How to Improve Revenue Accuracy in Behavioral Health Billing

How to Improve Revenue Accuracy in Behavioral Health Billing

Running a behavioral health practice requires compassion. You spend your days helping people heal, guiding them through their darkest moments. However, there is a silent partner in your room: the business side. If your cash flow falters, your mission as a healer may suffer. This is why behavioral health billing solutions are so vital. It is not just about numbers and revenue, but more about keeping your practice’s doors open for those who need you to be their healer.

Many providers find billing a major headache. It feels like a separate language, with all the coding details, insurance needs, and ever-evolving regulations. Behavioral health billing is not that hard to catch when the right strategic approach is applied. When you master your billing, you reclaim the time that should be spent on patient care. You can focus on your patients instead of your billing spreadsheets.

Why Behavioral Health Billing is Unique

In general medicine, billing is often straightforward, with basic treatments such as treating a cold or relocating a bone. In behavioral health, things are different. Sessions vary in length, while some are held in groups. Others may happen in a crisis. This complexity makes behavioral health claims management a specialized field to cater to.

Insurance companies look for very specific details when catering to a medical billing claim. They want to see the reason behind every session conducted. If your documentation lacks a tiny detail, they might reject the claim. This creates a revenue gap due to incomplete or unsupportive documentation. Closing this gap begins with the understanding of your unique revenue cycle.

Common Challenges You Face

• Time-Based Coding: Many codes depend on the length of your session.
• Pre-Authorizations: Some services need a “green light” before you start.
• Payer Differences: Each insurance company has its own set of rules.
• Rising Denial Rate: Mistakes and gaps leading to claim denials.

Processing the Behavioral Health Revenue Cycle Management

Think of your revenue cycle as a circle. It starts the moment a patient calls you, and ends only when the payment is received in your bank. This entire process is called behavioral health revenue cycle management (RCM). If one link in this chain breaks, the whole circle stops.

Improving accuracy means looking at every step of this circle. Not just one step of the process, but each segment has to be carefully observed. Most errors happen before the patient even sees a provider. Let us look at each step, considering the errors that could be eliminated to improve your revenue cycle.

The Power of Front-End Verification

The behavioral health billing process and its accuracy levels begin right at the front desk. When a new patient calls, verify their insurance eligibility immediately. Do not wait until the first session is over to confirm their coverage details. Make sure that you include all the relevant questions to gather the right information that supports their eligibility for the service:

• Is the policy currently active?
• Does their plan cover behavioral health services?
• Do they have a high deductible to meet?
• Is a prior authorization required for this specific service?

When you get this right, you prevent “surprises” later. Patients appreciate knowing their costs upfront. It builds trust. It also ensures you get paid for your hard work.

The Behavioral Health Claims Management

As the patient’s session with the physician ends, the billing phase begins. You must translate your clinical work into data. This is where behavioral health billing accuracy is important. It is the process of creating, submitting, and tracking claims within the payer-set timeframe.

• The behavioral health billing claim must be cleared as a clean claim. A clean claim is one that an insurer accepts on the first try. To achieve this, ensure that all details mentioned in the claim resonate with what actually took place in the session, including the ICD-10 and CPT codes and the clinical documentation.
• Track your claims like a hawk. Do not assume a claim submitted is a claim paid. Check your clearinghouse reports regularly. If a claim seems stuck in the process, find out the reason. Addressing a small error today saves weeks of waiting for the reimbursement later.

Pro Tip: Utilize a “scrubber” tool. Many behavioral health billing services have these built within their system. They catch such errors before you hit the send button.

Mastering the Codes

Accurate coding is a prerequisite, which is why many providers feel overwhelmed while handling behavioral health claims management. You have CPT codes for therapy and then the HCPCS codes for supplies or specific programs. Using the wrong code is a fast track to having your claim denied. Some common codes that are integrated in these claims on a regular basis include:

• 90834: Individual psychotherapy, 45 minutes.
• 90837: Individual psychotherapy, 60 minutes.
• 90853: Group therapy.

Ensure your clinicians understand the differences within each code, and that the clinical documentation clearly supports and mirrors the codes used in the claim. If the session was of 60 minutes, then the coded bill must be for 60 minutes as well. This alignment is the core that ensures accurate behavioral health billing.

