Do you want to increase your revenue, reduce stress, and avoid audits and penalties in your mental health practice? If so, you must pay close attention to your billing process and avoid common pitfalls that can cost you time and money. Mental health billing is a complex and challenging process that requires careful attention to detail and compliance with various regulations. However, many mental health providers make common mistakes that can lead to lost revenue, delayed payments, audits, and penalties.
This article will discuss five common mistakes to avoid in mental health billing and how to prevent them. By avoiding these mistakes, you can improve your billing efficiency and accuracy, reduce denials and rejections, and increase your cash flow. You can also save time and energy that you can devote to providing quality care to your clients and growing your practice.
1. Not verifying eligibility and benefits before each session
One of the most common mistakes mental health providers make in their billing process is not verifying eligibility and benefits before each session.
“Eligibility and benefits refer to whether the client is covered by a specific insurance plan and what services and conditions are covered under that plan.”
Suppose you only verify eligibility and benefits after each session. In that case, you may end up providing services not covered or reimbursed by the insurance company, or you may charge the client the wrong copay or deductible amount. This can result in denials, rejections, or underpayments of your claims, as well as dissatisfaction and confusion among your clients.
To avoid this mistake, you should verify eligibility and benefits using the insurance company’s website, phone number, or electronic verification system before each session. You should also ask the client for their most recent insurance card and verify their personal information. It would help if you looked for information such as:
- The effective date and expiration date of the plan
- The type of plan (HMO, PPO, EPO, etc.)
- The copay or coinsurance amount for each service
- The deductible amount and how much has been met
- The annual or lifetime maximum benefit amount
- The prior authorization or referral requirements
- The covered services and diagnoses
- The exclusions or limitations of the plan
2. Using incorrect or outdated codes and modifiers
Another common mistake mental health providers make in billing is using incorrect or outdated codes and modifiers for different services and diagnoses.
The insurance companies use them to determine the reimbursement rate and the medical necessity of the services. If you use incorrect or outdated codes and modifiers, you may undergo or overcome your services, resulting in underpayments, overpayments, or denials of your claims. You may also face audits or penalties if you use codes and modifiers that do not match your documentation or are considered fraudulent or abusive.
You should avoid this mistake by using correct and updated codes and modifiers for each service and diagnosis. You should also be familiar with the coding guidelines and rules of the insurance companies and the professional organizations that govern your specialty. It would be best if you looked for information such as:
- The current version of the coding system (such as CPT, ICD-10, DSM-5, etc.)
- The specific codes and modifiers for each service and diagnosis
- The definition and criteria of each code and modifier
- The frequency and duration limits of each code and modifier
- The documentation requirements of each code and modifier
- The changes or updates of the codes and modifiers over time
3. Providing insufficient or inaccurate documentation
A third common mistake mental health providers make in their billing process is providing insufficient or inaccurate documentation for each service and diagnosis.
“Documentation refers to the written or electronic records that describe the services provided and the diagnoses treated, such as intake forms, progress notes, treatment plans, assessment reports, etc.”
Documentation serves as the basis for billing and coding and for proving the medical necessity and quality of the services. If you provide insufficient or inaccurate documentation, you may miss or misrepresent important information that can affect your billing and coding process. You may also face denials, rejections, requests for additional information from the insurance company, audits, or penalties if your documentation does not support your claims or contains errors or inconsistencies.
You should provide sufficient and accurate documentation for each service and diagnosis to avoid this mistake. You should also follow the documentation standards and expectations of the insurance companies and the professional organizations that govern your specialty. It would help if you looked for information such as:
- The format and content of each type of documentation
- The date and time of each service
- The name and credentials of the provider
- The frequency and duration limits of each code and modifier
- The codes and modifiers used for each service and diagnosis
- The goals, objectives, interventions, outcomes, and recommendations of each service
- The signature and attestation of the provider
4. Submitting claims late or manually
A fourth common mistake mental health providers make in their billing process is submitting claims late or manually.
If you submit claims late or manually, you may miss the filing deadlines or make errors in the claim forms that can affect your billing process. You may also face delays, rejections, or denials of your claims, reduced cash flow, and increased administrative costs.
To avoid this mistake, you should submit claims electronically and promptly. You should also use reliable and secure software or service to help you with your claim submission process. It would help if you looked for information such as:
- The filing deadlines and policies of each insurance company
- The electronic claim submission options and requirements of each insurance company
- The software or service features and benefits that can help you with your claim submission process
- The claim form fields and information that you need to fill out correctly and completely
- The claim status and confirmation reports that you need to check and verify
5. Not tracking or following up on claims status
A fifth common mistake mental health providers make in their billing process is not tracking or following up on claims status.
“Claims status refers to the progress and outcome of your claims after you submit them to the insurance company.”
It indicates whether your claims are accepted, rejected, denied, paid, or pending. If you do not track or follow up on claims status, you may lose track of your claims or miss important information or actions that you need to take to resolve your claims. You may also face reduced cash flow and increased accounts receivable.
To avoid this mistake, you should track and follow up on claims status regularly and diligently. You should also use reliable and secure software or service to help with your claim tracking and follow-up process. It would help if you looked for information such as:
- The claim status and payment reports and notifications that you receive from the insurance company or the software or service
- The reasons and explanations for any rejections, denials, or delays of your claims
- The actions and steps that you need to take to correct, appeal, or resubmit your claims
- The deadlines and policies for taking any actions or steps to resolve your claims
- The outcomes and results of your actions or steps to resolve your claims
FAQs
Some possible consequences of inaccurate coding and incorrect billing are Delayed, reduced, or denied reimbursements, Charges of abuse or fraud, and Adverse effects on patient care and satisfaction.
To unbundle procedural codes means using separate codes for each service component that should be billed as a single code. For example, if a provider performs a biopsy and a surgical excision on the same lesion, they should use a single code that covers both procedures.
Some common code mistakes are Using outdated or obsolete codes, incorrect modifiers, the wrong level of service codes, and non-specific diagnosis codes.
Final Analysis
Mental health billing is a complex and challenging process that requires careful attention to detail and compliance with various regulations. However, avoiding some common mistakes can improve your billing efficiency and accuracy, reduce denials and rejections, and increase your revenue. These mistakes are not verifying eligibility and benefits before each session, using incorrect or outdated codes and modifiers, providing insufficient or inaccurate documentation, submitting claims late or manually, and not tracking or following up on claims status. By avoiding these mistakes, you can also save time and energy that you can devote to providing quality care to your clients and growing your practice.