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As a behavioral health organization, your primary goal is not to collect money from your patients… it's to help them get treatment. Unfortunately, many behavioral health organizations have no choice but to spend countless hours on the billing side… because there's so much involved. Ultimately, billing is what keeps your doors open as a behavioral health organization.
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https://etactics.com/blog/mental-health-billing
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It is possible that so many mental health practices and facilities find it so difficult to bill not because it is impossible, but because they have not streamlined their process.
The first step in the mental health billing process is gathering information.
You can’t invoice your services without collecting information from your customers. That may sound like an obvious statement, but it’s more complicated than it seems.
What information do you need to collect from your mental health clients for billing purposes? You will need to be able to provide the following information on your end…Provider Tax ID, Employment Identification Number or Social Security Number, Individual Provider NPI, Organizational Group NPI, Provider License, and Address. There are only 4 pieces of patient demographic information that you need at a minimum for billing purposes…Full Legal Name, Date of Birth, Address, and Gender. In addition to demographic information, you will collect the following patient insurance information…Card Member or Subscriber ID, Group Number, Authorization Number, Claims Address, and the phone number of the mental health/behavioral health provider (the one that qualifies).
The second step is to verify the information and determine eligibility.
Collecting information from your clients is just the first step, it is also your responsibility to ensure that this information is accurate, up to date, and eligible. In a streamlined mental health organization, this process begins the moment the patient comes in for their visit and continues through to their appointment. This is an important step in the process, verifying eligibility early helps prevent these types of denials months before you would receive them. You could call the patient’s provider to verify eligibility, but that takes time. Instead, there are many systems that can verify eligibility on your behalf in a more efficient way than by calling. This technology can be provided by your EHR, clearinghouse, or other third party.
Thirdly, there is the CPT code registration.
CPT codes are essential for billing. Without them, the payer would not be able to understand what happened during your client's visit. Capturing them should be done immediately after the appointment. The four most common CPT codes are… 90791 which is Exclusively for the first appointment with a client… 90832 for a session of 16 – 37 minutes… 90834 for a session of 38 – 52 minutes… and 90837 for a session of 53+ minutes.
Although it seems simple, it is good to mention that you first invoice the first appointment and then use the other codes based on the session duration.
Fourth, you must file a claim.
There are many different techniques you can use to file your claims, but the best option is a total package of a claims filing portal and clearinghouse provider.
These clearinghouses (such as ours) can automatically perform multiple alternative claim submission processes for each unique scenario.
That way, if a customer comes in with a payer that only accepts paper claim submissions, you let the clearinghouse know and it will automatically generate and send a CMS 1500 or UB-04 form. Oh, and it also integrates with your PM/EHR system and vice versa.
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Step five…clearinghouse rejections.
Before you “officially” send your claims to your client’s payers, your clearinghouse should assist you through scrubbing and rejections. Both of these are processes I referred to in the definitions of those terms, but this is a good place to mention them again.
The sole purpose of your clearinghouse is to assist you when it comes to mental health claims.
This means it should be able to alert you to mistakes you make when filing your claim and automatically correct them.
This step occurs concurrently with Step 4, but should be mentioned because it is an added benefit of opting for a complete claims submission portal and clearinghouse provider package.
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