Psychiatry and Mental Health billing and coding requires an in-depth understanding of insurance plans, patients’ benefits, and insurance requirements. Claims need to be error free to get paid with initial submission and avoid payment rejection. Coding is based on time and service and must be carefully noted in the exam and cross-checked with the claim. CPT codes used on claims will depend on the duration of the visit and the type of treatment done.
Mental Health plans are set up much differently from medical coverage plans. A medical plan might have no restrictions, require no authorization, or referral, whereas mental health plan for the same insurance might require pre-authorization, referral, or have restrictions on the number of visits allowed. No two plans are the same. The biller should make a chart with insurance names and requirements in order to avoid claim rejections. Insurance requirement information should be shared with the provider as well as office staff. A well-informed practice is like a well-nourished body, they both thrive on healthy habits.
Insurance Coverage for Mental Health
Insurance benefit must be verified and noted before the visit date. Keep in mind that a patient can change insurance or plan coverage at any time, so it is important to make sure to have the correct information on file before each visit. Some insurance, such as Healthy Blue will cover up to 8 visits for patients less than 21 years of age without prior authorization, and up to 16 visits for patients over 21 years of age.
After these visits are exhausted, the office will need to reach out to insurance to get authorization for additional visits. Mental Health claims often get denied for coordination of benefit (COB) issues as well; another important reason for verifying insurance benefits before appointment. COB issues can only be fixed by patients by calling the insurance company. If there is any problem with coverage, inform the patient to contact insurance to make needed corrections.
Lot of times patients will say that they have contacted insurance and everything is OK now. Billers still have to re-verify to be certain all issues have been resolved and claims will be processed.
Mental Health Billing
Well documented exams are the best supporting evidence for claims. Providers need to make detailed documentation in their exam notes noting all aspects of the visit and treatment. Many times, insurance companies will send letters asking for medical records before processing claims. Office may need to submit medical records to lawyers, courts, or other legally binding parties as well. Staff need to be alerted never to disclose any medical records without the knowledge of the provider.
It is also a good idea for the provider to review all notes before submitting them to third parties. Billers also need to have updated knowledge of bundled codes, appropriate modifiers, and unbundling rules. It is also a good practice to download Local Coverage Determination (LCD) rules for insurances that are billed frequently.
Whether you are billing for Psychiatrists or Mental Health therapists, having an in-depth knowledge of Mental Health plan coverage and restrictions will definitely bring success to your practice. A well-run practice is proactive in gathering patients’ demographic and insurance information at the time of the appointment. Successful billers always verify coverage a few days before the appointment date and establish effective communication with patients. Well-informed staff and well-informed patients are a winning combination for successful medical practice.
Farida Chowdhury, OCSR, MA, BS
Billing and Coding Specialist