaid (CMS)’s assigned values to determine how much they will reimburse a provider for that code. The important thing for agencies to understand about these codes is that the more accurate diagnosis and specific a code they can assign to a service, the more likely it is that their claim will be reimbursed. 

Helpful Resources for Billing CPT Codes

Providers can’t get complacent about coding. Every coding error runs the risk of causing a claim to be delayed or rejected entirely. If an agency garners too many errors, they could be audited, charged with fraud and abuse, or even have their license revoked. 

The good news is that though CPT codes may change from time to time, they don’t change often. The last big overhaul of the system was in 2013 when the entire coding framework was redone. While you’ve been billing with these new codes for the past seven years, it never hurts to have a “go-to” place to double check. We suggest checking with the industry-leading authority on procedure coding, AMA’s current CPT manual.

3 Tips to Make Billing Easier

Mental and behavioral health billing can be more complex than medical billing because procedures are typically not standardized. Factors like therapeutic approach, client age, and session length can impact both treatment and billing. This has led many insurance payers to require pre-authorization for mental health services as well as outlining standards for treatment type and length. If these standards aren’t met, the payer won’t pay. From an insurance side it makes sense. Numbers need to add up and treatments need to be trackable for insurance companies to be able to create a system. Unfortunately, this often leaves agencies and the people they care for in a sticky situation. 

Tip #1

Have a Strong Onboarding Process

Onboarding can apply to everything from welcoming new staff to the first time you see a client. Both of these are processes you can control and systematize. By doing so, you’ll gain peace of mind that everyone is on the same page and gathering or providing the information your practice needs to be able to successfully bill.

Onboarding Your Team

You likely already have an onboarding process for new team members. If you don’t, there are many free resources available on how to build an onboarding plan. Regardless of how established your process is or isn’t, it’s always helpful to revisit it. When you do, be sure to pay extra attention to any training that’s included related to billing and onboarding clients. Be sure you have a standardized system to avoid any typos or missed information when your staff is welcoming clients and checking them in. Your team should be trained on this right away.

After your team has been trained, make sure that someone is assigned to stay on top of changing billing codes. This person can also be tasked with training the rest of the team when there are changes. Staying up to date will help you avoid denied claims and keep your clients happy.

Onboarding Your Clients

Before you can do any billing, you need to collect basic information on your client such as their name, date of birth, and gender. Sometimes this seemingly simple task is the one that causes the most problems. One tiny typo can make the difference between a claim getting paid or being denied.

If you’re a solo practice, the same rule of thumb applies. Find a process that works for you and make sure you repeat that with every client you see. Adding that information directly into your EHR system, like Procentive, can help you avoid misplaced paperwork and streamline your client onboarding process.

Tip #2

Perform a Verification of Benefits

To avoid having claims denied, check your client’s insurance coverage before seeing them. This will give you an idea of what is covered, and what’s not, even if they have active insurance. You can do this through an insurance company’s online provider portal or follow up with specific questions via their helpline. Once you and your client have an understanding of what will and won’t be covered by insurance, it’s up to the two of you to determine the next steps in their health journey.

It’s up to you what diagnosis codes to use, though the more specific and accurate diagnosis code you use the better. Insurers are more likely to pay these and your clients will be less likely to be stuck with the bill.

Tip #3

Know Your Agency’s Billing Strengths and Gaps

If billing isn’t your agency’s sweet spot, don’t worry. Especially for small agencies, having the billing expertise on staff to make everything run smoothly can be cost prohibitive. That’s where services like BillCare can come in to help. 

Before you dive into building an internal billing team or hiring an external vendor, consider a few things.

  1. Understand the cost of internal versus external billing. (Use our handy calculator to get started)
  2. Figure out what you are, and aren’t, willing to do internally. Not all billing services offer the same services so be sure that you know what you need and what they can offer. Talk with the billing service’s specialists to get the full picture before diving in.
  3. Know that no matter how you choose to do your billing, it’s a vital part of your practice and deserves enough time and attention to be done right. Otherwise, your agency could be heading for financial woes.

Billing for mental health, substance use disorder agencies, and other behavioral health services is complicated. One of the most complicated parts of it is navigating the billing codes. There are a few simple steps you can take to make the whole process easier but the best thing you can do to safeguard against claim denials is to stay up to date with billing codes and with your patient’s insurance information to minimize errors on your claims. Stay current and work with a trusted billing service to keep your billing stress-free and efficient.

The Bottom Line

BillCare exists to help ease your agency’s billing burden. Our team of experts help agencies every day reduce their claim denial rates and manage revenue cycles. Schedule a free consultation today to see if we can be of service to you.

Tired of ever-changing billing codes? We can help!

Schedule a complimentary phone call with our team and learn how we’ll make managing codes and getting paid a snap!

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We Promise

To assign one representative to your practice who will listen to you, learn from you, and serve you. 

To pursue payment on every claim denial, writing off that revenue only after we’ve pursued all possible avenues of resolution. 

To act in good faith by charging you only 6 percent of your collected revenues and zero startup costs, assuming a shared financial risk, and providing an additional incentive for us to advocate for your best interests.