Behavioral health medical billing can be complicated, but understanding a few basics can help you get your head around it quickly. Here are a few of the most important aspects and tips of the billing process.
Behavioral health medical billing models
The first thing to understand is the different billing model types. There are five billing models, including daily per diem, value-based reimbursement, fee for service, per member per month, and physical integration. ABA billing, psychology, family psychology, and the like all use these models.
Daily per diem
Daily per diem is a flat rate paid to providers for their mental health care and services. This fee can change, though, depending on the types of professionals a person is seeing and the types of services they require.
Value-based reimbursement is a model that rewards quality over quantity. Service providers are paid rates relating to their treatments’ effectiveness and how much the patient changes over time.
The fee-for-service model is one of the most common and well-known and is simply the service provider being paid for each session they conduct. Simply put, a patient will pay at the end of their session, which will continue until they finish.
Per member per month
With a PMPM billing method, a managed care organization receives a certain monthly amount for each member from other organizations such as Medicaid and Medicare.
The physical integration model combines behavioral health and primary care. This model is often found in primary, specialty, and long-term care settings.
Tips for billing
Providers should remember a few tips when billing, as this will make the process easier but also easier to scale and makes mistakes less likely.
Pre-authorization is not often needed for most cases, especially on the basic level of initial mental health sessions. However, it is almost always needed for lengthy or multiple sessions.
Many insurance companies will also require pre-authorization in these cases, so it is important to check beforehand whether this is needed.
Update patient data regularly
Always ensure that the patient’s insurance coverage is up-to-date with their latest information and that any changes and admissions have been added. Everything from their address to any new diagnosis should be added.
This should be done, at the very least, yearly. Don’t forget that even things not directly related to their treatment must be changed, such as marital status, etc.
File claims on time
Depending on the client or patient, there might be different submission requirements for particular claims. These requirements may include filing the claim by a specific date or within a particular window.
Therefore, it is always important to remain on top of each and every claim and ensure that none of them miss their filing dates
Identify inaccuracies quickly
Claim denial is one of the most annoying and tedious problems you can have, and they only become more annoying if they happen repeatedly. More often than not, claims are denied due to inaccurate information.
Because of this, spotting these inaccuracies before the claim goes out will save you a ton of time and effort and keep your claims process moving smoothly.
Information needed for behavioral health billing
There is a long list of necessary information for billing. As this is the basic list, additional information may be needed depending on where you live. You will first need the patient’s detailed and up-to-date medical and mental health history.
Next, you will need the patient’s address, contact information, email address, etc. You will also need the details of the patient’s insurance, such as their Medicaid ID, Medicare ID, or insurance ID.
You will need to provide information about the nature of the treatment, what the treatment is for, and about the service provider. You will also need to provide information on the diagnosis and treatment results.
Additionally, you will need to provide testing and treatment dates, a behavioral health treatment plan, and a complete list of factors that could increase the health risks of the person that is being treated.
This is only a small part of the world of behavioral health medical billing, but these are the basics that everyone involved in the process needs to understand from the start, whether the care provider or the patient.
While some details may vary, these are the standard practices and methods in place that will apply to almost anyone, regardless of their insurance provider or treatment that is needed.
Remember to stay informed about any updates or changes in billing regulations, codes, and requirements specific to behavioral health. Staying current with industry news and attending relevant workshops or webinars can help you adapt and optimize your billing practices.