Running a healthcare service requires more than just providing quality healthcare services. It is a complex process. Running a laboratory, hospital, or dental clinic requires getting several things right. In this regard, Mental Health Medical billing plays a very important role.
Medical billing is a crucial part of the healthcare revenue cycle. It is often referred to as the backbone of the process. It is crucial for the survival of any laboratory or practice. Medical establishments need to bill and collect money from patients efficiently. However, there are many challenges in medical billing.
Many mental health experts struggle with billing. Mistakes in billing and coding may jeopardize your practice financially. Therefore, it is important to take care of billing while also taking care of patients.
Mental health practitioners should avoid these top seven mistakes to ensure a steady revenue flow from reimbursements steady revenue flow to refunds.
7 Common Medical Billing Errors
Using Incorrect CPT Codes:
Being specific with the procedure codes in mental health billing is helpful, especially when recording the time spent in a session. The majority of the time, if you are using the auto-pilot mode, you will use the same code throughout each session. It is possible to overbill for a shorter session or underbill for other billable services. Adding a new service can be time-consuming as you need to go through the code descriptions for each service.
If you don’t know CPT codes, two things can happen. First, you may not receive payment for your services. Second, you may overcharge, which could prompt an investigation by authorities.
Using ICD-10 Code Constantly:
Mental health professionals often fall into the trap of using the same ICD-10 code repeatedly, which can lead to billing errors. To avoid audit risk, it is important to have variety in billing. Billing the same diagnosis code for all patients, like anxiety disorder, is a red flag.
Exceptional Error-Indicating Codes:
Using certain codes in mental health billing can be problematic as they may raise red flags. Billing numerous codes that are specific to mental health services can cause issues for your practice. There are three codes to be aware of. These codes are billing code 90837, billing code 99215, and billing code 90853. Billing code 90837 is for individual psychotherapy. Billing code 99215 is for established patient visits. Billing code 90853 is for group psychotherapy.
Using Outdated Codes:
It’s important for mental health providers to stay current on the latest ICD and CPT codes. It helps to stay updated on any changes and updates to these codes, as they are constantly evolving. There is a grace period when the code sets are changed.
The payers expect the biller to use the most recent codes during submission. After the grace period, if you haven’t used any changed codes, they will be rejected or denied when you try to claim them. The mental health practitioner should avoid using the old code when submitting claims.
Unbundling Codes:
Unbundling codes is a practice in mental health billing where multiple codes are used to increase payment.
Mental health billing should avoid unbundling as it is a red flag for the audit team. Unbundling is commonly linked to fraudulent or abusive practices. Knowing the code description is crucial. If there is only one code available, use it.
Up-Coding:
Medical providers engage in up-coding when they assign a higher billing code to a patient’s diagnosis or treatment than what is actually warranted. Higher reimbursement can be obtained from insurance companies and government programs. Fraudulent up-coding can lead to legal action and penalties. Medical providers should code their services accurately. This ensures fair and ethical billing practices.
Up-coding is used to increase claims. It involves using a single code that offers higher payment than the service provided. This is different from unbundling, which uses multiple codes to increase payment. Up-coding occurs when you use a code that represents a longer session than the actual session. For example, if you use code 90837 for a 30-minute psychotherapy session, you are up-coding.
Knowing the correct codes and accurately tracking the therapy session time is essential to avoid triggering a fraud investigation. It’s important to understand all aspects of the codes, even those that are unfamiliar to you.
Incorrect Modifiers:
Using modifiers incorrectly can lead to confusion and ambiguity in your writing. It’s important to make sure that your modifiers are placed correctly and modify the intended word or phrase. Misplaced modifiers can change the meaning of a sentence entirely. Make sure to place your modifiers as close as possible to the word or phrase(adjective or verb) they are modifying.
Misusing modifiers can lead to an investigation by authorities for fraud or abuse if it becomes a regular practice. If you are unsure about modifiers and their rules, it’s best to avoid using them.
Modifiers are used to give extra information to the payer. The suggestion can indicate the location and manner of the service provided.
Seek Assistance with Mental Health Billing
To make your workflow easier, you should consider seeking assistance with your mental health billing.
Billing for mental health services is different from billing for medical services. Taking on patient billing needs can be overwhelming for counselors and staff members. This can have an impact on client service.
Offices that focus on mental health services may face issues if billing and coding procedures are rushed. Insurance companies may deny claims that are not filed or coded accurately.
For that, get outsourced mental health medical billing services.
Outsourced Mental Health Medical Billing
Healthcare providers often lack the time and expertise to handle billing. Additionally, only a small number of individuals or businesses have the resources necessary to establish an internal billing department. It is particularly applicable to mental health providers.
By outsourcing medical billing, you can benefit in several ways by outsourcing tasks such as statement preparation, data entry, filing, and follow-ups with zero probability of error.
Benefits of Outsourced Mental Health Medical Billing
Submit Claims Accurately:
Proper coding is crucial for prompt reimbursement. A top medical billing service can ensure that your claim is submitted accurately on the first attempt. They use traditional medical billing software. The software begins by verifying the client’s insurance coverage. They code the claim accurately and submit it immediately. You will also see a significant decrease in rejections and partial payments. Increasing cash flow and maintaining focus on patients can be achieved simultaneously.
Reduction in Unpaid Claims:
We understand that disputing with the insurance company over unpaid claims can be very problematic. Working with an outsourced billing service can decrease the number of unpaid claims and they can also contest rejected claims. Billing services can help you avoid the hassle of dealing with insurers.
The job requires investigating claim rejections. It also involves monitoring the payment status of partially reimbursed submissions. Additionally, the task involves staying updated on approved claims that are still unpaid. Outsourced medical billing services can help you manage your receivables effectively.
Provide Direct Care:
Tracking down claim information takes time away from providing direct care during your business day. Missing out on potential income opportunities is a consequence of disruption. Suppose you charge $100 per hour. You spend one business hour every day on billing. You could be losing as much as $500 per week in this situation. Employing a billing service can help you recoup lost time. It can help lead to an increase in your income potential. In fact, the added revenue generated can exceed the cost of the billing service.
Cost-effective Solutions:
Outsourcing billing can help your organization free up a significant amount of in-house resources. Your employees can focus on quality assurance and improving patient care instead of spending time on billing duties.
This article is researched by Billing Freedom, a service for healthcare providers in the United States. We specialize in mental health billing services. Our team of billers and coders is dedicated to providing coding and billing services for every type of mental disorder treatment. Every bill generated goes through an expert control team who helps guarantee complete accuracy for prompt and thorough reimbursements.
