What is Behavioral Health?
Behavioral health refers to the study, diagnosis, and treatment of mental and emotional disorders, as well as substance abuse and addiction. It encompasses a wide range of conditions, including depression, anxiety, bipolar disorder, addiction, and schizophrenia, among others.
Behavioral health professionals, such as psychiatrists, psychologists, and counselors, work to help individuals overcome these conditions and improve their overall well-being. This can involve a combination of therapy, medication, and lifestyle changes, depending on the individual’s needs.
Behavioral health is essential for overall health and wellness and is becoming increasingly recognized as an integral part of primary care.
Behavioral Health Billing
Accurate Coding for Reimbursement
Behavioral health billing revolves around the accurate coding of services rendered using established coding systems, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the Current Procedural Terminology (CPT) codes. Precise coding is essential for ensuring proper reimbursement from insurance companies and government programs.
Negotiating Payer Regulations
Each payer, whether a private insurance company or a government program like Medicaid or Medicare, has its own set of rules, regulations, and reimbursement policies. Behavioral health billers must stay up-to-date with these constantly changing guidelines to maximize reimbursement and avoid denials or audits.
Streamlining Claims Submission
Many behavioral health practices and billing companies utilize specialized software (robotic process automation (RPA)) and clearinghouses to streamline the claims submission process. These tools can help identify and correct errors before claims are sent to payers, reducing the risk of denials and improving cash flow.
Effective Denial Management
Even with meticulous coding and submission processes, claim denials are sometimes inevitable. Effective denial management involves analyzing the reasons for denials, appealing them when appropriate, and implementing measures to prevent future denials, ensuring optimal reimbursement for services rendered.
Behavioral Health Credentialing
Ensuring Provider Qualifications
Credentialing is a crucial process in the behavioral health industry that verifies the qualifications, credentials, and professional standing of healthcare providers. It is a mandatory requirement for providers to be credentialed by insurance companies and healthcare organizations before they can provide services and submit claims for reimbursement.
Maintaining Compliance and Quality
The credentialing process involves a comprehensive review of a provider’s education, training, licensure, certifications, malpractice history, and other relevant credentials. This rigorous process ensures that patients receive care from qualified and competent professionals, promoting quality of care and patient safety within the behavioral health sector.
Navigating Complex Requirements
Different payers and organizations may have varying credentialing requirements, making the process complex and time-consuming. Behavioral health providers must navigate these intricate requirements, gather the necessary documentation, and maintain up-to-date credentials to remain in good standing with insurance companies and healthcare organizations.
Both behavioral health credentialing and billing are critical components of the healthcare industry, ensuring that qualified providers deliver quality care while being appropriately compensated for their services. Navigating the complexities of these processes requires specialized knowledge, attention to detail, and a commitment to compliance and excellence.
Billing & Credentialing Particulars
Services
- Primary and Secondary claims processing
- 24-hour turn around on Claims Submission
- Prompt follow-up with Approved and Denied Claims
- Posting EOB’s
- Correcting Patient Information
- Clean AR under 90-days
- Creation of a Payer Matrix
- Fee Schedule Set-up and Maintenance
- Credentialing for new and established Providers
- Etc,.
Serving the Following Types of Behavioral Health Providers
- Inpatient
- Outpatient
- Residential
- Inpatient Hospital
- Small and Large Private Practices
Common Mental / Behavioral Health CPT Codes
- 90791: Psychiatric or psychological intake interview without medical services
- 90792: Psychiatric intake interview with medical services
- 90832: 30 minutes of individual psychotherapy
- 90833: 30 minutes of individual psychotherapy performed with an E/M service
- 90834: 45 minutes of individual psychotherapy
- 90836: 45 minutes of individual psychotherapy performed with an E/M service
- 90837: 60 minutes of individual psychotherapy
- 90838: 60 minutes of individual psychotherapy performed with an E/M service
- 90847: 50 minutes of family psychotherapy with the patient present
- 90846: 50 minutes of family psychotherapy without the patient present
- 90853: Group psychotherapy
- 96101: Psychological testing, interpretation, and reporting per hour by a psychologist
- 96102: Psychological testing per hour by a technician
- 96111: Developmental testing
New CPT Codes for Mental Health Services
- Code 96156 has replaced codes 96150 and 96151
- Code 96152 has been updated to 96158 plus 96159
- Code 96153 has been updated to 96164 plus 96165
- Code 96154 has been updated to 96167 plus 96168
- Code 96155 has been updated to 96170 plus 96171
Modifiers
- The usage of behavioral health modifiers
Summary
Outsourcing your behavioral health billing and credentialing can offer several advantages to mental health providers and facilities. Billing for mental health services can be complex, time-consuming, and requires specialized expertise. By outsourcing this process to a third-party billing company, mental health providers can save time and reduce administrative burden, while ensuring billing accuracy and compliance with regulations.
Additionally, outsourcing can provide access to advanced billing technology and expertise in mental health billing, which can help maximize revenue and improve the financial health of the practice or facility.
Medwave is a leader in providing comprehensive medical billing services to behavioral health providers. Whether you are a psychiatrist, psychologist or clinical social worker, we work with you to provide an excellent performance-driven experience that will make a difference in your office’s reimbursement.
With over 20 years plus of behavioral health billing and credentialing experience, we have assisted new and established practices accurately process many hundreds of thousands of claims. We are able to utilize your current cloud-based software or we can help you discover new products tailored to your behavioral health practice volume.
Let our team of professionals guide your practice to a successful and productive new year. Contact us today to speak to a member of our team on how we can help your behavioral health practice.