Technology Alone
Doesn't Get Claims Paid.
Knowledge Does

The demand for mental health services gets increased rapidly. However, with a shortage of psychiatrists, how can we ensure that providers deliver the best possible care to their patients.

The United States is experiencing an increasingly acute mental health crisis. Between 2017 and 2018, one in five Americans had a mental illness, and the epidemic has exacerbated feelings of anxiety, depression, and isolation. According to Mental Health America, moderate to severe anxiety reached its peak in September 2020, with more than eight out of 10 people showing moderate to severe symptoms at anxiety and depression screening.

The mental health care supply chain is down. More and more people are taking professional care, but it has become harder to get the care they need. They’ve found providers that don’t accept new patients, are out of the network, or just don’t fit.

Today, 37% of the US population lives in areas with a shortage of mental health professionals. For example, there are only 30 psychologists for every 100,000 people compared to 156 primary care physicians for every 100,000 Americans. Moreover, there is a national psychiatrists shortage, but more than half of those who practice therapy accept insurance or Medicaid, making high-quality care prohibitively expensive for many. Because of this lack of access, 60% of adults in the United States do not receive treatment for diagnosable mental illness each year.

The crisis affects all Americans, not just those with mental health symptoms and their loved ones. Mental health symptoms adversely affect physical health, leading to higher costs for insurance companies and employers to care for. For instance, people with the major depressive disorder show a considerable increase in patients compared to the total population.

Examining mental health care deficiencies

There are two major priorities for resolving this crisis: increasing the number of mental health professionals and helping those existing ones to handle their cases better.

The first is a difficult task. It needs an average of eight years of higher education and medical school and four years of residency to become a licensed psychiatrist. Even as new psychiatrists enter the field, more than 60% of psychiatrists are now 55 or older and rapidly retire. The fourth-oldest group in medical specialties will create a potential shortage of 6,000 to 15,000 psychiatrists by 2025.

This deficiency will put more pressure on the practice of psychiatrists. Fifteen-minute visits every three months have become the norm in many places, where there is not enough time to correctly complete the progress record, let alone provide high-quality medical care. The right long-term solution is to enable psychiatrists with technology and appropriate support functions instead of replacing them.

Innovation is needed, not first aid solutions.

There has been tremendous progress in increasing access from the adoption of telemedicine to premium consumer-focused therapy and mindfulness applications over the past decade. However, this is not enough.

Historically, the opportunities for psychiatrists have not presented themselves in a flexible, clinically driven way. High-quality providers are usually only available for hospitalized patients or on an out-of-network basis. Moreover, many find it challenging for 

• Opening a private practice with low reimbursement rates for services
• Handling the burden of coordinating with insurance companies
• Working on the subsequent administrative tasks that follow every day

All the above factors can be stressful for psychiatrists, preventing them from giving remedies to their patients.

A blood test cannot diagnose depression, and psychiatrists do not have the right tools to track their patients’ progress. In addition, psychiatry lacks transparency and data for determining outcomes instead of most other disciplines. Research executed by the Centers for Disease Control and Prevention (CDC) found that almost 60% of psychiatrists do not use an approved electronic health records system, and 40% do not use it at all – meaning they are still writing on paper.

Technology can go a long way in more stressful aspects of managing mental health practices, including billing, insurance, and appointment schedules. But these measures have more potential, allowing providers to gain in-depth insights into their patients, track patient progress, enhance psychiatric practice, and achieve high-quality results.

Against the backdrop of the ever-increasing demand for the services of psychiatrists and mental health providers, it has become critical for providers to provide flexibility in treatment methods.

Who can be contacted to get the best mental health billing?

DENmaar provides an improved patient payment system, staff claim tools and quickly resolves the claim issues. Contact us today to do your credentialing using DENmaar’s psychiatric billing process.

Mental health bills differ from medical bills because of changes in mental health care that are not found in primary or specialist care. Here’s how to handle it.

