Mental health billing is as complex as the science of behavioral health itself. In general medicine, medical billing tends to be repetitive and standardized. But behavioral health providers often struggle with mental health billing because of variations in the types of services, differences in the time spent with a patient and the scope of treatment, and payor constraints on mental health treatments. Then there are the challenges of keeping up with changing mental health billing regulations and understanding the billing processes of each insurance company.
Office budgets also magnify the difficulty in mental health billing. A medical practice typically has a separate team to manage non-clinical tasks such as medical billing. But with mental health, the office setup is often smaller, with limited support for billing and office duties. The provider may attempt the billing themselves to be overwhelmed with time management problems and lost revenues.
Avoiding mental health billing issues is vital for the well-being of your practice. Here are practical tips for improving mental health billing collections in your practice.
- Documentation is everything
Insufficient documentation is one of the most significant contributors to claim denials in mental health billing. Ensure that you record the following information:
- The start and stop date of mental health service rendered to the patient.
- Ensure that the patient’s name and service date is recorded on each page.
- Indicate the type of behavioral health service (for example, was it individual or group therapy?)
- Specify whether it is an initial, subsequent, or sequela encounter.
- Document the problem statement and the medical necessity of the prescribed treatment/ tests.
- Include information on therapeutic interventions such as CBT / DBT.
- Include information/ observations which are specific to the patient.
- Document the mental status exam.
- Mention the risk factors.
- Guidelines on Individual Treatment Plan (ITP)
- The mental health billing should be done within three visits or 14 days.
- The documentation should be individualized – not templated.
- Include the diagnosis and tie it to the initial assessment.
- Document the type, frequency, and duration of service.
- Specify the measurable mental health goals and specific timeframes; ensure that both the provider and the patient sign it.
- Follow the mental health billing guidelines for specific ICT codes
Here are the guidelines associated with the most frequently used ICT codes
- Usually, this can be used for a patient once per year.
- However, it may be used again if there is a significant change in the patient’s status, diagnosis, or treatment plan.
- It is a standalone code, which cannot be billed with other services.
- Is typically allowed once every six months to one year or
- It may be used again if there is a significant change in the patient’s status, diagnosis, or treatment plan.
- The code has built-in E/M, so do not bill E/M on the same day.
- Psychotherapy 30 minutes
- Psychotherapy 45 minutes
- Psychotherapy 60 minutes
(Bill these last three codes only once per day and by adding up all the time sent with the patient.)
90839 and 90840
- Psychotherapy for a crisis, life-threatening condition, or complexity that requires immediate attention to a patient in high distress.
SBIRAT – Screening, Brief Intervention, Referral to Treatment
- Medicare: G2011, G0396-G0397
- Medicaid G0396-G0397, G0442-G0444, H0049-H0050
- Commercial 99408-99409
Family and Group Psychotherapy
- Include comments but do not make it evident who was there in the group therapy.
- Mention patterns of behavior
- Document what was worked on.
96156 – 96171
- Use these codes for the face-to-face assessment or evaluation of patient response to disease, illness, and treatment.
- These codes are time-based.
- Medical diagnosis is required.
- Document who is present.
Also, refer to this CMS mental health billing document.
If accurate billing and resolving claim denials are too challenging, it is time to consider outsourcing mental health billing at your practice. However, before you choose a mental health billing service, ensure that they have a demonstrated record of improving revenue collections for their customers. Other crucial aspects to evaluate before outsourcing mental health billing are communication and information security. Will the service provider be accessible to respond promptly to any queries you may have? What data security protocols do they have in place to safeguard the sensitive information of your clients.
PracticeForces has been working with physicians and behavioral health providers for almost two decades, and our teams are available for a free consultation on mental health billing. Call us at (727) 732-2831 to know more about improving mental health collections at your practice.