Mental Health Billing vs Medical Billing

mental health billing for dummies

Oftentimes, we’ll get a lot of the questions, just like what you’ve posed here, and what we typically will refer people to is what’s called our CPT network and our knowledge base. And it’s a group of coding experts that I actually managed here at the AMA to handle specific coding queries, because as we all know, sometimes the nuances come in the documentation and the details. Having said all that, we built this before integrated services and collaborative coordinated services were really becoming commonplace. And Epic, from my understanding, and other EHRS are working to provide tools that actually support these going forward. I wanted to call that out and probably in the subsequent so you can see you’ve got a variety of different types of codes and services that are available for reporting. And I know that when Jacob comes on, he’ll be talking a little bit about how they’ve worked in his practice environment.

  • If your practice has an online providers portal, you can also check there to discover and verify a patient’s benefits and eligibility for your services.
  • Learning more about the mental health billing process can make it easier for you to spend more time and energy on your patients and less on inconvenient discrepancies.
  • With the reduction in administrative burden, you can spend more time with clients.
  • And in this case, again, because the E/M section is designed for physicians and qualified health care professionals to report, in this case, we have two parallel sets of codes.
  • Another tip for submitting claims properly is to familiarize yourself with common claims forms that many insurance companies use, such as the UB-04 form.

The behavioral care manager works closely with the patient and the primary care provider to coordinate that patient’s care, to follow up on treatment adherence, and to really own the care plan. Now, one more thing that really makes this very different than what you’re used to is that the majority of this is done over the phone, and that was even before COVID. With that, I’ll probably go to the next slide and we’ll start talking about really the continuum and kind of do a little level setting for everyone in the audience. And certainly COVID has heightened everyone’s awareness and quite likely the need for behavioral health services to be available in addition to addressing medical concerns.

Fraud Committed by Medical Providers

Beneficiaries should NOT send checks to VHA OCC for their annual deductible; as claims are processed, charges are automatically credited to individual and family deductible requirements for each calendar year. Health behavior assessments mental health billing or reassessments require a referral from a physician or nonphysician practitioner. The link between behavioral health and mental health conditions – and the way the two are or are not manifested – varies from patient to patient.

Under the CHAMPVA In-house Treatment Initiative (CITI), CHAMPVA beneficiaries may receive cost-free health care services at participating VA facilities. A large shortage of providers for these services goes a long way toward explaining why so many people suffering are not getting the help they need. Of the more than 50 million American adults experiencing some form of mental illness today, 60% are not receiving any services for those illnesses. Success in obtaining a new or revised CPT code is dependent on understanding the process and preparing an application with the complete information required. Obtaining support from the appropriate medical community, society, or provider group that requires or endorses the need for the code is essential for the CPT approval process. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits.

COVID-19 (2019 novel coronavirus) resource center for physicians

We hunt for other ways to ensure claims are filed in a timely manner. We call and ask for specific people to submit claims to, reps that can receive faxes on a call, or setup systems to ensure claims are successfully submitted and processed by each insurance company. We get it, it’s why we created a mental health insurance billing service after all. Health care fraud can be committed by medical providers, patients, and others who intentionally deceive the health care system to receive unlawful benefits or payments. The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions.

Many providers find managing their own billing to be outside of their job parameters. If you want to spend less time doing your billing and more time working with clients, getting paid, then consider hiring our mental health insurance billing service. I’m definitely mixing up the names and what is true at Northwestern, but that’s an example that might happen with a patient. It’s one of, if not the only specialty that is often carved out of insurance plans. So currently what we see in a lot of primary care practices is that the primary care provider is delivering behavioral health interventions to the patient directly.

DSM-5 vs. ICD-10: Diagnostic Codes for Mental Health

That means it should be able to alert you of errors you make during the claim submission process and correct the same automatically. There are also many systems that can check eligibility on your behalf in a more efficient manner than making phone calls. This technology could be supplied by your EHR, clearinghouse, or a different third-party. This is a key step https://www.bookstime.com/ in the process, verifying eligibility early helps stop this type of denials months before you would receive them. Gathering the information from your clients is only the first step, it’s also your responsibility to ensure that it’s accurate, up-to-date and eligible. This type of form replaced UB-92 forms in 2007 and it’s also sometimes referred to as CMS 1450.

  • Reimbursement for mental health is also often lower for mental health providers.
  • You see, some clearinghouses (like ours) can automatically accomplish multiple claim submission process alternatives exactly for this unique scenario.
  • That means it should be able to alert you of errors you make during the claim submission process and correct the same automatically.
  • So I wanted to highlight that certainly, and I understand, based on yesterday, that I think the PHE has been extended another 90 days.
  • Filing claims involves submitting each date of service with all this information one by one.
  • A patient’s medical record determines what is billed for the mental health service, which means that all required information must be adequately documented.
  • This medical record will help support the diagnosis and procedure code that is billed to insurance.

The company is tech-focused and allows clients round-the-clock access to information such as claim status, client balances, authorization status, and more. You can work hard to submit your claims, and go above and beyond for it as well. But all the work will be in vain if the billing isn’t done properly. The psychiatric diagnostic evaluation, also known as a psych evaluation, is typically performed to evaluate patient’s medical and mental health.


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