TOP 5 COMMON ERRORS WITH MENTAL HEALTH BILLING
Navigating
the insurance claim can be challenging for mental health practitioners, mainly
if you are into individual or small facility practice.
While
most large medical facilities have an entire dedicated department trained in
researching, submitting, and following up on the billing and the claims, you
might be 'winging it. It is because mental
health billing is more complex and complicated than other medical
billing. In fact, there is a lack of uniformity in the billing process.
In most
medical practices, standardized tests and services are performed. However, in
mental health, the practitioner has to undertake various procedures to treat a
patient. Adding to this, the different approaches in mental therapy make the
billing and coding process quite convoluted.
Knowing
how the different services and procedures is a must to warrant an error-free
billing and submission. Failure to understand or follow the correct billing and
coding procedure would mean losing out on revenues.
It is a
must that any mental health practitioner would know the five common mistakes
with mental health billing to ensure they can avoid them and get the payment
for the services rendered.
Top 5 Common Mistakes In Mental
Health Billing:
Billing
and coding mistakes can doom your practice financially; hence, while you take
care of the patients, you need to take care of the billing. However, if you
thought you were the only one struggling with billing as a mental health
practitioner, you are wrong. So, to warrant your revenue flow is regular with
the reimbursements, here are the top five mistakes any mental health
practitioner must avoid.
1. Wrong CPT Code Usage
It
would help if you were quite specific with the procedure codes in mental health
billing, mainly when it has to be recorded for the time spent in a session. In
most cases, if you are using the auto-pilot mode, you will be using the same
code for every session. Therefore, it runs the chance of overbilling for a
shorter session or under billing when you have provided some other billable
services. In addition, if you are offering any new service, you have to dig
into the code descriptions for these services you provide each time, which can
be pretty time-consuming.
The
lack of knowledge about CPT codes means either you are leaving the money for
the services you offer or overbilling, which can bring you under scrutiny by
the authorities. The only way to fix it is by knowing the CPT codes and
understanding them as per the procedures.
2. Mentioning Out-dated Codes
ICD and
the CPT codes are being updated continually, so as a mental health
practitioner, you need to know the latest codes and the changes. There is a
grace period when the code sets are changed. However, the payers expect the
biller to use the most recent codes during the submission. Therefore, after the
grace period, any codes that have been changed and not used by you would mean
claim rejection or denial.
The
mental health practitioner thus must ensure that they do not use the old code
during the claims.
3. Unbundling Codes
In
mental health billing, using multiple codes to raise the payment is called
unbundling codes. In unbundling codes, the practitioner uses various codes when
there is a single code available for the service, which can be used to reflect
the procedure accurately.
Any
mental health practice should avoid unbundling because it is a red flag for the
audit team. In addition, unbundling is often associated with fraud or abuse. It
is vital to know what is included in the code description, and when a single
code is available, you should be using that.
4. Using Up-coding
Even up-coding
is used for getting higher claims, and once again, it is a red flag. Unlike
unbundling, where multiple codes are used instead of a single code to increase
the payment, up-coding uses a single code that offers higher payment than the
service provided. For instance, when a psychotherapy session is for thirty
minutes, and the code 90837 is used for sixty minutes, you are doing up-coding.
Up-coding
can again trigger an investigation for fraud, so knowing the correct codes
while tracking the time accurately for the therapy session is a must. It is
also vital that you learn the aspects included in the codes that you are
unfamiliar with so you don't do up-coding.
5. Using Incorrect Modifiers
Modifiers
are used to provide additional information to the payer. For example, a
two-digit code is added at the end of the CPT code.
It can suggest where and how the service was offered. But a practitioner cannot
just randomly use the modifiers. There are rules for it that need to be adhered
to.
Failure
to abide by the rules and use the correct modifier can result in claim denial
or rejection. Also, the misuse of modifiers can bring the practice under
scrutiny by the authorities due to fraud or abuse if it is done regularly.
Hence, unless you are sure about the modifiers and the rules that come with
them, please don't use them.
How to Mitigate these Issues?
One of
the best ways to overcome mental health billing issues is using good ERM
software. It can help you with the proper coding and reduce errors. Also, it
can help you go paperless, and by digitizing the process, you can stay
organized easily by attaching the intake forms and insurance cards to the
clients' files. In addition, adding session notes and comments and collecting
them for billing becomes easy.
ERM
software also helps in monitoring the practice's health by providing
comprehensive reports regularly. But if you are wondering where to find the
right ERM software and how to operate it for your mental health practice, the
solution is 24/7 Medical Billing Services. We work with all the latest ERM and
other revenue management software to ensure a scalable and profitable practice
while reducing billing and coding errors. We are one of the best mental health
billing and coding outsourcing company that can help you flourish without
worrying about making any billing mistakes.
About
24/7 Medical Billing Services:
We are
a medical billing company that offers ‘24/7
Medical Billing Services’ and support physicians, hospitals, medical
institutions and group practices with our end to end medical billing solutions.
We help you earn more revenue with our quick and affordable services. Our
customized Revenue Cycle Management (RCM) solutions allow physicians to attract
additional revenue and reduce administrative burden or losses.
Contact:
24/7
Medical Billing Services
Tel: +1
888-502-0537
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