Behavioral and mental health practices face unique billing challenges that are very different from other medical specialties. Complex documentation requirements, evolving payer guidelines, and the nuances of time-based coding can make managing the revenue cycle a daunting task for outpatient mental health providers. That’s where specialized behavioral & mental health billing services come in. At Medisys, we offer customized billing solutions exclusively for outpatient behavioral and mental health providers. Whether you’re a solo practitioner, group practice, or clinic, our services are designed to streamline your billing process, reduce claim denials, and maximize reimbursements.
Why Behavioral & Mental Health Billing Is Different
Unlike other medical specialties, behavioral and mental health billing involves a unique set of challenges. Insurance companies often impose stricter documentation and authorization requirements for mental health services. Additionally, many outpatient behavioral health services are billed using time-based CPT codes, which increases the risk of coding errors. Some key differences include:
- Time-based CPT codes (e.g., 90834, 90837, 90853) requiring accurate session tracking.
- Frequent pre-authorizations for psychotherapy and counseling services.
- Complex billing scenarios, like multiple services provided on the same day (e.g., individual therapy and group therapy).
- Telehealth billing rules, which vary by payer and often change without notice.
These complexities make having an experienced billing partner essential for behavioral and mental health providers.
Our Behavioral & Mental Health Billing Services Process
Medisys follows a streamlined, end-to-end billing process that simplifies revenue cycle management for outpatient mental and behavioral health providers. Our approach ensures accuracy, compliance, and efficiency at every step.
- Patient Insurance Verification & Eligibility Checks: We verify patient coverage before appointments, ensuring services are covered and identifying any co-pays or deductibles upfront.
- Prior Authorization Management: We manage and track all prior authorizations, minimizing the risk of claim denials due to authorization issues.
- Accurate Charge Entry & Coding: Our certified coders are proficient in CPT codes such as 90832, 90834, 90837 for psychotherapy; 90853 for group therapy; H-codes (e.g., H2019) for Medicaid behavioral health programs; and ICD-10 codes for mental health diagnoses (F-codes). We ensure correct modifiers are used, such as modifier -25 when billing an E/M service with psychotherapy or modifier GT or 95 for telehealth services.
- Claim Submission & Scrubbing: Before submission, we scrub every claim for coding accuracy and compliance with payer-specific guidelines to avoid rejections.
- Payment Posting & Reconciliation: We post payments promptly and reconcile all transactions to identify underpayments or discrepancies.
- Denial Management & Appeals: Our team analyzes denials, identifies the root cause, and resubmits corrected claims quickly. We handle appeals when necessary.
- Patient Billing & Support: We offer patient-friendly statements and dedicated support to address any billing-related questions from your patients.
- Compliance & Reporting: We ensure HIPAA compliance and provide detailed reports on claim status, payments, and accounts receivable to keep your practice informed.
Billing Challenges in Behavioral & Mental Health Services
- Authorization Issues: Many behavioral health services require prior authorization, and missing this step can result in denials. We manage prior authorizations proactively and send timely reminders for renewals.
- Time-Based Code Errors: Using the wrong CPT codes or incorrect session durations can lead to underpayments or denials. Our coders are experts in time-based CPT codes and ensure accurate documentation and billing.
- Telehealth Billing Complexity: With evolving regulations, it’s easy to make mistakes in telehealth billing. We stay current with payer-specific telehealth guidelines and apply the correct place-of-service codes and modifiers.
- Same-Day Services Denials: Billing multiple services on the same day often results in denied claims. We correctly apply modifiers like -25 and ensure documentation supports the medical necessity for each service.
- Credentialing & Enrollment Delays: Uncredentialed providers can’t bill for services, causing significant revenue loss. We offer credentialing and enrollment services, expediting the process so your providers can begin seeing patients sooner.
Our Tailored Behavioral & Mental Health Billing Solutions
No two practices are alike. That’s why we offer customized behavioral & mental health billing services based on the unique needs of your practice.
- Solo Practitioners: We manage your entire billing cycle, letting you focus on your patients.
- Group Practices: We handle complex billing scenarios, including multi-provider services and group therapy billing.
- Clinics & Treatment Centers: We streamline high-volume billing and manage diverse services like IOP, PHP, and ABA therapy.
Our solutions are flexible and can be tailored to fit your workflow, practice size, and specialty focus.
Our Proficiency in Behavioral & Mental Health Billing Software
We work seamlessly with leading behavioral & mental health EHR and billing software, ensuring a smooth billing process without requiring you to change systems. Our team is experienced with SimplePractice; TherapyNotes; Kareo; AdvancedMD; and other billing software. Whether you prefer cloud-based EHRs or integrated billing platforms, we can manage your billing within your existing system or use our in-house tools.
Why Choose Medisys for Behavioral & Mental Health Billing Services?
- Exclusive Focus on Outpatient Providers: We specialize in outpatient behavioral and mental health billing, offering services tailored to your unique needs.
- Tailored Billing Solutions: Our services are fully customizable, whether you run a solo practice or a multi-provider clinic.
- Proficiency in Top Billing Software: No need to switch software! We work in the system you already use.
- Credentialing & Enrollment Services: We expedite the credentialing process, helping you onboard new providers and expand your practice.
- Reporting & Communication: You’ll receive regular updates, performance reports, and quick responses from our dedicated account managers.
- HIPAA-Compliant & Secure: We prioritize data security and compliance to protect your patients and your practice.
Simplify Behavioral & Mental Health Billing with Medisys
At Medisys, we understand the complexities of behavioral & mental health billing services for outpatient providers. Our tailored solutions, software expertise, and credentialing services ensure that your revenue cycle runs smoothly – allowing you to focus on delivering quality care. Ready to streamline your billing process? Contact us today for a free consultation!
