Behavioral Health: Case Study

By Author: Medisys Team
Total Articles: 3
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With more people becoming aware of psychological health issues and spending more money on psychiatry during the past ten years, the number of mental health experts and clinics has increased dramatically. Despite the growing need for mental health services, it is becoming increasingly more difficult for providers to receive fair compensation for their labor.

Before we get into how our client’s operations encountered an unexpected growth, let’s take a quick look at how mental wellbeing billing functions. Many different but specialized professions work in the field of mental health. Psychiatrists, counsellors, psychologists, clinicians, therapists, family doctors, and clinical social workers are common professions in the field of mental health.

With the advent of COVID-19 pandemic, the cases of mental health has been increasing day by day. With the increase in the cases it is difficult for the medical practitioners to focus on the billing structure and then carry out the paperwork. It is a tedious task and it calls for a lot of hours to be put into so it is better to hire a medical billing company. Before diving ...
... in to the kind of work that the medical billing companies can offer you, let us take a look at the kind of medical billing services that are involved in the behavioral health industry.

1. Health billing for the behavioral industry

2. Billing under physiotherapy

3. Billing under psychiatry

4. Billing under counselling

5. Billing under therapy sessions

6. Billing for non-profit organizations.

When we take a look at the medical billing services, there have been instances where the doctor has failed to recover the amount, due to the number of patients that are constantly working with the doctor. For an instance, the revenue that you might have calculated for the entire year, is not being generated and has been verified when the books have gone for the audits There is a gap, and you are unable to retrieve the gap. This gap in billing is in turn burning up the money that you have earned and have put your hours into. Thus, medical billing agencies will help you in covering up such gaps such as Medical billing companies in Delaware.

Let us take a brief look at some of the cases which in turn contributes to the medical billings not being done in a proper way:

1. Faulty payer credentialing, which they believed had already been taken care of by their internal staff.

2. The patient demographics and insurance details were either incorrectly recorded or the payers’ benefits and coverage were never confirmed.

3. While submitting the claims, the customer did not adhere to the most recent and correct billing and coding standards. For example, they were categorizing the CPTs that were just replaced and withdrawn.

4. Due to ongoing issues with their billing processes and patient issues, the firm fell behind in timely billing out all the charges to the payers.

Why Is Medical Billing for Mental Health Care So Difficult and Complicated?

The kinds of services, duration, breadth, and restrictions put on treatment for mental illnesses make medical billing for these services more challenging than in other healthcare settings. For instance, if someone goes to the doctor for a usual checkup, they will probably undergo a typical set of examinations and tests. This often entails measuring the patient’s height and weight, taking their blood pressure, hearing their heartbeat, and maybe drawing blood.

These tests are generally the same for every patient, require the very same period of time, and just slightly vary from case to case. Similar to this, when providers bill health insurance for these routine exams, the billing is uniform, repetitious, and frequently combined into one total price.

Due to a shortage of resources for mental health professionals, medical billing of mental health treatments is often challenging. Numerous mental healthcare is provided by solo or small-group practitioners with little to no administrative assistance. This implies that the responsibility for medical billing falls on the doctors themselves. However, the medical billing companies can take care of the paperwork for you.

Certain tips for mental health billing:

1. Our first piece of advice is to make sure you are aware of each patient’s insurance benefits and plans before to each session. This may seem like a very time-consuming task, and it certainly is. However, you will ultimately get a higher return if you make sure you are aware of the coverage options for each client before they obtain any services. We advise performing a validation of claims for every client before any therapy or services are rendered in order to ascertain what coverage your potential patients have.

2. Insurance companies utilize CPT codes, also known as ” Current Procedural Terminology ” codes, to calculate how much money should be reimbursed to medical facilities. Knowing the services your practice provides and the related Standards and codes is essential when dealing with community mental health billing, or in fact any sort of medical billing. Some providers of medical billing services will assign the same CPT code to each patient, however this is not permitted or advised. So, if you take help of Medical billing companies in Ohio, there is a better chance at reimbursement.

3. You must submit a claim in the proper billing format, which differ based on the insurance provider, in addition to filing the right code to the right insurer, in order to be reimbursed for a claim. Make sure you file according to the insurance plan’s deadline and that you are aware of the preferred filing method used by the insurance company.

As you’ll see, submitting claims accurately for therapists requires a lot of work. It is not surprising, however, that many healthcare practitioners opt to engage a third party invoicing company to manage claims so they can devote more time to patient treatment and care such as Medisys Data Solutions.