• Mental health bills differ from medical bills due to some of the variables included in the mental health treatment providers.
• For mental health bills, you should familiarize yourself with medical coding, verify patient insurance, and use the appropriate payer form.
• For best results, always check the benefits, store copies of crucial information, take notes when you talk to payers, and start the billing process as soon as possible.
• Mental health professionals look to improve their existing billing process or start accepting insurance and working directly with fee payers.

Mental health care patients usually have one common complaint: Many providers do not have health insurance, which can be expensive without insurance. As a mental health care provider, your approach may be different. You may not accept insurance because the mental health billing process is complex and frustrating.

However, this guide can assist you in understanding the mental health billing process. In addition, improved mental health billing structures come with more capacity for patients using insurance, which means more revenue.

How are mental health bills different from medical bills?

Mental health bills differ from medical bills in the following ways:

Pre-authorization: Payers must pre-authorize mental health services to patients before submitting medical claims. However, a 2019 report found that mental health visits are five times more likely to be out of network than primary or specialist services. Unfortunately, pre-authorization – even if requested promptly – is rare and complicates billing.

Front Office Staff: Medical practices usually consist of administrative staff handling billing and coding, leaving practitioners to focus solely on patient care. This system is less common in mental health care systems. These practices are usually sole proprietorships or small partnerships, meaning they do not have front office staff. Without additional staff, practitioners should handle the billing themselves.

Standardized billing procedures: While primary care physicians often perform the same tests and examinations on their patients, mental health practitioners provide a very diverse and customized service. The recurring nature of primary care means that medical bills are usually ready to go. The opposite is true for mental health care, making billing more complicated.

Creating an excellent standard: Standardizing primary care means that practitioners can easily combine multiple services into one perfect bill. On the other hand, the more diverse nature of mental health services makes it more challenging to create significant bills. The result is a longer and more difficult billing process.

How standardization affects mental health bills

Standardizing services provided is probably the most significant hurdle of the above factors in mental health care billing. Standardization issues arise from how these factors differ from primary or specialist care:

Session duration: Medical billing assumes approximately the same time for each patient – after all, regular blood tests and physical examinations take a long time. However, the duration of mental health sessions can vary greatly. For this reason, mental health billing codes vary based on session length, which is not heard in medical bills.

Daily or weekly service limits: In general, there are no primary or expert level restrictions on how often a patient can be treated. The same does not apply to mental health services. In hopes of standardizing mental health care bills, taxpayers set the maximum number of treatments a mental health patient can receive in a day or week. These artificial roofs can present billing challenges.

Therapeutic method: Cognitive behavioral therapy requires an entirely different CPT code than psychoanalysis. The result is more billing challenges.

The Bottom Line

The billing process can be frustrating and usually leaves a big sigh of relief compared to treating patients. And if you’re worried about not completing the process yourself, the billing features of DENmaar can be invaluable. 

We have assisted many health care organizations in their mental health billing process, thus helping them concentrate on patient care. Call us today! 

Understanding the process of credentialing is simple. It is a process that entails the procurement and verification of information that ascertains whether or not a physician is capable of fulfilling his or her medical obligations. The process is fundamental for everyone involved with the healthcare industry. This includes the practitioners, nurses, and of course, the patients. 

The credentialing process in itself, however, is burdensome, to say the least. A typical credentialing process can take 90 to 150 days to conclude. Hurdles like missing or incorrect information in the applications submitted can result in claim denials, which essentially means you’ll have to undergo the entire process all over again, costing you both valuable money and precious time. 

That being said, you can’t simply ignore the process either. Credentialing is important for a variety of reasons. 

• •     It can help build patient trust
• •     It lowers the risk of medical errors.
• •     It helps medical organizations from losing revenue
• •     It improves a practitioner’s reputation. 
• •     It can help you save costs
• •     It protects healthcare organizations from future lawsuits. 

