Psychiatry and behavioral health are unique fields. Diagnosing mental health conditions can be tricky and complex, but it’s vital for a patient’s overall health.
Because this specialty is so detailed, billing for behavioral health and psychiatry can be more complicated than in other medical areas. To run your practice smoothly, it’s important to understand these challenges and make sure your psychiatry medical billing team has the right tools and support to help your patients effectively.
The Challenges of Psychiatry Medical Billing
Psychiatry medical billing is notably different from standard medical billing due to the complexity and variability of mental health treatments. Unlike a straightforward surgical procedure, psychiatric billing involves various services such as therapy, psychological tests, and medications, often billed based on the total duration of care rather than a single service. Recently, billing practices have evolved to account for the entire duration of a session, not just face-to-face time.
Working with insurance companies adds another layer of complexity. While initial therapy sessions typically don’t require prior authorization, many insurers will ask for it after a certain number of sessions or for specific tests and medications.
Even though prior authorizations are common in many medical fields, mental health treatment often faces additional challenges due to inconsistencies in parity laws. These laws are intended to ensure mental health coverage is on par with other medical conditions, but enforcement is uneven and often has gaps, leading to more obstacles in obtaining coverage.
Prior authorizations can be a significant burden for many medical specialties, with 86% of physicians reporting high or extremely high administrative loads. Psychiatrists, who often work with smaller or no support staff, face even greater challenges. Additionally, prior authorizations can negatively impact patient care, such as discontinuation of medication, and many psychiatrists avoid prescribing certain medications due to these requirements.
If your practice is involved in telepsychiatry, you have likely seen changes in billing practices during the COVID-19 pandemic. While temporary expansions in Medicare and Medicaid coverage for telehealth have been beneficial, these changes are not yet permanent. The Centers for Medicare & Medicaid Services (CMS) have made some efforts to extend telehealth coverage, but the situation remains fluid.
Given these complexities, it’s understandable that psychiatric billing can be challenging. Identifying key features and solutions to streamline and automate the billing process can help manage these difficulties effectively.
Essential Tools for Medical Billing in Psychiatry and Behavioral Health
Using the right software can make psychiatry medical billing much simpler. Moving away from generic billing systems meant for primary care can really boost your practice’s efficiency.
- Specialized Codes
Billing for mental health requires its own set of codes, which are different from those used in primary care. Generic systems often include unnecessary codes that just slow things down. Software made for behavioral health focuses on the specific codes you need, making the billing process smoother.
- Custom Dashboards
Good billing software for behavioral health should come with a dashboard designed for your specialty. This means you will get reports that are relevant to your practice, helping you see how your billing is going and where you might need to improve.
- Tools for Clean Claims
To get paid quickly, you need to submit clean claims. As more insurance plans cover mental health services, having software that helps with this is crucial. Look for tools that help you keep claims accurate, check coverage before services are provided, and speed up payments from insurers.
Strategies to Improve Your Practice’s Medical Billing Workflow
Below, we have described the top 3 strategies to improve your psychiatric practice’s workflow:
- Hire a Reliable Software Vendor
There are two options for using EHR/EMR software for your billing needs: either using your own software or outsourcing it to a reliable psychiatric billing company. Now, you might be wondering, which would be the better option? Right?
In our opinion, outsource it to a reliable software vendor. Look for software with billing profiles, which lets you group codes for common conditions like ADHD, anxiety, and depression. This feature helps keep your patient charts organized and ensures accurate billing. Also, make sure your software supports DSM-5 coding for better payment accuracy.
Good software should also offer bulk claims processing, real-time claims updates, and a reporting dashboard. These tools help you track and fix any billing issues quickly.
- Consider Outsourcing to Experts
If managing billing is too complex, outsourcing to a specialized billing team might be a good option. Look for companies that have a strong record of handling clean claims, resolving denials quickly, and optimizing payments. They should also be able to fix coding mistakes and have certified professional coders on staff.
Experts who provide psychiatric billing services can make a big difference in your practice’s revenue and billing efficiency.
- Work with an Experienced Account Manager
Skilled billers and coders are essential, but having someone to evaluate the overall financial health of your practice is also crucial. Are you seeing improvements in your cash flow? What strategies can help you expand your practice? A dedicated account manager can provide insights into these questions and highlight opportunities for optimization. Regular reports and check-ins will keep you on course.
To Wrap Up
Psychiatric medical billing can be complex, but there are ways to streamline the process. As mentioned before, applying top-notch medical billing software or a revenue cycle management service can help address the unique challenges of psychiatric billing.