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The Difference Between Behavioral Health and Medical Billing

August 8, 2022

A common misconception about mental and behavioral health is that health insurance covers services the same way other medical services are covered. Unfortunately, this is not the case, and it can cause significant headaches for providers in the mental and behavioral health sphere. 

The differences and restrictions related to mental and behavioral health cause some providers to refrain from accepting insurance, or limit themselves to accepting only a few plans, because the billing process can be complex and arduous. A thorough understanding of benefits, eligibility, and how insurance reimburses for mental and behavioral health can help a specialist move beyond frustration and gain more out of the billing process. Coronis Health understands the unique differences in mental and behavioral health billing, which ensures you can focus on what is most important – your patients. 

What Is Mental and Behavioral Health Medical Billing?

Standard medical billing focuses on standard services such as physical exams, diagnostic testing, and follow-up visits for chronic conditions. Mental and behavioral health care varies based on different types of therapy, psychological testing, and associated medical treatments. Insurance places more restrictions on the billing practices for behavioral and mental health, such as the number of visits allowed in a month or year, or a requirement to obtain pre-authorization before rendering services. Understanding the distinct differences in mental and behavioral health medical billing is the first step to earning more from the services you provide. 

Mental and Behavioral Health Medical Billing: What’s Covered

Mental and behavioral health medical billing focuses on the treatments patients receive for long-term conditions such as depression, anxiety, bipolar disorder, substance use disorders, or schizophrenia. The most important aspect of billing for mental health services is the restrictions placed on facilities and the patient, such as limiting the number of visits in a week or month, and placing time limits on the actual visit. Pre-authorization is sometimes required before visits are covered. 

Some insurance plans do not cover mental health services, and some providers are out of network with a patient’s plan, so mental health providers must be prepared for patients who are paying out of pocket for services. 

coronis health doctor consulting female patient mental and behavioral health medical billing

Billing for behavioral health services also requires a good bit of knowledge and a dedicated employee to focus on the billing component of a patient’s mental health services. Many mental health providers end up spending substantial time on the administrative process, distracting them from the vital care of their patients. Coronis Health can eliminate the challenges of mental health billing to ensure that the facility is gaining more from the services they render.

How Medical Billing Works for Each Type of Health Care

Medical billing for mental and behavioral health services requires a comprehensive level of knowledge of insurance plans, CPT codes, and reduction in denials to increase reimbursement for a facility.

  • Verification of benefits ensures that services are either covered or not covered
    • This includes verification of the need for pre-authorization for services
  • CPT codes used during a visit include the evaluation and management (E&M) codes, which require extensive knowledge of the difference between standard E&M codes and psychiatric evaluation codes
    • Special attention must focus on time, as the time spent with E&M codes cannot attribute to the time of a psychotherapy service
  • Understanding CPT codes ensures that claims are not rejected, resulting in a higher rate of reimbursement, and a lower number of days in accounts receivable. 

Coding Regulations for Mental and Behavioral Health Medical Billing

Billing for mental and behavioral health services is more than just diagnosis and CPT codes; there are vast differences that can create confusion for billers who are not well-versed in this type of medical billing. Submitting claims can even differ from one payer to another, so it’s important to focus on the regulations and codes that apply to the services rendered, and the guidelines of the patient’s plan.

  • E&M codes are not as straightforward as medical billing
  • Time associated with a visit is included for psychotherapy 
  • Payers may require certain codes to be submitted with claims
  • Billing format is critical, and also differs from one payer to another, such as a CMS1500, or a UB-04, or electronic billing through the facilities’ electronic health record (EHR) system

The coding regulations placed on mental and behavioral health claims ensure that the services are captured accurately and that reimbursement is paid accordingly. 

coronis health female worker at computer behavioral health medical billing

How Are They Different?

The differences between behavioral health billing or other medical billing boil down to the specific services that are rendered. Medical billing includes straightforward services, such as diagnostic testing (laboratory tests or radiologic exams). Mental and behavioral health services range from psychotherapy to medical management, and psychological testing services to inpatient or outpatient rehabilitation. The biggest hurdle with coding for mental and behavioral health services is understanding the differences in coding and the restrictions within a patient’s insurance plan. 

These differences create a mountain of work for a facility, so outsourcing can save a lot of time, effort, and money. In addition, facilities that outsource tend to receive higher reimbursements, allowing them to provide better care for their patients. 

Questions about Mental or Behavioral Health Medical Billing? Contact Coronis Health Today!

Coronis Health has certified, trained billing experts that know how to help you gain the most out of your mental and behavioral health claims. If you are struggling to keep your claims current and your coding correct, call Coronis Health today. We can give you back the time you need to focus on the most important part of your work – your patients. Don’t hesitate – call us now.

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