Needless to say, the credentialing process is too valuable to pass. Yes, it can be uniquely frustrating to perform. However, we believe the following checklist can guide you competently for a smoother credentialing process. 

So without much further, allow us to acquaint you with the only Physician credentialing process checklist you’ll need for a seamless experience. 

  Physician Credentialing Process Checklist

The very first thing to do when starting the credentialing process is to make sure you are always one step ahead. The way to ensure that is by starting as early as possible. With that out of the way, you can begin the process. 

1. Submit the Pre-Application

It won’t take you time to notice or experience how tedious the credentialing process can be. To begin with, you will need to submit a pre-application based on the healthcare facility or insurance network you want to join. It is at this juncture in the process that insurance companies weed out applicants that are not eligible for credentialing. 

This step involves a background check. You will be checked for:

• •     Board Certifications
• •     Criminal Records
• •     Record of disciplinary action taken against you or your practice. 

If any issues arise here, you will be asked to submit further information. If there aren’t any issues, then you move on to the next step. 

2. Submitting the Applications

This step forms the actual meat of the process. You will be required to submit all information possible that vouch for your legitimacy as a healthcare provider. The most fundamental checklist will be as follows:

• •     Transcripts and educational history
• •     DEA registration
• •     Board certification
• •     Medical license
• •     Continual malpractice coverage
• •     Work history
• •     Professional and personal reference
• •     Explanation of gaps in work history
• •     Personal immunization record
• •     Personal health history
• •     CAQH Enrollment
• •     Hospital affiliation

All of the above information must be backed by solid documentation and relevant letters of recommendation. 

3. Receipt Verification

Once the application is submitted, you might feel inclined to take a sigh of relief. However, it will be too early to do so. In fact, we recommend constant follow-ups via call and emails to confirm that your application has been received and is under review. The credentialing board may reach out to you for further information. If that does happen, we recommend submitting the information as quickly as possible. Make sure you have copies of all the documents submitted ready at a moment’s notice. 

The above procedure entails the checklist for a traditional physician credentialing process. Medical practices may need to work with a new checklist to assist them in adding new providers. So if you are someone who runs a medical practice and wants to add a new provider to your staff, then the following checklist is for you.

  Checklist for adding a new provider

1. You will need to provide an updated CAQH profile with a new practice affiliation. Also, make sure the provider’s driving license and DEA are updated with the new state if the affiliation is different from their previous one.
2. The group that will be adding the new provider will be required to supplement a list of payers that they are currently affiliated with. This will include Medicaid HMOs, worker’s compensation, Tricare, Medicare advantage, etc.
3. Update your practice’s CAQH profile and supply tax companies with your Tax ID. 
4. You will be required to submit a new and updated malpractice policy and also update it in your CAQH profile. 
5. You will be required to provide the practice’s primary billing type. This information will be listed on your application with Tax ID. 
6. Mention Medicare’s PTAN that you plan to be included on. This information will be listed on the Medicare application of the new provider linked to your group. 
7. The following Documentation will be mandatory. 
   • •     Professional State License
   • •     Board Certification
   • •     CAQH Login and Password
   • •     PECOS Login and Password
   • •     PLI Certification
   • •     Professional School Diploma
   • •     State Medicaid Login and Password
   • •     Current CV with precise beginning and end date
   • •     Hospital Admitting Privilege
   • •     Certification of completing internships, fellowships, etc.

  The Bottom Line

Credentialing demands a plethora of information from practitioners. So much so that the whole process might feel a tad bit overwhelming. It also counts that all the information you do gather is complete and accurate. The consequences of failing to ensure that can be disastrous. 

So if you are still confused about the process and have no idea what information to carry, then we suggest you give our physician credentialing specialists at DENmaar a call. We are at your service whenever you need us. We’ll assist you with the entire process as well, making sure you make it on a payer’s network without a hassle. 

Contact us now to learn more.