Medical billing and behavioral health billing are interconnected components of healthcare billing. Both require submitting requests to insurance providers and other payers, utilizing coding systems and precise documentation and processes.
However, there are also major differences between billing for behavioral health services and general medical billing. The services rendered by behavioral health practitioners are diverse and unique, and the billing process can be a little more complex.
How does behavioral health billing differ from medical billing?
Insurance providers place different restrictions and limits on behavioral health and medical billing processes. This means that practices need a nuanced and expert billing team to ensure their claims are submitted correctly.
These are some of the main differences between the two billing processes:
Billing according to session length
Although both billing processes involve billing codes, medical billing codes are more set and straightforward than behavioral health billing codes, such as ABA therapy billing codes.
Mental health sessions tend to vary in length, and instead of billing codes per treatment type, they are also billed per time spent in sessions. The billing codes apply to different 15-minute sessions; for example, 30 minutes of individual ABA therapy would differ from 45 minutes of individual ABA therapy.
Medical billing codes tend to be more standardized, such as one for drawing blood or another for a well-woman visit. They don’t tend to differ in length, making billing slightly less complex.
Appointment limits
Insurance providers set different limits and restrictions on behavioral health services. They often impose daily, weekly, or monthly maximum limits for the number of treatments provided and can impose limits on the length of each session.
Insurance applies limits to medical billing procedures differently, so it’s critical to understand the difference in the limits between the two.
Prior authorization
It’s unlikely that an insurance provider will need pre-authorization for a routine doctor’s visit for an illness or blood draw. However, they normally require pre-authorization for outpatient procedures like MRIs, X-rays, or in-patient surgical procedures.
However, insurance companies almost always require authorization for mental health billing before a patient gets treatment. This can cause complications if patients are not aware of the required pre-authorization restrictions, as they may be unable to afford treatment fees out of pocket if the claim is denied.
Telehealth billing
The increased use of telehealth since the pandemic has added further complexity to the billing system. Many insurance providers are happy to pay out claims for telehealth medical billing services and have a standardized approach to codes and coverage. It is not quite as straightforward for mental health or behavioral health services.
Behavioral health practices need to add modifiers to their usual billing codes, or they could be expected to use a completely separate set of billing codes for telehealth services. Different codes are used for assessments, evaluations, treatment, and management, and insurance providers don’t always cover all of these options for telehealth patients.
Changing regulations
As mental and behavioral health treatment becomes less stigmatized, it is slowly being integrated into the greater healthcare landscape. Although this is a positive step for behavioral health treatment, it does mean that billing rules and regulations are constantly evolving. Providers must stay on top of these changes to ensure they submit the correct claims with the right documentation.
Tips for behavioral health billing
Behavioral health billing is complex and time-consuming. Practices often lack the resources, time, and software to handle their billing needs, which can lead to underpayment, late payment, or no payment at all.
These tips can help ABA therapists save time on billing, optimize their processes, and maximize reimbursement.
Ensure proper pre-authorisation
The first step when taking on any client is to ensure that you clearly understand their insurance and what their coverage entails. Ensure that their insurance will cover their assessment and customized treatment plan. Make sure the client knows if they are expected to cover any out-of-pocket expenses.
Maintain detailed documentation
Maintaining meticulous client records will help you with pre-authorizations and avoid claim denials and rejections. Keep accurate records on client demographic information, diagnosis specifics, medications prescribed, and treatments delivered.
Keep up to date with the latest codes and regulation changes
It’s essential that your practice stays up to date with the most current coding information, regulation changes, and more in the industry. This ensures that you correctly submit claims and avoid denials and rejections that could delay reimbursement.
Partner with a billing expert like Missing Piece
One of the best ways to ensure that your billing process is effective and efficient is to enlist the help of a behavioral health billing expert. There are many benefits to outsourcing ABA billing, such as reducing staffing costs and overhead space requirements, access to industry information, faster revenue collections, and much more.
Most importantly, when you partner with a company like Missing Piece, we free up your time to do what is most important: Giving your clients the quality care and service they deserve.
Contact us to schedule a free billing consultation today and learn more about how we can help you with our outstanding behavioral health billing solutions.