To give you an example, there are public payers for every county in the state of Ohio that handle alcohol, drug addiction and mental health services (ADAMHS). However, you’re in a unique scenario within the mental health space where you have to deal with MCOs, mental health EHRs and state-level government ordinances. Thus, if you don’t have a clearinghouse that has specific processes in place to help you with each of those mental health billing-related aspects, you should seek a new one. The last step in the mental health billing process is to rework your denials and submit them for an appeal. CPT codes communicate services and tasks performed by mental health professionals during sessions.

Payers and clearinghouses will allow you to track electronically-submitted claims on a user dashboard. Third-party billing services should provide you with regular status reports. To avoid these situations, it’s a good idea to evaluate clients’ insurance coverage before each visit, if possible. By contacting insurers and making sure that clients’ coverage mental health billing for dummies is still in effect and has not changed, mental health professionals can stay informed and avoid wasting time on rejected claims. This can be labor intensive, but the time it will save makes it worthwhile. In the mental health field, patients and insurers are billed primarily for therapy, medical management and psychological testing services.

Understanding Mental Health Billing

Mental health services are essential for the well-being and emotional healing of so many. These services and treatments span a wide range of necessary components to ensure a smooth process. However, mental health billing can often hinder the treatment process if there are errors in the system, inaccurate or inefficient documentation and pre-authorization issues.

Sometimes when eligibility responses come back it will explain what’s “in-network” and “out of network”. They’re a 5-digit code that the Department of Health and Human Services (HHS) created to instill uniformity. Rejections are better to receive than denials because they happen sooner and don’t affect your bottom line nearly as much. You see, the average initial claim denial rate in Q3 of 2020 alone hit over 11%. At the time that was an all-time high and the survey that that statistic came from suggested that denial rates weren’t slowing down.

How to Code Correctly for E/M Payment

As a mental healthcare provider, you can do everything right up until you submit a claim, but all of your hard work will be undone if you don’t do it properly. For instance, after you provide a service, you should expect to receive a reimbursement from a claim. However, if you file an incorrect code or accidentally file it to the wrong insurer, you can be denied or run into other billing issues. If you know the available coverage for every patient before you provide services, it will be much easier for you to submit proper claims and minimize frustration for you and your patient.