Medical billing can be a crucial, but complicated process. It constitutes one of the most vital components of the health care industry, especially the behavioral healthcare sector. What makes the behavioral medical billing process concerning is the frequent billing errors that are pervasive throughout the industry.
Errors in coding are frequent sights to witness, especially when it comes to behavioral health, as such the diagnosis, treatment and coverage for a patient can be extremely messy. This, in turn, makes the claim submission process messy, resulting in most cases with denial of the claim.
Prominent Billing Errors
If we have any chance of combatting the issue of billing, we must first try to understand its cause. Some of the most common errors are listed below.
Errors such as incorrect spellings, typos in insurance ID’s are a major reason for insurance firms denying claims. The name, contact, and address of both the provider and insurance company could be entered incorrectly. This is because the medical bills can be influenced and changed by dozens of people, hence such errors are common
Apart from incorrect information, outdated or obsolete information can also put a wrench in your claim approval ambitions. Outdated information may come from the patient themselves. Claims can be rejected if data is found to be outdated; hence keeping data up-to-date is crucial.
An incorrectly entered quantity can end up charging the patient extra. Even erroneously adding a zero at the end of a number might widely exaggerate the cost of the treatment. Such errors should be avoided at all costs.
Most physicians have illegible handwriting. At this point, this has developed into a cliché amongst various medical professionals. However, this can also result in claim rejections as the handwritten documents are simply too messy to be comprehensive.
Double billing, unfortunately, is a common Behavioral medical billing mistake that has been going on since time immemorial. A patient might be charged twice, once by the doctor and once by a nurse who wasn’t aware of the doctor’s actions. A patient might also be charged twice for both drugs prescribed and drugs administered.
Undercoding occurs when the act of behavioral medical billing for a service is less expensive than the treatment provided, or leaving out codes altogether. Patients might be undercoded by providers to minimize patient’s costs or avoid any audits. Unlike other errors, this error affects the provider more than the patients.
Upcoding occurs when the act of billing for a service is more expensive than the treatment provided. This happens when a billing code is incorrectly changed to represent a more severe treatment or diagnosis. Upcoding has been deemed illegal and can also inflate a medical bill.
Incorrect or Mismatched Codes
Incorrect or mismatched codes can occur when a provider upcodes a patient’s diagnosis without changing his billing code. Mismatched codes can also inflate claims due to upcoding.
Unbundling is an act of billing for individual services that can be covered under a less expensive treatment plan. This basically means that charges which were typically falling under one code are now being listed separately.
Best Practices to Avoid Billing Errors
With the above causes now crystal clear, let’s look at some of the best practices that can help you avoid billing errors, and thus prevent claim rejections.
- • Double Check Patient’s Personal Information
This is probably one of the easiest ways to avoid medical billing errors-simply verify and re-verify your patient’s personal information. Make sure all the information submitted by them is correct and devoid of any silly mistakes and omissions.
- • Double Check Patient’s Insurance Information
Make sure to call your patient’s insurance company before you provide them with your services. Check whether their policy number and coverage are the same and that you have updated billing contact information.
- • Establish a policy to compile billing information
Establish a clear and precise policy that communicates accurately how billing information needs to be handled and managed by your staff. You have to ensure your patients aren’t being charged twice, hence make one person-in-charge of monitoring and managing the staff that handles billing.
- • Follow up on your claims
You can avoid errors by simply being diligent in your follow-ups with insurance companies. A representative working on your claim might be able to inform you of errors, allowing you to rectify and re-submit a polished claim again.
- • Establish Clear Communication and Co-ordination
Everyone working on a claim in your staff should be well aware of their roles and responsibilities. They should also be well organized and coordinated to know how to communicate with each other effectively. Stay up-to-date It is crucial that you stay up-to-date with your claim process and avoid the entry of any kind of obsolete information from your documentation.
DENmaar’s Mental Health Medical Billing Service
As you can guess from the article, behavioral health medical billing is not a walk in the park. A lot of effort, blood, and sweat goes into the entire process. It can be time-consuming and really frustrating for mental health practitioners who just want to tend to their client’s needs.
