FAQs: Frequently Asked Questions

frequently asked questions behavioral health billing

Understanding behavioral health medical billing can sometimes be confusing. Below, we have listed some frequently asked questions for the field of behavioral health medical billing, as well as some definitions of some industry terms.

Synergy Concepts is always here to help you with your behavioral health medical billing needs. If you have any questions, please contact us by phone or email and someone will get to you shortly to help you.

What makes Synergy Concepts’ billing solutions unique?

The growth of Billing Solutions has been organic, acquiring business through reputation and referral-based practices. We have developed some of the best billing practices in the industry by having over 20 years’ experience on both the provider and administration side of the behavioral health and substance abuse industry. We have always maintained a philosophy that no facility is too big or too small, going above and beyond what your typical billing service would provide. Beginning with admission all the way to clinical, our approach is hands on. Our Founder and COO are always available to speak to clients. We take pride in being progressive. Our experts are knowledgeable and quick to recognize trends in the industry in order to inform clients of any upcoming changes or shifts in the insurance world. We obtain documentation to ensure that providers are in true compliance with insurance companies, and we provide customized reporting so that our clients know exactly what is going on with their account.

How does Synergy Concepts keep up with regulatory changes?

One of the many benefits in partnering with Synergy Concepts is our expertise in the field of behavioral health and substance abuse, and our specialized legal and clinical team’s commitment to keep you updated on regulatory changes.

What are the benefits of outsourcing a billing company?

The landscape for Behavioral Health is shifting rapidly. We are seeing new and changing regulations, different payment approaches, proliferation of practice management software, and challenges of out-of-network billing. These changes bring new challenges AND opportunities to our industry. So, how does outsourcing benefit our clients?

  1. Compliance knowledge reduces denial rate.
  2. Availability performance and claim quality data, provided in a meaningful way, gives you more insight of what factors affect your revenue cycle.
  3. Financial expertise helps you make decisions based on better projections of revenue.
  4. Experience in administering billing services across a wide cross section of substance abuse treatment centers provides a better understanding of how insurance companies respond to a variety of claims.
  5. The volume of claims generated allows quick identification and reaction to payer requirement changes.
  6. Outsourcing allows you to focus on what you do best, helping people.
  7. Operational costs will be minimized and revenues maximized.
  8. Reliable partnerships and advocates are created.

What is Medical Billing?

Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider.

What is Behavioral Health?

Behavioral health describes the connection between behaviors and the health and well-being of the body, mind, and spirit. This would include how behaviors like eating habits, drinking or exercising impact physical or mental health.

What is Behavioral Health Medical Billing?

Behavioral health medical billing is the process of submitting health insurance claims in order to receive treatment for behavioral health issues. Some of these issues include drug abuse, alcoholism, addiction, and eating disorders.

How is mental health billing different than medical billing?

The way therapists and counselors provide services is greatly different than the way services are provided by other medical professionals. For example, in a medical setting, patients and their insurers are billed for specific treatments, such as an x-ray or a lab test.

In the mental health field, patients and insurers are billed primarily for therapy, medical management and psychological testing services. Insurers have rules about how long a session they’ll pay for, how many they’ll pay for per day or week, and often a maximum number of treatments that they will pay for. The mental health needs of the patient may exceed the services the insurer is willing to pay for, making balancing an effective treatment plan with adequate reimbursement tough for mental health professionals.

Behavioral health providers should be aware that many commercial insurance companies and state Medicaid programs outsource their mental health claims to an outside third party. This is important because the claims address on the card isn’t always the correct address and if you submit to the wrong address your claims will be rejected. It gets complicated so it’s important to have a biller who makes sure that the claims are filed correctly to avoid payment delays.

What is the turnaround time for a claim payment?

With a clean claim format, the turnaround time for payments with major insurance carriers is two to four weeks.

In most cases, it will take at least 30 days from the date the insurer receives a claim to when your mental health practice will receive reimbursement. Some insurers move faster, with turnaround times of two to three weeks, but, as a rule, 30 days is what most practices can expect.

Can your software integrate with our Electronic Health Record (EHR)/ Electronic Medical Record (EMR) system?

Yes. We can successfully integrate our software with your facility’s system to reduce duplicate work and increase efficiency for authorizations as well as improve medical records retrieval and clinical compliance. Billing Solutions works with a variety of EHR and EMR platforms to maximize efficiency in the utilization management of your clients.

Can clients be billed for the balance after insurance reimbursement?

Mental health practices that have contracted with insurance companies cannot balance bill their clients. They must accept the rate the insurer provides and write off any remaining balance. If you’re out of an insurer’s network, you may accept reimbursement from the insurer and then bill the patient for the rest.

While you may feel a bit stung for having to accept $80 for a $150 service, remember that insured clients tend to be more reliable repeat customers than those that pay with cash. Accepting the lower reimbursement may be worth it to secure regular clients.

What should I do when clients don’t inform me about changes to their insurance plans?

In many cases, clients aren’t even aware of changes to their insurance plans. Yes, insurers send out letters explaining the changes, but these letters are often difficult to understand and are rarely read. In other cases, clients have changed jobs and gotten a new plan or have lost their coverage.

