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Essential Behavioral Health Billing Guidelines

April 21, 2023

Behavioral health billing can be a complex and time-consuming task for healthcare organizations. However, it is essential for your organization’s financial health and sustainability. Our guide will discuss important behavioral health billing guidelines, common pitfalls to avoid, and tips for improving your billing process and reducing denials.

Why Is Behavioral Health Billing Important for Your Organization?

Behavioral health billing is essential because it ensures you receive reimbursement for services rendered. 

Maintain cash flow

Accurate and timely billing is crucial for maintaining cash flow and ensuring the financial stability of your organization. Additionally, behavioral health billing services can help you to comply with regulatory requirements and avoid potential audits and fines.

Improve patient care

Proper reimbursement for behavioral health services can also help improve patient care access. When healthcare organizations are not reimbursed for services provided, they may need to limit the number of patients they can see, reduce their services, or even close their doors. These obstacles can be especially problematic in behavioral health, where access to care is already limited and demand for services is high.

Track patient care trends

Behavioral health billing services can also help you identify and track trends in patient care. Monitoring these trends helps to assess your organization’s performance and allows you to make necessary adjustments accordingly. Additionally, it can help track the cost of care, the time of service, and the utilization of services, which can be beneficial in budgeting and financial forecasting.

Common Pitfalls to Avoid With Behavioral Health Billing

Failing to code services and stay updated on guidelines

Poor coding practices can result in denied claims and lost revenue. Another risk is not staying current with billing guidelines and regulations, which can lead to denied claims. Failing to promptly and effectively follow up on denied claims can tighten your organization’s cash flow.

Forgetting to confirm patient eligibility

Another pitfall to avoid is failing to confirm that the patient is eligible for services. This can happen when there is a change in the patient’s insurance coverage or when the patient is not aware of their coverage, which places the burden of the cost of care on the organization.

Failing to verify pre-authorization requirements

Failing to verify pre-authorization requirements with insurance payers or not obtaining pre-authorization when required can lead to denied claims and financial loss for your organization. 

How to Handle Claim Denials

When a claim is denied, always review the reason and take action to correct the issue. These initial first steps may include resubmitting the claim with updated information or appealing the decision. It is also essential to track denied claims and identify patterns or areas where your billing process may need to be improved.

Having a system in place for tracking and reviewing denied claims can help organizations to identify trends and patterns in denied claims, which allows them to improve and make necessary adjustments accordingly.

coronis health remote workers employees discussing behavioral health billing guidelines

For example, if a large number of claims are denied for a specific code, this may indicate that the billing staff does not have adequate training on the use of that code; or, if claims are frequently denied due to missing documentation, your organization may need to review its documentation policies and procedures.

It’s also important to have a system for follow-up and appeals for denied claims. Partnering with a third-party behavioral health billing company can assist with this process.

Tips for Improving Your Billing Process and Reducing Denials

coronis health behavioral health worker talking with patient

To improve your billing process and reduce denials, consider partnering with a team that utilizes behavioral health billing software. This software can help to automate many of the tasks associated with billing and ensure that all relevant information is captured. 

Implementing software will enable your team to manage medical billing more efficiently, eliminating the need for manual processes, which can slow down the process and lead to mistakes. Automated systems can also ensure that all relevant information is captured.

Using the Correct Behavioral Health CPT Codes

Coding services correctly is essential for reimbursement. Correct behavioral health CPT codes ensure that insurance companies understand the nature and scope of services provided. Familiarizing yourself with the most up-to-date behavioral health CPT codes and ensuring they are used consistently is crucial. Using the correct behavioral health billing codes can also help you track the organization’s performance and identify any areas needing improvement.

Coronis Health behavioral health specialist talking with patient

Outsourcing ensures that your organization uses the correct codes and complies with all relevant regulations. Behavioral health billing companies have experts who are well-versed in the latest billing guidelines and codes and can assist with coding, billing, and reimbursement.

At Coronis Health, our revenue cycle management (RCM) team specializes in behavioral health billing. We stay abreast of the best practices to ensure behavioral health facilities improve revenue and remain financially independent. We provide end-to-end RCM so our clients can focus on what matters most: providing the best care possible to their patients.

Contact us today to schedule a free financial health consultation. We find missing revenue in 95% of our audits. Find out how we can help your behavioral health center thrive.

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