The services of psychiatrists, psychologists, counsellors, and therapists are distinctly different from other health care professionals. When a patient goes to a GP, the standardized health checks and tests are relatively easier to document and code. The amount of time spent with patients varies, but only marginally.
That is not the case with mental health providers. Each mental health patient presents a unique combination of symptoms and requires a customized therapy plan, including the duration of therapy. The proposed treatment varies depending on the age and willingness of the patient, location of the patient, and the patient’s mental health history.
Insurance companies have attempted to standardize mental health billing by stipulating the maximum number of mental health treatments for a patient, the length of treatment, and the number of patient consultations per day or week. However, ensuring accuracy in insurance pre-authorizations in mental health billing is an ongoing challenge for providers.
Additionally, mental health services are generally smaller group practices, with no dedicated resources to handle the revenue cycle management aspect of the practice. The onus of resolving mental health billing denials usually becomes the responsibility of the office administrator or the provider themselves.
As a result, the insurance collection rate of mental health practices is generally lower than other types of medical practices.
4 Tips on Improving Mental Health Billing Collections
As a mental health service owner, are you collecting less than 95 percent of claims in the first submission? Our experience with mental health billing tells us that you should definitely be doing better.
The following mental health billing tips, coupled with some perseverance and strong knowledge of billing, will reduce claim denials and improve your practice revenue within weeks.
Monitor the time with each patient and the permissible billable time as per the insurance service.
Before you meet the patient, be aware of the permissible time limit for (a treatment/ session) by the payer. For instance, if the patient’s insurance covers a one-hour session, and you spend more time with a patient, you cannot bill for the additional time. It is entirely up to you to assess how much time your patient requires, but then you must bill only for the payer’s permissible time limit for the claim to go through.
Being aware of this detail before the patient comes into your office will allow you to plan each session better and reduce your unbillable hours.
Other aspects related to the time of service may raise chances of mental health claim denials. For instance, billing too many patients than you can see in a day without affecting the quality of treatment is a potential red flag in mental health billing.
Monitor the weekly patient appointments.
It is standard practice to see a patient once a week or once every five to six days. Most payers consider seeing a patient multiple times a day or several times a week as excessive.
Ideally, a patient who requires treatment several times a week should be evaluated for a higher level of care (e.g., inpatient admission). However, in exceptional cases, call the insurance company. You may get special approval for more than one service a day for the same patient.
Diversify use of ICD-10 codes.
The expansive list of ICD -10 codes was introduced to reduce the incidence of unspecified coding and repetitive coding. Overuse of an ICD-10 code or the use of unspecified codes in mental health billing is viewed negatively by payers and increases the risk of claim rejection.
Diversity is key to successful billing. Regular claim audits will help you spot codes you may be using too often. Also, the use of unspecified code should be an exception. Educate your billing staff on the latest ICD-10 codes for mental disorders. Alternatively, seek the assistance of a U.S. medical billing service.
Be thorough in documentation submitted with the claim.
Specific mental health billing codes and patient categories are prone to claim denials. For instance, billing codes –
- 90837 (individual psychotherapy)
- 99215 (established patient visit), and
- 90853 (group psychotherapy).
Ensure that claims submitted under these codes are accompanied by thorough documentary proof of the service performed. The documents should include timesheets, session notes, place and time of service, and a signed patient consent (or family consent) of the treatment plan.
While the above revenue management tips are specific to mental health billing, you must also follow the basic revenue management guidelines. These include –
- Accurate pre-insurance eligibility checks before the appointment date
- Sending appointment reminders to patients through alternative modes to minimize patient no-shows.
- Pre-informing patients about their billing liabilities to reduce the risk of surprise billing.
Do you need help with mental health billing for your practice? We are happy to offer you 30 minutes of free consultation. Book a session now.