Being a mental health professional can be incredibly fulfilling, but there are also many days when the drawbacks seem to outweigh the advantages. When you constantly feel as though you need to keep an eye on the bottom line (even when your schedule is full), it might be challenging to focus all of your time into offering outstanding customer care.
It doesn’t matter where you look; mental health billing is a challenging task. The difficulties of pre-authorization, changing insurance policies and financing sources, confusing billing methods, and more place mental health care practitioners at a particular disadvantage when compared to other health providers.
This means that getting payment for services from customers and insurance companies can be difficult, and it’s thought that mental health providers only get paid approximately 85% of what they bill. The sustainability of the practice is under a lot of pressure because most practices simply cannot afford to pay 15% of their overall earnings.
One thing to keep in mind is that you’re not the only one going through this, and there are things you can take to future-proof your practice. We’ll discuss a few of the factors that contribute to the complexity of behavioral health billing. Then, we’ll look at some doable actions you can take to raise your approval rate and directly affect the financial performance of your practice.
What Services Fall Under Mental Health Billing?
The main medical specialists who deal with mental health issues are:
- Psychiatrists
- Psychologists
- Clinical social workers
- Counsellors
- Occupational therapists.
Why is Mental Health Billing Complicated?
The most frequent issues that affect mental health billing and make it challenging for mental health providers to submit proper invoices and get paid for their work are as follows:
1. Multiple Funders
As a mental health provider, several different organizations—frequently not the client themselves—may be in charge of paying your client’s account. Their employer (due to a work-related incident), the government, their health insurance, or a private payment (by the client or a family member) may cover the cost of the sessions.
Furthermore, due to the possibility of shared or joint responsibility for the invoices based on causation, the difficulties are multiplied. An illustration would be a workplace accident that affects a few employees, but only one of them needs medical attention because of underlying contributory causes. The provider will need to determine who is responsible for making payment for each session because the employer may be ready to share responsibility in this case but not pay the entire treatment expense.
2. Treatment Process
The services provided by mental health experts differ significantly from those of other healthcare providers and are typically far less tangible, which makes invoicing very difficult. Most of your time with a counsellor or psychologist will be spent talking rather than getting your skin checked out or getting an X-ray. Even so, therapy sessions will still be somewhat unstructured to allow for customization to the needs of each client.
Take three patients who visit a mental health facility with the identical symptoms as an example. Depending on other criteria, there is a good likelihood that there may be three alternative approaches to diagnosis and therapy.
3. Treatment Outcomes
The results are also difficult to measure, which adds another layer of complexity. It’s not like having a broken leg, when you receive X-rays, get fitted for a cast, and then a few weeks later the limb has recovered. No ‘magic drug’ exists to treat depression, anxiety, or suicide thoughts.
Although improvements can be measured, they remain highly subjective, strongly impacted by personality and background factors, and may change day to day. Regarding aspects like financial stability, family support, prior mental health history, and more, each client is starting from a distinct platform.
4. Interacting with Insurers and Funders
Payers have relatively limited options for accepting and remitting claims from mental health providers, regardless of where they live or who is in charge of paying the bill. There are frequent requirements that must be met regarding diagnosis, the number of treatments, and the type of intervention.
Most of the time, they will only agree to pay claims if the mental health professional complies with their established guidelines, which set limits on the number of sessions they would cover and the length of each session.
Additionally, there can be a difference between what they originally agree to and what they’re willing to pay for when you invoice them. For this reason, it’s crucial to obtain a written contract before working with a customer.
It is nearly impossible to balance billing restrictions and standardize billing with providing your clients with the highest calibre of care due to these intricate interactions with insurers and funders.
5. Staying on Top of Funder Requirements
Running a solo practice can exacerbate the problems because you will likely be handling your own billing, which adds more pressure to keep up with evolving rules and billing codes as well as the billing procedures of your clients’ insurance providers or the funder in charge of paying the bill. And this will inevitably result in a rise in the number of contested bills.
And that’s before accounting for the filed bills that seem to mysteriously vanish into the funder’s system. This makes your practice more susceptible to non-payment since, particularly if you don’t have much experience working with the particular funder, you might not know who you should be talking with at the company.
How Can Mental Health Practice Management Software Help?
You must be able to appropriately charge your clients or funders and, when necessary, submit insurance claims for payment in order for your practice to succeed. By reducing poorly printed invoices and keeping track of client overdue, billing software designed specifically for practices that provide mental health care services helps expedite operations.
This will aid in managing disputes and cash flow while ensuring that you always have a clear understanding of your financial situation and are in compliance with all legal regulations. The medical practice management software tool must help with the following in order to achieve this:
- Making accurate invoice preparations – If you want to get paid as soon as possible, your claims must be made accurately the first time. In order to decrease the amount of rejected or postponed claims, the software should promptly be developed and offer accurate coding for claims.
- Including all necessary data – This comprises the patient identification number and the insurance provider number, both of which have to be immediately imported into the system.
- Interface that is simple to use and intuitive – The software you select should be simple to use and simple to integrate into your mental health practice. This will aid in choosing the appropriate billing codes and guarantee that staff members are prepared to bill promptly and correctly.
- Integrations for billing – The software you employ should be able to handle credit card processing, online payments made through secure payment gateways, and simple remittance.
What Other Steps Can You Take?
Here is a checklist you may use—or your practice manager can—to make sure you keep up with your billing:
- Before each session, check the client’s billing account to make sure all payments are current and there are no past-due bills or rejected invoices.
- Always produce and issue invoices as quickly as feasible following the session if the client is not going to pay right away.
- Keep a current list of the billing formats that each insurance provider and third-party funder demand.
- Keep a current list in your practice management software of the billing codes that can be applied to your procedures.
- Make careful to keep the bill’s overall amount to no more than what the insurance company will be required to pay, if any.
- Make sure to always utilize the correct policy number when filing insurance claims.
- Before the first session, confirm if pre-approval is required for the therapy and make sure you have it in writing in case there is a disagreement.
- Think about including an invoice fee for accounts that aren’t paid on the spot.
Being a healthcare provider, it can be difficult to strike a balance between giving your patients the finest care possible and ensuring you get rewarded for your efforts. especially when you take into account the complexity of the funding arrangements and the nature of the activity.
Finding the trouble spots in your accounts receivable management is the best approach to relieve tension and make sure that you are paid as fast and painlessly as possible. When you identify the problems, you can create more stringent billing and payment procedures and employ practice management software that is precisely tailored to your mental health clinic’s requirements.
