What Is Mental Health Medical Billing?
Mental health medical billing is the process of managing the administrative and financial side of behavioral and mental health services provided to patients.
It begins before a claim is submitted and can continue until the insurance company has processed the claim, payment has been posted, and any remaining balance has been appropriately resolved.
For a mental health practice, the process may include:
- Insurance eligibility verification
- Benefits verification
- Provider credentialing
- Prior authorization
- Charge entry
- Claim preparation
- Electronic claim submission
- Claim tracking
- Rejection and denial management
- Payment posting
- Accounts receivable follow-up
- Patient balance management
- Reporting
A billing company or internal billing team coordinates these activities so the provider can spend less time dealing with administrative issues.
Why Is Mental Health Billing Different?
Mental health billing has many of the same basic components as other medical billing, but the services, provider types, payer requirements and coding considerations can be different.
Mental health practices may provide psychotherapy, psychiatric evaluations, medication management, psychological services, family therapy, group therapy, crisis services and telehealth services.
CMS's Medicare mental-health guidance, for example, identifies commonly used psychiatric and psychotherapy codes including 90791, 90792, 90832, 90834, 90837 and related services.
The appropriate code and billing process depend on the service actually performed, the provider's qualifications, documentation, payer requirements and other applicable rules.
The Mental Health Billing Cycle
A successful billing process can be thought of as a cycle.
1. Provider Credentialing
Before a provider can bill many insurance plans as an in-network provider, enrollment and credentialing requirements generally need to be completed.
Credentialing may involve:
- Provider information
- Licensure
- Education and training
- NPI information
- CAQH
- Practice locations
- Malpractice information
- Payer applications
- Recredentialing
CAQH's Provider Data Portal is used by providers and participating health plans to share and maintain credentialing information.
2. Eligibility Verification
Before an appointment, the practice may verify whether the patient's insurance is active and determine applicable benefits.
Important information can include:
- Active coverage
- Network status
- Copay
- Deductible
- Coinsurance
- Out-of-pocket information
- Authorization requirements
- Visit limitations
Eligibility information is not a guarantee that a claim will ultimately be paid.
3. Charge Entry
After the service occurs, the billing information is entered into the practice-management or EHR system.
4. Claim Submission
The claim is submitted electronically through the applicable clearinghouse or payer process.
For example, Medicare professional claims are generally submitted electronically using the 837P transaction, with CMS-1500 used in applicable situations.
5. Claim Follow-Up
A claim should not simply disappear into the payer system after submission.
Claims may be:
- Accepted
- Rejected
- Pending
- Denied
- Paid
- Partially paid
Outstanding claims need appropriate follow-up.
6. Payment Posting
Payments and adjustments are posted against the appropriate claims and patient accounts.
7. Denial Management
If a claim is denied, the billing team needs to determine why and identify the appropriate next step.
That could involve:
- Correcting the claim
- Resubmitting
- Providing additional information
- Requesting reconsideration
- Filing an appeal
8. Accounts Receivable
Unpaid claims become part of the practice's accounts receivable.
A good A/R process identifies aging claims and prioritizes appropriate follow-up.
Why Professional Billing Management Matters
A practice can provide excellent patient care and still experience financial problems if its billing process is poorly organized.
Common problems include:
- Claims submitted late
- Incorrect insurance information
- Unworked rejections
- Unresolved denials
- Missing authorizations
- Credentialing problems
- Aging insurance balances
- Incorrect payment posting
- Lack of follow-up
- Poor visibility into outstanding A/R
The goal of professional billing isn't simply to submit more claims.
It is to create a consistent process from the patient's first insurance verification through final payment.
Mental Health Medical Billing Services
Mental Health Medical Billers provides specialized billing support for mental and behavioral health practices.
Our services can include:
- Insurance eligibility verification
- Claims submission
- Claim follow-up
- Denial management
- Payment posting
- A/R management
- Credentialing
- Insurance enrollment
- Prior authorization support
- Revenue-cycle reporting
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