ClinicTracker Blog Avoiding the Common Pitfalls: What's So Difficult About Mental Health Billing Payments and Adjustment Codes?

Mental health billing is a complicated subgenre within a system that's already remarkably complex. That is why having a dedicated, scalable billing platform is so important for care providers in the fields of mental health and substance abuse recovery. First, clinic managers should know that their staff are not necessarily doing something "wrong" if constant billing issues keep cropping up. It is very likely that the billing platform you are using simply can not meet your practice's needs.Let us see why mental health billing payments and adjustment codes can be so challenging to track.Mental Health Billing: Many Moving PartsWhen submitting billing, office staff members need to ensure that all proper codes and documentation are in place, including those involved in the patient's specific treatment. On the service end, you have to include CPT codes to prevent claims from being rejected or bounced back to you unpaid. All of this comes in addition to actual services that your office or clinic is providing on a day-to-day basis.Care providers in mental health and recovery generally have less uniformity in billing than traditional medical providers. For instance, a general practitioner may use the same standardized tests, protocols and services when the bulk of patients seen are coming through the door for routine physicals. The same goes for specialists who perform very targeted diagnostic tests related to one body system or illness on all patients. By contrast, a provider specializing in mental health deals with a broader variety of procedures.Many other factors make billing for mental health such a wildcard. First, there are many different approaches to therapy. Insurance providers also vary in what they consider "mainstream" enough to cover. This is partly due to the stigmatization that still exists around mental health. Even a patient's willingness to participate in certain treatments can impact billing. As a result, care providers in mental health meet several roadblocks during the planning stage for treatment.Pre-authorization requirements also create hurdles for mental health billing. Getting pre-authorizations just right before treatment even begins is critical to making sure patients are not stuck with unpaid bills because of initial coding errors. Adding to the stress is the fact that most clinics run on very tight margins as it is. This is especially true of community and not-for-profit clinics and offices that operate in underserved areas. Every minute that a staff member is trying to untangle a billing or communication error is one less minute spent interacting with and serving clientsAnother factor that sometimes complicates billing is that reimbursement rates can vary based on a provider's credentials. Fee schedules are often based on the education to certification level of the provider. This means that providers will need to sift through many different billing codes to find the right one for their credentials. Choosing the incorrect code can result in denials. ClinicTracker can help with this by automatically applying the correct code based on the provider's credentials.Bundled billing is another way to streamline the process. It combines a group of similar services provided by multiple care providers within a specific period. These services are billed together as an "episode of care," instead of separately. Bundling payments is more cost-effective, efficient, and usually results in higher reimbursement rates for providers.How Better Billing Can Improve the Entire Practice or ClinicAccurate mental health billing can lift an entire practice by merely removing the time and tension that would normally be devoted to billing. When choosing what to focus on, CPT codes should get priority. Using the wrong code can truly throttle cash flow and solvency for a smaller practice. Any bottlenecks that prolong the billing-reimbursement lifecycle essentially tie up available cash flow. Claims rejections and denials aren't just frustrating because your practice has to float without payment longer. In some cases, these lags can result in missed payments that slip entirely through the cracks without any follow-up resolution.The Dangers of Sloppy BillingUnfortunately, "sloppy" CPT codes can also chip away at the integrity of your practice over time. Repeated coding mistakes could cause your practice to be flagged for fraudulent practices. Yes, even a well-meaning employee who is making the same billing mistakes over and over can create a big headache for your practice. It's also possible that insurance companies can interpret an honest mistake as an intentional strategy for overbilling a patient or payer. It can be tough to prove that you did not intend to commit fraud if someone sounds the buzzer on overbilling. Your office's coding needs to be impeccable across the board.Why Coding Errors and Billing Mistakes HappenCoding errors and billing mistakes are common when the agency/practice doesn't have an infrastructure that protects them. As anyone who has ever worked in a provider setting knows, these mistakes are rarely malicious or intentional. However, they have overwhelmingly negative consequences for providers, patients and payers. Here's a look at the top 10 coding errors and billing mistakes holding practices back today:Incomplete Corrected Claims: Often, corrected claims are missing the original claim number and remark codes for reference.Inconsistencies: One of the biggest reasons why bills get bounced back and forth is that payment may be coming in from a different company than the entity being billed. The reasons for this can range from everything from an outdated record to fraud.Differences in Payment: Payment received could be lower than the contracted amount.Incomplete Resubmissions: Remark codes are not being adequately tracked and revisited on denials during the resubmission process.Incorrect Recipients for Remaining Balances: Balances could be submitted to the wrong payer without a way to track or retract.Missing Information for Coordination of Benefits: When handling COB, necessary information regarding the non-primary payer is often left out.Unaddressed Payment Requirements: Applying universal or incorrect requirements when payment requirements differ is common when a system doesn't allow for custom notes and exceptions.Use of Outdated Codes: Older systems often don't update to keep up with the constant updates in mental health coding..Default Upcoding: Manually entering a code that allows for more time/higher billing rates because a staff member/therapist isn't familiar with codes can be a fraud trigger.Incorrect Modifiers: Simply using a modifier to elaborate on services incorrectly can cause a claim to be rejected.These are the most common errors that can create billing bottlenecks and rejected claims from a technical perspective. Your office might also increase the chances of claim rejections or audits because of how billers code some services. For instance, many clinics run into claim-acceptance issues when allowing a single patient to see multiple therapists within the same facility. On the payer end, there may not be justification for essentially "paying double" for a single client.From a care-planning standpoint, it may be necessary to help clients find ways to align the benefits they are getting from seeing multiple therapists into a more cohesive plan that only involves one therapist. If a client prefers to continue with seeing multiple therapists, very tidy billing is necessary because you are already in the "red flag" zone for payers. Each therapist should be diligent about accurately billing only for the services they provide on the specific dates that they are seeing clients.It is also essential to ensure that staff members are not caught in a cycle of overusing specific codes. A staff member who does not have the resources to narrow down appropriate codes that can be applied may fall into the trap of using the same code for almost every patient. It is vital for facility-wide education regarding the use of proper, specific codes. Therapists and care providers must also do the work of finding codes that are as particular as possible when creating a formal diagnosis for each patient. Unfortunately, many mental health practices take a shortcut by simply relying on common or unspecified codes to cut down on the amount of research time needed for each bill. For some practices, this seems like an easy way to avoid investing in an upgrade of the office's billing system or outsourcing billing to a third party because an artificially "simplistic" method is being used. In reality, it is a recipe for fraud accusations from payers. What is more, taking shortcuts like this can cost practices more in the long run merely because they are dealing with denied claims, delayed claims and overlooked services.Bring Better Accountability and Accuracy to Mental Health BillingWhen updating billing practices, it is important to see where the numbers fall in terms of the bigger picture. That is why it is recommended that behavioral health practices take measures to identify revenue streams, examine allocations, create project budgets, track funds and manage payables using an integrated accounting platform. This is especially important for practices that are trying to move into growth spaces by attracting new clients and expanding client-retention initiatives. Our accounting system uses your own data to help you define and reach objectives using a cloud-base system that pulls from your newly integrated revenue management platform. This means you can base projections on the actual numbers coming through your practice instead of guesses based on nothing other than annual revenue and expenditures. This approach moves your revenue management plan from being reactionary to being predictive and reactive.For practice owners and clinicians, the time of office staff is valuable.Yes, it looks like a lot to bring together