10 Common Mental Health Billing Problems
A mental health practice can lose time and delay reimbursement because of relatively small administrative problems.
Some issues happen at the front end of the revenue cycle. Others appear only after a claim has been submitted.
Here are ten common areas practices should monitor.
1. Incorrect Insurance Information
A patient's insurance information may be incorrect, outdated or incomplete.
Potential consequences include:
- Claim rejection
- Denial
- Patient confusion
- Delayed reimbursement
Regular eligibility workflows can help identify issues before the claim is submitted.
2. Provider Credentialing Problems
A provider may be incorrectly enrolled, not enrolled with the payer, or have outdated information.
This can create significant billing problems.
Credentialing should therefore be treated as part of the revenue cycle—not as a completely separate administrative task.
3. Missing Authorization
Some services or plans may require authorization.
If the requirement isn't identified before the service, the resulting claim may face payment problems.
Authorization requirements vary by payer and plan.
4. Claim Rejections
A rejected claim may not have entered the payer's normal adjudication process.
Common problems can include incorrect demographic information, payer information or claim data.
Rejected claims should be corrected and resubmitted promptly when appropriate.
5. Claim Denials
A denial means the payer did not pay the claim as submitted.
The correct response depends on the denial reason.
The billing team should investigate rather than simply write the balance off.
6. Filing Deadline Problems
Insurance companies generally impose claim-submission deadlines.
A claim submitted after the applicable deadline may be denied unless an exception applies.
Practices should have processes to prevent claims from sitting unsubmitted.
7. Aging A/R
A/R that continues aging without follow-up can become increasingly difficult to collect.
Practices should know:
- How much is outstanding
- How old it is
- Which payer owes it
- Why it hasn't been paid
- What action has been taken
8. Incorrect Payment Posting
If payments or adjustments are posted incorrectly, the practice's financial reports may not accurately reflect what remains outstanding.
Payment posting therefore isn't just clerical work.
It affects the accuracy of the practice's financial picture.
9. Lack of Follow-Up
Submitting a claim is only one step.
A claim may remain unpaid because it is pending, denied, rejected or awaiting additional information.
Without follow-up, these balances can sit unnoticed.
10. Lack of Reporting
A practice cannot effectively manage its revenue cycle if it cannot see what is happening.
At minimum, management should have visibility into:
- Charges
- Payments
- Denials
- Aging
- Outstanding claims
- Collection trends
How to Reduce Billing Problems
A good billing process combines:
Front-end controls
→ eligibility
→ credentialing
→ authorization
Claim controls
→ accurate charge entry
→ claim submission
→ rejection monitoring
Back-end controls
→ payment posting
→ denial management
→ A/R follow-up
→ reporting
The strongest approach is to treat these as one connected revenue cycle.
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