MENTAL HEALTH MEDICAL BILLING
Mental health providers typically enter the mental health space to help others. This purpose can be hindered by the challenges of mental and behavioral health billing. Time spent navigating challenging billing rules and regulations lead to lower provider profits and less time spent helping patients.
19.86% of adults experience a mental illness, equivalent to nearly 50 million Americans. With the prevalence of various forms of mental illness, mental health services provide crucial support to many of us.
COMMON CHALLENGES IN MENTAL HEALTH MEDICAL BILLING
Complicated Billing Processes
Mental and behavioral health has overall more complex and nuanced billing methods. There are two major reasons for this complexity: high treatment variance and pre-authorization. Many factors contribute to differences of mental health services: • Location of services • Session length • Patient age • Prescriptions • Type of therapeutic approach
Pre-Authorization
Typically, health insurance plans require some form of pre-authorization. Patients cannot receive coverage for mental health services until this pre-authorization is received. Pre-authorization slows down insurance billing, preventing providers from getting paid for services and from patients receiving a necessary treatment.
Insurance Ineligibility
Mental health is a form of medicine where patients are more likely to go out-of-network. Compared to physical health practices, for mental health services patients are much more likely to find a provider that is not covered by their insurance plan. Because of this higher inclination towards out-of-network providers, many more patients come to practices that either are out-of-network or their insurance doesn’t cover the services that they’re in need of. This creates challenges when it comes to billing, as there is no insurer to guarantee payment.
Incorrect Patient Information
Accurate patient information is one of the easiest issues to fix in medical billing, but one of the most common challenges. If a patient’s information is incorrect, it typically leads to a dreaded denial. Whether an incorrect address, incorrect spelling, or out of date insurance information, a claim will be denied if it’s inaccurate.
Evolving Regulations
The healthcare landscape undergoes constant flux, with billing regulations for gastroenterology procedures subject to rapid alterations. It remains imperative for healthcare providers to remain abreast of these changes to avert billing discrepancies and denials.
Claims Denials
Denials are a burden on medical practices of all types. Denials get in the way of cash flow, and put a wrench in efficient revenue cycle management. What’s even more challenging? Denials are inevitable. Even the strictest claims systems still get the occasional denial.
Lack of Staff
Lack of resources is another challenge that mental healthcare providers struggle with when it comes to medical billing. Many medical practices often have an administrative team that handles billing and coding, while practitioners can put their focus on caring for patients.
MENTAL HEALTH MEDICAL BILLING
Mental and behavioral health has overall more complex and nuanced billing methods. There are two major reasons for this complexity: high treatment variance and pre-authorization. Many factors contribute to differences of mental health services: • Location of services • Session length • Patient age • Prescriptions • Type of therapeutic approach
Pre-Authorization
Typically, health insurance plans require some form of pre-authorization. Patients cannot receive coverage for mental health services until this pre-authorization is received. Pre-authorization slows down insurance billing, preventing providers from getting paid for services and from patients receiving a necessary treatment.
Insurance Ineligibility
Mental health is a form of medicine where patients are more likely to go out-of-network. Compared to physical health practices, for mental health services patients are much more likely to find a provider that is not covered by their insurance plan. Because of this higher inclination towards out-of-network providers, many more patients come to practices that either are out-of-network or their insurance doesn’t cover the services that they’re in need of. This creates challenges when it comes to billing, as there is no insurer to guarantee payment.
Incorrect Patient Information
Accurate patient information is one of the easiest issues to fix in medical billing, but one of the most common challenges. If a patient’s information is incorrect, it typically leads to a dreaded denial. Whether an incorrect address, incorrect spelling, or out of date insurance information, a claim will be denied if it’s inaccurate.
Claims Denials
Denials are a burden on medical practices of all types. Denials get in the way of cash flow, and put a wrench in efficient revenue cycle management. What’s even more challenging? Denials are inevitable. Even the strictest claims systems still get the occasional denial.
Lack of Staff
Lack of resources is another challenge that mental healthcare providers struggle with when it comes to medical billing. Many medical practices often have an administrative team that handles billing and coding, while practitioners can put their focus on caring for patients.
Our team is well-versed in managing these challenges, ensuring that your practice can focus on patient care while we handle the complexities of billing
BILLING SOLUTIONS FOR MENTAL AND BEHAVIORAL HEALTH PRACTICES
- Activate Credentialing and Insurance Enrolment : Telemedicine and the growing demand for mental health services have led to an influx of new providers, increased insurance acceptance, and the consolidation of smaller practices into larger, multi-provider entities.
- Credentialing Process and Importance: Credentialing and contracting are essential for insurance companies to verify a practice’s qualifications and establish terms for in-network reimbursement; without them, claims may not be processed.
- Insurance Reimbursement Variance:
Reimbursements vary widely due to differences in credentials, licenses, and insurance plans across states and providers.
- Identify specialty and carve-out plans Carve-out insurance plans in mental and behavioral health add complexity to billing due to varying claim addresses, limited electronic processing, and differing benefit and authorization requirements compared to the main carrier.
- Billing differences for Medicare, Medicaid, and commercial plans: Licensure, credentialing, and billing requirements vary by state and plan type, leading to differing coverage, coding, and service constraints across Medicare, Medicaid, and commercial insurance.
- Create a Denial Management Process: clean claims are vital to minimize denial management, yet practices must be ready for inevitable claim rejections.
- Ensure Patient Balance Follow Up and Payment: Patient payments in mental health are sensitive due to patients’ mental states, financial issues related to therapy, divided household responsibilities, and confusion over medical bills.
Why Choose EZ Settle Solutions?
Having accumulated industry experience over years, our team at EZ Settle Solutions has successfully managed over 3 million claims for more than 300 providers. Our 200+ dedicated employees bring multi-disciplinary expertise to ensure each claim is processed with precision and care. Our comprehensive understanding of mental and behavioral health billing allows us to deliver error-free billing, helping practices avoid costly mistakes and optimize revenue.
Our Expertise in Mental and behavioral health Billing
At EZ settle solutions, we prioritize Mental and Behavioral practices due to constant changes in the CPT codes & CMS guidelines it is important to collect the accurate reimbursement from respective insurance payers.
System Agnostic
We work with numerous EHR systems, so we can easily adapt with any given billing systems.
Accurate credentialing
Getting practices in-network with the appropriate insurance payers depending on the county and state.
Updated CMS guidelines
CMS provides constant changes in the billing guidelines for Mental and behavioral health, we make sure we are up to date.
Why Outsource to EZ Settle Solutions?
The global outsourcing market for medical billing is projected to reach $20.98 billion by 2026, reflecting the growing need for specialized billing services. By partnering with EZ Settle Solutions, Mental and Behavioral health practices can:
Streamline Billing Processes
Our cheat sheet and expert team simplify the complex billing processes, reducing the likelihood of errors.
Optimize Revenue Capture
We ensure that all services are billed correctly, maximizing your practice’s revenue.
Ensure Compliance
Our rigorous quality checks and adherence to compliance guidelines protect your practice from audit risks and financial penalties.
Contact EZ Settle Solutions Today
For Mental health professionals, navigating the complexities of medical billing can be a burden. However, mastering mental health billing is crucial for ensuring timely reimbursements and maximizing your practice’s revenue. Let EZ Settle Solutions handle it for you. With our experience and expertise, we ensure accurate, timely billing and optimize your practice’s revenue cycle. Contact us today to learn how we can support your mental and behavioral health practice.