Behavioral health practitioners must be adept at medical billing in order to survive, whether that means billing in-house or vetting and partnering with a competent third party to manage it for you. Good billing practices can make the difference between a business that flourishes or one that barely treads water.
Even if accounting isn’t your first love, you can learn to manage the process well. Following the best mental health billing practices will set you on the road to financial success and hopefully reduce managerial headaches.
Good billing practices are key to financial success
Believe it or not, financial success is not a given just because you see plenty of patients. If the claims you submit for those services aren’t managed properly, you won’t receive the money you deserve.
Whether you’re a solo practitioner, a practice manager with billing staff, or looking to hire a third party, you need to know these best practices for submitting and following up on claims.
- Collect patient data carefully at intake. Insurance will reject claims containing even small mistakes, so strive for correct spelling and accurate information on every bill you send.
- Get the copay up front. You’re less likely to collect payment from patients if you send the bill after the fact. Require patients to provide the copay amount before services to guarantee you see that money. Alert self-pay and uninsured patients that you’ll charge the full service fee before their appointment.
- Check eligibility right away. Check benefits before a new patient’s first visit to make absolutely sure that you both know what is and isn’t covered. Conduct eligibility checking on all patients at intervals throughout the year, since insurance status can change quickly.
- Create a billing agreement for patients to sign. A well-written agreement can protect you from losing money when insurance fails to cover the entire cost of services. Keep credit card information on file for each patient and obtain written consent to charge the card for any balance leftover after insurance payment. (However, be aware of limitations to balance billing as per the No Surprises Act). You can also auto-charge for no-shows.
- Complete claims promptly so as not to miss deadlines. Different insurance carriers enforce different deadlines for claims submission. If you always send claims promptly, you won’t miss these cutoffs.
- Code to maximize revenue. You/your clinicians should bill for every single service provided during an appointment, even small things like administering a depression rating scale. Small reimbursements for small services add up faster than you realize.
- Maintain a regular cadence of checking up on claims. Run reports on aging, rejected, and denied claims, then investigate what went wrong. This check should happen at regular, frequent intervals.
When implemented correctly, these mental health billing practices will protect you from lost revenue and strengthen your financial position.
A financial comparison of billing done right and billing done wrong
You can see the financial impact of good billing at every step of the revenue cycle. Let’s take a look at billing done right, and billing done wrong, in the context of a behavioral health practice.
Practice A puts billing best practices to work every day. They have a regular process and workflow for managing claims.
Practice B does not. They handle billing sporadically, on the edges of all the other office work.
How does this affect revenue at each practice?
New patient intake
Practice A: Front desk staff collect patient information carefully, mindful of correct spelling and typos. They collect patient copays right away, guaranteeing that money up front.
Practice B: Front desk staff hurry through the intake procedures and consequently misspell a few names and miss typos in insurance info. They don’t collect copays consistently and have to rely on billing the patient later.
Claims submitted
Following treatment, claims must be generated and sent to insurance.
Practice A completes claims promptly. Their billing software helps keep track of the coding requirements for different carriers, so they know exactly how to code for each appointment. They make sure to include every service provided.
Practice B finally gets around to completing a batch of claims after weeks of backlogged work. They code for the basics of the appointments but miss some services they could have included—money slips unnoticed through their fingers. When they go to submit the claims, they realize that one insurance company has a short submission deadline—just 60 days—and the deadline has already passed for a handful of the bills they just prepared. They essentially gave those appointments away for free.
Later, they’ll learn that several of the submitted claims were rejected due to mistakes and incorrect information, which all started back at the intake appointment. Someone will spend significant time away from other work trying to untangle the mistakes and resubmit the claims.
Monitoring claims
Practice A’s biller pulls up a report on aging claims as part of the weekly billing workflow, and discovers that a claim sent weeks ago is not progressing through the system. The biller contacts the payer promptly and discovers that the patient’s insurance plan has changed, and the service they received from the behavioral health provider is no longer covered. This change will be noted at the practice and staff will reach out to the patient about alternate methods of payment given this change. The patient agrees to pay out of pocket for the service moving forward, which strengthens the practice’s cash flow.
Practice B doesn’t have a regular rhythm for checking up on claims. They do it whenever they happen to have time, and they don’t realize how many bills are past due until it begins affecting their cash flow.
Some of the overdue claims are taking too long to negotiate. Because the practice is behind on billing, they prioritize which denials they have time to appeal, and which they don’t. They lose several bills that insurance likely would have reimbursed them for if they’d had more time to work on it.
They also discovered that a couple of patients have either lost insurance or changed plans, and their mental health treatment is no longer covered. Because the practice didn’t catch this change early, both patients have attended multiple sessions since they lost coverage. Once again, the practice has essentially given away appointment times for free.
Collecting insurance payment
Practice A sees a steady inflow of payments from insurance because they have submitted claims on time, checked up on those claims regularly, and navigated denials and rejections quickly. Their compensation reflects the amount of work their therapist put into each appointment.
Practice B’s revenue is less predictable because of all the late or missing bills. The patients who received care several times without insurance coverage have dragged down the month’s revenue.
They payments Practice B does receive aren’t as large as those at Practice A, because Practice B isn’t coding claims as carefully. Practice B’s coding is so shaky, in fact, that they just found out they’re being audited, which will put them further behind on work and likely lead to more billing woes.
Collecting from patients
Practice A has already collected copays from all patients, and now must bill for any balance not covered by insurance. Thanks to their regular eligibility checks, these amounts are usually small, and few patients have trouble covering the cost. Practice A bills the credit or debit card they have on file for each patient to get their money on time.
Practice B tries billing for copays through the mail, but many of the bills are ignored. Because they don’t conduct eligibility checking on a regular basis, Practice B ends up billing several patients large amounts for services rejected by insurance. Not all patients pay on time. Cash flow at the practice falters.
At the end of the quarter, Practice A has met and surpassed their revenue goals. Practice B is trying to keep its head above water.
Don’t be Practice B
As you can see, mistakes in the billing process can compound quickly and hurt your practice. Don’t be like Practice B, stumbling your way through claims each month and losing revenue.
Yes, these best practices take time and effort to implement. That can be challenging, especially for practices that can’t afford a team of billers. However, a strong EHR built specifically for behavioral health can ease this burden, save you time, and put best billing practices within your reach.
Valant software’s billing feature has everything you need: easy eligibility checking, automatic bill generation, pre-submission claim checking, robust mental health coding functionality, a claims tracking dashboard, flexible reporting, a payment feature in the patient portal, and so much more.
And billing is just the tip of the iceberg. With a full suite of features designed specifically to support the work of behavioral health providers and practices, Valant can relieve hours of administrative work across the board, from intake to progress notes and beyond.
Contact Valant today and learn more about how we can support your practice.