Here at DENmaar, we partner with concerned practitioners to offer pre-authorization, third party billing, claims follow-up, and to assist with appeals for any denied insurance claims. With DENmaar, you get the assistance of our behavioral health billing specialists to make your billing process easier than ever.Learn More
Medical billing on its own is a seriously complicated process. However, medical billing for Mental and Behavioral Health Billing Guidelines is a whole new level of the headache-inducing choir. It comes with its own set of unique and complex challenges. When you take into consideration the size and time availability of office staff, unbundling concerns, pre-authorization, etc., behavioral health practitioners are always at a disadvantage compared to their contemporaries in other fields
Understanding the process of behavioral health medical billing is the only way for mental health practitioners to achieve salvation. As then and only then can practitioners spend more time and money on something that matters to them beyond everything else – their patients.
Having emphasized the importance of comprehending the process, we at DENmaar have designed an intricate and precise behavioral health billing software that aims to lift the unnecessary weight of medical billing off your shoulders, thus allowing you to focus on what you are good at, which is tending to your patients.
What Makes Medical Billing for Mental Health So Difficult
The variety in the types of services, the time, scope, and restraints put on mental health treatments, all of them work in conjunction to make the medical billing very difficult. For practices other than mental health, the process is easily standardized; hence the medical billing process remains fairly easier to understand and implement.
However, the very volatile and diverse nature of behavioral health treatment doesn’t allow the luxury of convenient medical billing to those who practice it. Behavioral health treatment differs vastly. The session length, the therapeutic approach, the location in which services are rendered – all contribute to the complex nature of behavioral health medical billing.
Behavioral Health Billing Guidelines
So how can you, as a Mental and behavioral health practitioner, combat the tedious nature of medical billing? Read on for the answer.
1. Double Check Each Patients Insurance and Coverage
The very first thing you need to do as a responsible mental health practitioner is to learn about each of your patient’s insurance plans and coverages before each visit. Although this may sound like a time-consuming choir, knowing each and every patient’s insurance plan will reap greater returns in the end.
You can check all of your prospective client’s coverages by conducting verification of benefits for each of your patients before you begin treatment or serving the client in any manner.
Verification of benefits allows providers to unearth important information that is not available in the patient’s insurance card. By checking the VOB, you can rest assured knowing that they are insured for the services they are getting from you and will know how much the insurance company is willing to pay for the services of a client.
Many insurance companies provide online provider portals that can be used to perform verification of benefits by the provider. If a portal is not available, then you can directly call the insurance company to gather the needed information.
To conclude, it is very important to know the coverage and insurance plan of all of your patients, so you don’t end up with rejected claims and unpaid bills.
2. Understand CPT Codes
CPT or ‘common procedural technology’ are codes used by insurance providers to determine the amount of reimbursement to be delivered to healthcare facilities. When dealing with billing, it is imperative to know the associated behavioral health codes for billing. It is extremely crucial to understand the services your facility offers and its respective CPT codes.
Some mental health practitioners use the same CPT codes for all their services. This is illegal, and we recommend our clients never to do such a thing. There are two types of CPT codes available for behavioral health practitioners – E/M Codes and Psychiatric Evaluation Codes
E/M Codes are used to evaluate new medical issues and must have three documentation elements provided. They are:
Medical Decision Making
On the other hand, Psychiatric Evaluation Codes are used for diagnostic assessment. It can include E/M services, but the time associated with E/M services is not counted.
3. Submit Claims Properly
For you to get reimbursed for a claim without a hassle, not only do you need to file the correct code in reference to the correct insurer, but also submit the claim in the correct billing format. Make sure that you are well aware of the insurance companies filing method, and that you do file within the time allotted to you by the insurance company.
DENmaar’s Mental Health Medical Billing Service
As you can guess from the article, medical billing for mental health is not a walk in the park. A lot of effort, blood, and sweat goes into the entire process. It can be time-consuming and really frustrating for mental health practitioners who just want to tend to their client’s needs.
Here at DENmaar, we partner with concerned practitioners to offer pre-authorization, third party billing, claims follow-up, and to assist with appeals for any denied insurance claims. With DENmaar, you get the assistance of our medicare behavioral health billing specialists to make your billing process easier than ever.Learn More