To avoid these situations, it’s a good idea to evaluate clients’ insurance coverage before each visit, if possible. By contacting insurers and making sure that clients’ coverage is still in effect and has not changed, mental health professionals can stay informed and avoid wasting time on rejected claims. This can be labor intensive, but the time it will save makes it worthwhile.

If you’ve filed a claim and had it denied because the client is no longer covered by his or her old plan, you’ll need to contact the client and get their new information. If they don’t have insurance, you’ll need to try to get payment from the client. If they do have coverage, you’ll need to file with the new insurer.

Do most sessions require pre-authorization?

Again, this is something that varies from insurer to insurer. In most cases, an initial session or regular office visit does not require pre-authorization. More extensive services such as psychological testing may require approval from the insurer. Also, some insurers allow a set number of visits without authorization before requiring authorization for any subsequent visits.

What should I do if a session required pre-authorization and the client did not obtain it?

When a provider is contracted with an insurance plan, it is the provider’s responsibility for obtaining authorization. Patients often don’t know or don’t understand insurance requirements which is that is why it is critical to verify benefits and authorization requirements in advance. In the event that authorization is not obtained and you have already seen the patient, you may be able to convince an insurer to back date authorization. This will require some diplomatic skills on your part, as insurers are often loathe to do this. They may make some exceptions if the client is a new member and didn’t know about the need for pre-authorization or if you are extremely persuasive. If you don’t have a contract with an insurance plan, the patient can be billed in the event of non-payment from their insurance company.

Can I bill clients for more than one session per day?

Most insurers are pretty strict about the one session per client, per day rule. Under some circumstances, mental health practices may be able to obtain approval for more than one service in a day. For example, if the practice has a psychiatrist and counselor on staff, the psychiatrist may perform one service, and then a counselor may perform another, and the insurer may reimburse for both. Or if the patient has to travel a long distance for an appointment and needs a longer session. Staying in contact with insurers and having good diplomatic skills will help in these situations.

What’s the time limit on filing a claim?

This varies from insurer to insurer. Some insurers require claims to be filed very soon after services – 90 days is often a rule among private insurers. Others are more lenient with their time limits. For example, Medicare usually allows providers to file claims within a year to 18 months after services are provided. Knowing the insurers you work with and their claims submission rules will help you avoid having claims denied because of late submission.

Is it okay to bill claims under another provider’s name and NPI number?

This happens a lot in group practices where not all the providers are credentialed with all the insurance plans. A therapist who sees a blue shield patient may not be paneled with that insurance but will bill under under the name and number of another provider in the group so he can get paid. Sometimes it is acceptable to bill this way if you use a billing modifier (Q6) on the claim that indicates the provider is “supervising” care by another clinician. You’ll need to pay close attention to your payer contracts in order to bill for non-credentialed providers correctly. If your new provider is not replacing anyone and if the health plan requires only credentialed clinicians provide services, you cannot bill for services rendered by that provider. A practice would be in violation of their contract with the health plan. In some cases, the health plan will only require physicians be credentialed; in others, plans require all providers (physicians and mid-levels) be credentialed and tied to the contract.

Should I go cash only?

The answer to this varies from practice to practice and market to market. Some insurers have good reimbursement rates for mental health services, while others have low rates and rules that make getting paid extremely difficult. In some areas, the low-paying insurers may be the dominant carriers, and few clients in the community may have the better plans.

When considering whether to join a network or accept payment from insurers, it’s important to evaluate their pre-approval rules and their limits for payment. In some cases, the low payments and hassles of dealing with insurers make it more profitable to switch to a cash-only model and accept lower payments from clients or establish an income-based sliding scale.

How do I deal with an audit?

It’s important to know that in the behavioral healthcare industry there is a high possibility that you will be audited. However, there are steps you can take to be prepared. During an audit, reimbursement is held (or suspended) from the payer. Therefore, it is pertinent that your facility consistently maintains accurate and complete records for clinical and financial accuracy. Upon receipt of an audit, you must contact your billing company, or, if you do not have a billing company you must contact the payer to ensure that you submit exactly what they are requiring from your facility. This submission of records must be done quickly, and in any format they require. The easier your records are to understand, the faster the audit will be completed.

I am new to the Behavioral Healthcare Industry. Can you help me create a successful business plan?

Synergy Concepts prides itself in our commitment to assist new practices develop both clinical and business components for success. Our staff has over 20 years of expertise in both behavior health treatment and billing services. From choosing the appropriate benefits for treatment coverage, assistance in clinical documentation to avoid denials, to collection and appeals; we ensure that your facility is poised to succeed.

Lots of Frequently Asked Questions for Behavioral Health

Working with a behavioral health billing company can help behavioral health practices improve their collection rates, often allowing practices to collect 96 percent or more of money owed to them.

There are lots of frequently asked questions about the behavioral health insurance billing industry. We hope this FAQ page helps you navigate behavioral health a little easier. If you have any other questions about behavioral health billing, please fill out our contact form and ask us! We’d love to add new frequently asked questions to our list!