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Comparing Mental Health Billing With Medical Billing

Comparing Mental Health Billing With Medical Billing
Mental health billing is not the same as other medical billing so the company that you outsource to has to understand the nuances.

While there‚Äôs a lot of discussion of mental health these days, from the point of view of the provider, it may feel like the increased visibility hasn’t led to increased help with the workload. In fact, most practices have found that the past few years brought an increase in clients, sometimes beyond the capacity of their practices, without a similar increase in support staff in the front office (since we’ve lost a large part of our workforce and job expectations have shifted considerably). To compensate, some providers are outsourcing what they can, such as scheduling or medical billing services. In mental health, outsourcing billing may or may not work as simply as one would hope. Mental health billing is not the same as other medical billing (due mostly to limits imposed by insurers) so the company that you outsource to has to understand the nuances. Let’s examine those by comparing the differences between mental health billing and standard medical billing here.

Session Length

Session length plays a large role in mental health visits; this isn’t usually the case with standard medical billing. In most general practice offices, billing is done using codes that relate to the services rendered or ordered (one code for a particular blood test and another for a general check-up). However, in mental health, the code relates to the length of the session, with different codes applying to different session lengths (one code for a session lasting 16-37 minutes and another for a session lasting 38-52 minutes, for instance). Your billing service needs to not only know this and be able to track that information for your clients in order to bill appropriately.

Treatment Plans

Because mental health care requires unique, individualized treatment plans (more so than these symptoms result in this battery of tests), the billing for the different treatments is much more complicated.

Appointment Limits

Most insurers place limits on the number of sessions you can have in a given time (typically no more than one per week. If you aren’t careful, your claim could be denied because you schedule the appointments too close together (or if you bill them to the wrong date).

Appointment Locations

Billing for mental health also needs to specify if the treatment was in-person or via telehealth, and if that coding isn’t done correctly, the claim could be denied. This is also becoming a larger issue in general medical billing, but it is still much more common in mental health.

Pre-Authorization

Some insurers require pre-authorizations before they will provide services, and if the services aren’t coded and billed in accordance with those pre-authorizations it could cause issues.

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This entry was posted on Wednesday, October 26th, 2022 at 10:52 am. Both comments and pings are currently closed.