Transforming the Denial Rate into First-Pass

Denials are frustrating, as they typically mean the insurance company refused to pay you the reimbursement you are entitled to. But remember that this is not the end of the revenue cycle for that claim. It is almost like a puzzle that needs to be solved to crack the code. This is where behavioral health billing denial management comes into play.

Analyze the Reason behind the Denials

Re-submitting the same claim is not the solution. Look at the denial code and identify the reason the claim was denied in the first place. Identifying the reason clears the path towards the right approach to turn the denial into an accepted claim. See if the error was one of the few mentioned below:

• Duplicate Claim
• Missed Submission Deadline
• Unsupporting Clinical Documentation
• Unclear Medical Necessity

Build a Denial Log

Keep a list of every denial you receive and look for patterns within those denials. If one insurer keeps denying a specific code, discuss the reason for the denial and try altering that pattern. You might need to change how you document that service.

Reducing your denial rate by even 5% can change your bottom line, keep your revenue steadily flowing, reduce bottlenecks, and minimize denials.

Implementing the Behavioral Health Billing Solutions In-House

If you prefer to handle the complicated details of the medical billing process yourselves, then you’ll need the right tools. The old school ways are not compatible with the advanced billing formats today. With the far more efficient, automated systems of these advanced times, you can now easily manage behavioral health billing.

Acquire advanced software that synchronizes efficiently with your Electronic Health Record (EHRs). Information transfer and integration become smoother, and the scrubbing tool helps with the identification of errors before the claim submissions. It reduces the risk of erroneous duplicate claim filings, removing a higher percentage of errors. 

Key Features to Seek:

• Real-Time Eligibility Check: Verifies the eligibility in seconds.
• Integrated Scheduling: Links the appointments with claims.
• Custom Reporting: Know your exact money process.
• Auto-Posting: Save time by letting the software post payments.

The Human Element of Billing

We often talk about billing as a technical or rather tardy task. But remember, there is a patient at the other end, who feels the direct hit in case of an inappropriate bill. When your billing is accurate, their satisfaction with your practice remains constant. 

Clear communication is an integral part of behavioral health billing. Send clear, easily readable statements and offer payment plans if needed. It amplifies patients’ trust in your practice and maintains a healthy patient-practice relationship.

Billing Accuracy

Accuracy is not a single-handed obligation; it is achieved through team effort. And it is not just for the billing department. It begins with the front desk team and the clinician in the room, and continues through with the billing team.

Train Your Staff

Hold regular meetings about the billing. Keep the team in the loop on billing and HIPAA regulations, denials, and their reasons. Knowing these details helps impart the knowledge on the correct processing techniques and protocols to avoid those issues from recurring. 

Run Internal Audits

Don’t wait for an insurance company to find an error in your billing. Run your own internal audits by selecting 10 random charts each month. Check if the documentation matches the bills concluded. It is better to find a mistake yourself than to face the identification by an authoritative institute.

Why Outsourcing Behavioral Health Billing Services is the Better Choice

By doing it all in-house, you may reduce costs, but it will involve more hassle than ease in the long run. As a practice and healer, handling the duties of an accountant adds up to the duties you didn’t sign up for. And with the expertise required to conclude your billing processing on a regular basis is a costly aspect for an in-house team. This is why many practices find it easier to outsource behavioral health billing services.

Taking help from a professional service brings better possibilities to your practice’s doorstep. They know the payers and stay up to date on new laws. They have a dedicated billing team that diligently works on improving your revenue collection to the last penny.

Benefits of Outsourcing Behavioral Health Billing:

• Lower Error Rates: They focus solely on billing.
• Faster Payments: They submit claims as soon as possible.
• Reduced Stress: Your team can focus on patients.
• Access to Experts: They handle complex behavioral health claims management tasks.

When you know that your team has put in all that they could and haven’t succeeded much in reaching your revenue goals, now is the time. To target improved revenue generation through billing expertise, partner with a provider for your behavioral health billing solutions. It is an investment that delivers you ease from billing worries.

Conclusion

Improving your revenue accuracy is a journey that takes time, resources, and expertise. It doesn’t happen overnight, but it is a process where every small step counts. Start by checking your verification process. Then, observe your denial patterns.

When you prioritize the efficiency of your behavioral health billing, you protect your practice. You focus on strengthening your practice to deliver healthcare services to your patients for the years to come. Thus, focusing on healthcare and assigning billing duties to professionals is the best choice you could make for your practice. You ensure accuracy, which brings stability, helping your practice grow, allowing you to reach more people who need your help.