Mental Health Billing: Tips and Guidelines

mental health billing June 9, 2022

As a mental health provider, your goal is to provide the best care to your clients. It also plays a vital role in maintaining people’s well-being and healing their emotional wounds.

Insurance companies must be able to reimburse you promptly for services you rendered. 

However, there are often issues with mental health billing that can hinder the treatment process, such as inaccurate documentation or preauthorization. Mental and behavioral health providers may stumble upon one or more of these problems – and many others – which make it hard to run their practice effectively.

For instance, filing medical billing claims for mental health services takes too much time from patients. 

Thus, understanding the billing process’ complexities and finding ways to solve them can speed up the billing process and help you get paid faster for providing behavioral health services. Take this as a refresher course in mental health billing for dummies.

Throughout this article, you will learn the right mental health billing tips and guidelines.

Tips in Billing for Mental Health Services

While mental health billing isn’t easy, it can certainly be achieved with the right strategy and skill set. 

Here are some tips to help mental health practices bill for services more effectively, with more funds, more time for patients, and fewer denials. 

  1. Verify the Coverage and Insurance of Every Patient

The first tip is to know your patient’s insurance plans and benefits before each visit. However, making sure you understand the coverage available for each patient before receiving any services will lead to a larger return. 

While validating coverage may take much time, it pays off because you can ensure your client is covered and determine how much the insurer is likely to pay. Depending on the insurance company, you can verify coverage online or by phone. Verification of benefits (VOB) is also an excellent way to know what range your prospective patients have before they are treated.

It’s always best to check benefits before the first session and re-validate at the start of the year when coverage renews or if your client’s insurance changes.

  1. Know Your Common Procedural Technology (CPT) Codes

The American Medical Association (AMA) publishes and maintains the Current Procedural Terminology (CPT) code set. Most insurance payers use CPT codes to determine whether they will reimburse claims. You should use the correct codes for the services and stay up-to-date on the updates, which occur yearly. In this way, you can guarantee that the codes match the preauthorization, if applicable, and that you do not under-code or up-code. 

Below are the three most common mental health CPT codes:

  • 90791 – Intake session — to be billed for your first appointment with that patient exclusively
  • 90834 – 45-55 Minute Individual Therapy Session
  • 90837 – 56+ Minute Individual Therapy Session

  1. Pre-authorize When Necessary

In most cases, insurers don’t require preauthorization for initial visits or basic behavioral health sessions. In some instances, various payers have different rules (e.g., over 45-minute sessions or multiple sessions for one client in a day). When you start working for a new client, always check if preauthorization is required before providing any non-standard session.

  1. Learn How to File Claims Properly

For reimbursement on a claim, you have to file the correct claim code with the right insurer and submit the claim along with the correct billing format. Insurance companies may differ in this regard. If the insurance company has a preferred filing method, make sure you comply with it and the time frame set forth by the insurer. 

Most major insurance companies use the UB-04 claim form for specialized health centers such as mental health and rehabilitation clinics, so familiarize yourself with this form. 

You can fill out the UB-04 electronically or on paper, and several software programs have a current version of the form and instructions on how to complete it. Thus, ensure that your claim is properly filed to spend less time on it.

Guidelines to Make Your Mental Health Billing Process Easier

1.Electronic Health Record Software

To input the data and create the forms, you can try using a pure software solution, such as an EHR (electronic health record). It allows you to create and submit electronic claims easily. EHRs come with calendaring, appointment reminders, simplified documentation, internal messaging, a patient portal, and credit card processing. Look for an EHR explicitly tailored to the behavioral health providers.

2. Hire an Outsourcing Company for your Mental Health Billing Services

If you want to focus on providing healthcare rather than processing claims, you can hire a billing company to handle your claims. They can manage a variety of tasks for you. Aside from billing and claims submission services, some outsourcing billing companies also take care of prior authorization, VOB, claim denials, and follow-ups. 

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