It’s especially frustrating to file insurance claims for mental and behavioural health benefits. From the types of services offered to the pre-authorizations needed and who takes care of the books, you’re at a disadvantage compared to other health professionals. If you’ve been struggling to get claims honoured, don’t worry you’re not alone. Thankfully, there are several things you can do to improve your approval rate.
In the mental health billing, patients and insurers are billed primarily for therapy, medical management and psychological testing services. Insurers have rules about how long a session they’ll pay for, how many they’ll pay for per day or week, and often a maximum number of treatments that they will pay for.
The mental health needs of the patient may exceed the services the insurer is willing to pay for, making balancing an effective treatment plan with adequate reimbursement tough for mental health professionals.
Behavioural health providers should be aware that many commercial insurance companies and state Medicaid programs outsource their mental health claims to an outside third party. This is important because the claims address on the card isn’t always the correct address and if you submit to the wrong address your claims will be rejected. It gets complicated so it’s important to have a biller who makes sure that the claims are filed correctly to avoid payment delays.
Why Mental Health Billing Is so Complicated?
Counsellors and psychiatrists provide services in a distinctly different way than other healthcare professionals. Instead of performing an eye exam or taking x-rays, you spend most of your time in therapy sessions. Major insurance companies dictate how long these treatments can take, as well as how many can take place per day. This makes it extremely difficult for mental healthcare providers to balance adequate treatments with a successful billing plan.
The differences between medical billing and mental health billing are amplified by office budgets. Counselors who run private practices often process their own bills in order to cut down on operating costs. Without a dedicated staff member to keep up to date on healthcare billing codes, changing regulations and the billing practices of each insurance company, rejection rates will rise.
In order for an insurance claim to be quickly processed, you must:
- Use the required billing format for your patient’s insurance company.
- Apply the appropriate code for the treatment delivered.
- Limit the bill’s total to the fee allowed by your patient’s insurance policy.
- File within the time allowed by the insurance plan.
- Receive pre-approval for treatments when needed by the insurance plan.
- Include the appropriate policy number on the bill claim.
- Submit the claim to the right address.
Time limit on filing a claim
This varies from insurer to insurer. Some insurers require claims to be filed very soon after services 90 days is often a rule among private insurers. Others are more lenient with their time limits.
For example, Medicare usually allows providers to file claims within a year to 18 months after services are provided. Knowing the insurers you work with and their claims submission rules will help you avoid having claims denied because of late submission.
There are fewer pitfalls involved in medical billing vs. mental health billing simply because billing is more straightforward. The billing is also handled by an expert in most cases.
Highest Billing Concerns for Mental Health Providers
On average, only 85 percent of claims for mental and behavioral healthcare are approved. To start improving your approval rates, there are a few techniques you can use:
- Stay up-to-date on each company’s preferred filing methods.Paper and fax filing is on its way out, and more companies are switching to email and online filing services. Unfortunately, insurance companies don’t always inform you when they change billing methods, so it’s up to you to ask.
- Double-check your patients’ insurance before each visit. Policies change and coverage lapses. Unless we make an effort to stay updated, we’re often the last to find out through a billing rejection.
- Encourage easy cash payments for patients with poor quality or no insurance coverage. More than one clinic has given up working with insurance companies entirely. Whether you join a network depends largely on their pre-approval policies and the limits they’ll pay. While many patients expect to pay with insurance, it may be in your best interest to offer sliding-scale or deferred payments instead.
To ensure the financial health of your mental health practice, fast, efficient, and effective mental & Behavioural health billing services are essential. Contact us for a free quote today.