Just like all healthcare practices, behavioral health facilities depend on a smooth flow of revenue to function properly. There is not much difference between the revenue cycle management of a behavioral mental practice and other specialties. However, to maintain a proper workflow of Behavioral Mental Billing Services, you must have a strong understanding of the intricacies of the entire procedure.
To survive in the long run, it is important to ensure that physicians and other clinicians are reimbursed accurately and promptly. For that, it is important to verify eligibility, collect payments, do precise coding, process electronic claims efficiently, and manage rejections and appeals.
There are certain things that make behavioral billing more complex than other specialties. These are:
- Duration of Visit: The limit in behavioral health visits is limited from 30 to 60 minutes. Therefore, the coding process for visit duration varies, which does not occur in other specialty billing.
- Limit of Visits– From the end of payers, the number of visits is limited to within a month or year, so verifying eligibility is crucial to ensure that limits are not exceeded.
- Various components – When it comes to behavioral health billing, it can incorporate two components - psychotherapy and psychiatric evaluation.
All the coders and billers who are well-versed in the process and have a firm grasp of these unique aspects of behavioral health billing understand how each facet ties in with the complete revenue cycle. This specialty demands proper management and a team of experts who can connect one workflow with another. It demands a strong protocol from beginning to end that sets the tone for the facility’s ability to maximize the behavioral health revenue cycle.
Behavioral Health Billing Updates for Medicare in 2024
Update of Direct Billing by MFTs and MHCs
One important update that came into effect on January 1, 2024, is the ability of marriage and family therapists (MFTs) and mental health counselors (MHCs) to directly bill Medicare for their services. The aim behind this shift is to enhance accessibility for Medicare beneficiaries. It will address potential financial barriers to behavioral health services. A significant increase in demand is anticipated. Therefore, providers should prepare to capitalize on this opportunity while ensuring compliance with billing guidelines.
Telehealth Payment
One thing that will continue to impact behavioral health billing in 2024 is the extension of telehealth-related flexibilities through the Consolidated Appropriations Act 2023. Different services delivered via telehealth to individuals in their homes will be reimbursed at the non-facility PFS rate. This alteration is especially significant for expanding access to behavioral health services.
Extension of Telehealth Services
Telehealth service payment for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) is extended until December 31, 2024. It will maintain access to behavioral health services in rural and underserved areas. Continued flexibility in service delivery models will be ensured.
Delay of In-Person Requirements
There will be a delay in the in-person requirements for mental health visits furnished by RHCs and FQHCs. It means that providers will be offered additional flexibility. Therefore, continued access to necessary services without compromising compliance will be ensured.
Major Challenges in 2024 When It Comes to Behavioral Health Revenue Cycle Management
To Verify Eligibility
Let’s talk about the most common challenge in all healthcare facilities. There is a demand for eligibility checks before a patient arrives for an appointment, or at least as soon as he checks in. If you fail to capture a complete eligibility check, it might result in services rendered without coverage, inaccurate coding, or a denied claim.
Prior authorizations or referrals
There are various insurance payers who require authorization for services, or a referral from a primary care physician, before the service is rendered. If there is no valid authorization or referral, there is a high chance that claims might get rejected.
Delayed payments
There could be multiple factors responsible for delayed payments including errors with coding or billing, or lack of adequate coverage or authorization at the time of service. There is a possibility of issues with credentialing if the facility profile is inaccurate or a provider is not properly associated with the contract. In case a payment is unnecessarily delayed, a facility’s revenue is negatively impacted.
Frequently Changing Regulations
The only constant thing in the healthcare world is - change. Behavioral health is no different in terms of the regulatory requirements for coding and billing. Various regulations are in a constant state of flux, so the coders and billers need to stay updated on the latest changes to remain compliant with all the regulations.
Denial Management of Claims
All healthcare and behavioral health facilities must manage denied claims. It might relate to eligibility or coding errors. Regardless of the reason, it is necessary to have a process to properly manage denials. Various healthcare organizations have a small team of experts responsible for managing denied claims.
Non-Covered Services
Behavioral health is one of the most unique subspecialties in healthcare. Certain services are not covered under insurance. That is why the situation arises where patients have to pay out of their pockets. There are high chances that claims can also be rejected, for example, if psychotherapy services are delivered by an unlicensed provider
These challenges may appear in the Behavioral Mental Billing Services process. An experienced team like Unify Healthcare Services can analyze these challenges and develop a plan that will tackle any of these challenges with reasonable solutions.
Outsourcing Behavioral Mental Billing Services
One thing that you need to understand as a healthcare provider is that you are not giving away control when you are considering the option of outsourcing. You must accept the fact that you can function better and enhance your productivity with the right medical billing partner. A team that is dedicated to the success of your revenue cycle can transform your cash flow.
Following are the reasons why you must consider outsourcing your behavioral health coding, billing, and overall revenue cycle management:
- The process of coding, billing, and collections are overly burdensome
- More work and responsibilities for the coding and billing team are created by a higher rate of turnover
- Challenges with retaining talented Utilization Review staff
- Lack of knowledge on behavioral health coding and billing. This results in lower reimbursement rates.
- There are less resources for patients if providers are focused on revenue cycle management and not on patient care
- Errors with incomplete insurance payer credentialing or enrollment
- Mistakes in eligibility verification, or complete lack of verification before the services are rendered
- Not adhering to coding and billing standards. This includes using inaccurate or outdated codes
All these issues can be overcome with a reliable medical billing partner like Unify Healthcare Services. All the worries will be calmed. Therefore, outsourcing your behavioral mental billing services is the next step in creating success for your facility.
Why Partner with Unify Healthcare Services for Behavioral Health Revenue Cycle Management?
Until now, you must have a clear picture of how complex the revenue cycle management process is. This is even more true for a unique and specialized process like behavioral mental health. Your patients deserve your time and expertise, so it is time to partner with a medical billing service provider that can offer you peace of mind with your facility’s financial health.
Unify Healthcare Services have the power to kickstart your journey towards a healthy revenue cycle management. We prepare our services to meet your needs, but most of all, we are determined to the financial success of your facility so you can focus on your patients.
