What Makes Mental Health Billing So Difficult?

Vexatious Aspects of Mental Health Billing

Let’s face it, the healthcare industry is vast and complex, even more so for mental health providers. This is especially true when it comes to the billing process.

The variety in the types of services, the time, scope and restraints put on mental health treatments make the billing process quite demanding. If a patient visits his or her medical doctor, the doctor will likely perform standard tests and services, such as measuring a patient’s height and weight, checking blood pressure and perhaps drawing blood. Such tests tend to be standardized across patients, differing only slightly among patients and all taking nearly the equivalent amount of time. As a result, billing is also repetitive and standardized.

With mental health providers, however, services vary way more extensively. The length of the session, the approach to therapy and the willingness of the patient to partake make it far more difficult to standardize treatment and billing. 

Moreover, the manner in which insurance companies look at mental health is noticeably unlike the way they look at more traditional medical practices. For example, insurance companies can determine how long treatments are allowed to take and how many sessions can take place each day, making it challenging for mental health clinicians to balance effective billing with adequate patient treatment. 

Additionally, the requirement of pre-authorization has resulted in more difficulty and complexity for mental health billing.

The differences between medical billing and mental health billing are also magnified by office budgets. A large group practice might hire dedicated employees to focus wholly on medical health billing, but with mental health, it’s more commonplace to have small group or solo practices with limited administrative support for billing and other office duties. Some providers will even try to do the billing themselves but sooner or later, this will become overwhelming and produce time management problems, not to mention lost income.

All this makes the billing process quite demanding for mental health professionals. They need to make sure that they can keep income levels high while also assuring that each and every patient gets the utmost quality care.

Truth is, no one gets into the mental health field because they enjoy wading through insurance industry bureaucracy. People become mental health professionals because they want to help others. However, providers cannot help others unless they collect sufficient funds to run their practices and pay themselves.

It’s rather predictable, without a dedicated staff member to keep up-to-date on healthcare billing codes, changing regulations and the billing practices of each insurance company, rejection rates will climb.

Put simply, there are fewer pitfalls involved in medical billing versus mental health billing because medical health billing is more straightforward.

Avoiding billing issues is vital to the well-being of your business

As a mental health clinician, being paid for the services you provide to patients is paramount. Unfortunately, due to the frequency of insurance claim denials today, payment is not always assured for your services. Payer sources use denials and rejections as tools to force clinicians to hand over hard-earned dollars.

Let’s briefly look at some of the more common billing pitfalls.

  1. Seeing Patients Too Often.
    Serving and billing a larger number of patients than you could credibly see during a typical workday is one billing pitfall. For instance, seeing and billing 50 patients and using the same code for these patients could be a red flag to an insurance company. Similarly, if you work in a psych hospital for half of your workday and then are at a clinic for the second half of your workday where you claim to see 50 patients, this also is not considered feasible.
  2. Clients Seeing Multiple Therapists
    Another billing pitfall happens when a client is visiting multiple therapists. This can occur if a client must see a therapist in the same facility as his or her doctor, but he or she is also meeting a private therapist or counselor for personal reasons, such as the client prefers sessions with the private therapist. A payer source will not want to pay for two different therapists for a single client.
  3. Frequently Using the Same ICD-10 Code
    Using the same ICD-10 code too often is another common billing pitfall for mental health professionals. Variety is key in billing to avoid audit risk. When you bill the same diagnosis code for all of your patients, such as anxiety disorder, this is considered a red flag.
  4. Specific Codes That Raise a Red Flag
    Another billing pitfall surfaces from the use of specific codes in mental health billing that can raise red flags. Billing too many specific codes for your services can create problems for your practice. Three of the codes to be aware of are billing code 90837 (individual psychotherapy); billing code 99215 (established patient visit); and billing code 90853 (group psychotherapy).
  5. Treatment Plans
    The final billing pitfall for mental health professionals lies in treatment plans for patients. Not completing a treatment plan is a definite way to not receive payment or to be required to pay back money to a payer source after an audit.

Documentation and billing errors can also occur when a claim is missing progress notes and does not include a plan for the patient’s long-term care.  

The bottom line is that billing issues for mental health professionals can lead to reduced revenue, unproductive time and further stress.

Maybe it’s time to get help with your mental health billing

Okay, it’s been demonstrated that billing for mental health differs greatly from billing for medical services. We’ve also determined that mental health professionals often operate on a smaller budget than medical facilities and many offices employ a small staff.

As a result, taking on the billing needs of patients can stretch counselors and staff members thin, which can ultimately impact client service.

Reducing the time for billing and coding procedures can, however, be harmful to offices focusing on mental health services as insurance companies will quickly deny a claim that is not filed or coded accurately. 

Such is the dilemma faced by mental health professionals today!


What do you think?

Written by Lauren Lau

Medical billing and credentialing is an integral part of the health care industry because of the manner in which insurance is used to receive and pay for medical care services. Without it, revenue cycle management (at administrative offices of clinics and hospitals) has a hard time asking for payments from insurance companies. Medwave is an efficient and effective solution for medical practitioners that are hard-pressed for time and resources. Located in Cranberry Township, Pennsylvania, we take over the burden of billing and associated administrative duties from the healthcare provider and in essence increases their revenue.


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