How Is Mental Health Billing Different From Medical Billing?

It’s especially frustrating to file insurance claims for mental and behavioral health benefits. From the types of services offered to the pre-authorizations needed and who takes care of the books, you’re at a disadvantage compared to other health professionals. If you’ve been struggling to get claims honored, don’t worry — you’re not alone. Thankfully, there are several things you can do to improve your approval rate.

Why Is Mental Health Billing So Complicated?

Counselors and psychiatrists provide services in a distinctly different way than other healthcare professionals. Instead of performing an eye exam or taking x-rays, you spend most of your time in therapy sessions. Major insurance companies dictate how long these treatments can take, as well as how many can take place per day. This makes it extremely difficult for mental healthcare providers to balance adequate treatments with a successful billing plan.

The differences between medical billing and mental health billing are amplified by office budgets. Counselors who run private practices often process their own bills in order to cut down on operating costs. Without a dedicated staff member to keep up-to-date on healthcare billing codes, changing regulations and the billing practices of each insurance company, rejection rates will rise.

In order for an insurance claim to be quickly processed, you must:

  • Use the required billing format for your patient’s insurance company.
  • File within the time allowed by the insurance plan.
  • Apply the appropriate code for the treatment delivered.
  • Limit the bill’s total to the fee allowed by your patient’s insurance policy.
  • Include the appropriate policy number on the bill claim.
  • Receive pre-approval for treatments when needed by the insurance plan.
  • Submit the claim to the right address.

There are fewer pitfalls involved in medical billing vs. mental health billing simply because billing is more straightforward. The billing is also handled by an expert in most cases.

Biggest Billing Concerns for Mental Health Providers

On average, only 85 percent of claims for mental and behavioral healthcare are approved. To start improving your approval rates, there are a few techniques you can use:

  • Double-check your patients’ insurance before each visit. Policies change and coverage lapses. Unless we make an effort to stay updated, we’re often the last to find out through a billing rejection.
  • Stay up-to-date on each company’s preferred filing methods. Paper and fax filing is on its way out, and more companies are switching to email and online filing services. Unfortunately, insurance companies don’t always inform you when they change billing methods, so it’s up to you to ask.
  • Encourage easy cash payments for patients with poor quality or no insurance coverage. More than one clinic has given up working with insurance companies entirely. Whether you join a network depends largely on their pre-approval policies and the limits they’ll pay. While many patients expect to pay with insurance, it may be in your best interest to offer sliding-scale or deferred payments instead.

You can also get help from mental and behavioral healthcare billing specialists like BPS. Rid yourself of the worry and the liability that comes with the complications of insurance filing. Contact us for a free quote today!