Behavioral Health Medical Billing and Coding That Pays

Health care providers in this field have enough to deal with, so the last thing needed is an approval letter with rejected claims. Effective billing and coding of medical services is what can provide a steady income stream. Exact Core Group specializes in helping behavioral health practices to be reimbursed timely and accurately, leaving clinicians more time for their work with patients.

In general, medical practices bill for each visit. Behavioral health providers bill for each minute spent on sessions, which makes things complicated. The duration of a session, its nature, and

documentation will define which code should be used; and payers will review each code very thoroughly.

Psychotherapy codes are time-based codes: each of codes 90832, 90834, 90837, etc. is tied to a certain time period. That is why the lack of information about the duration of the session in a patient’s note can lead to downcoding or denial of the claim. Good medical coding requires precise documentation; and good documentation is a joint effort of clinicians and billers.

Many insurers have limits on the number of visits or require authorization prior to any further treatment. If you miss even one reauthorization, you can lose a month of billable sessions. The monitoring of these dates is a quiet yet crucial step in medical billing.

• Denials are usually not big mistakes.
• Diagnosis codes that do not validate the rendered service
• Incorrect or missing telehealth modifier and place of service codes
• Not determining eligibility prior to the initial visit
• The use of add-on codes like interactive complexity in the absence of proper documentation

All of these issues are easily fixable, but only if they are monitored and caught before submission.

Medical billing process should begin before the visit through verification of the patient’s insurance, eligibility, and authorization to ensure no unpleasant surprises later on.

Coders must use only the information that was in fact provided by the provider during the patient visit in the process of coding. This way you will protect yourself from any financial risks and ensure compliance in case an insurance company ever requests documentation.

A claim has been submitted but not yet paid. Any denials must be identified, corrected and resubmitted, and the reason must be found out to prevent any mistakes in the future.

We are your team’s extension. In essence, this translates to you receiving notifications of what has been charged, what has been paid for, and what is still outstanding, with explanations offered whenever need be. We deal with individual therapists, psychiatrists, counselors, and clinics, and we adapt our approach depending on your technology and insurance payers.

Your practice’s purpose is to help people. Why not let us worry about the administrative side of keeping things going? Reach out to Exact Core Group today for a brief review of how your practice is currently managing its billing procedures.