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How Is Mental Health Billing Different Than Medical Billing?

Mental health billing is often more complex than medical billing, here's why
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Feb 28, 2022

Medical billing can be a nightmare for any type of practice. The paperwork, the constant phone calls with insurance companies and providers to get paid what you deserve—it all takes its toll on medical professionals who have only two main options: building up their teams or outsourcing this responsibility entirely. The bureaucracy involved in managing these issues becomes more severe when dealing specifically with mental health practices because they often require additional steps compared with standard medical billing.

The limits that insurance companies place on mental health services can create a financial ceiling for providers of mental health services. While mental health providers may only be able to bill for one code during a behavioral health visit, another specialist will be able to bill multiple. This severely cuts into the amount of profit a mental healthcare provider can net. In a specialty that is already taxing, having to struggle with uncollected bills and lack of billing leniency leads to more stress for practitioners.

Mental health services are looked at differently by insurance companies and patients alike. This combination of cultural and corporate perception of mental health services places additional stress on providers.

Differences Between Medical Billing and Mental Health Billing

Major areas of difference or concern for medical billing versus mental health billing include:

  • Pre-authorization is almost always required before submitting medical claims.
  • Mental health providers often do not have front office staff who can handle billing and coding, this places those responsibilities onto the practitioners themselves.
  • Mental health practitioners provide and varied and diverse number of services customized to each individual’s needs making coding and billing more complex.

Standardization and Mental Health Billing

Mental health billing and standardization don’t mix well, but unfortunately insurance has rigid requirements that result in practitioners having to work with the lack of flexibility in billing and coding despite the flexibility required of their services. The major problems mental health practitioners face with mental health billing are session duration standardization and service limits. Different lengths of time spent with a patient must be billed using different codes, adding to the complexity of mental health billing. There are also maximum number of treatments a mental health patient can receive in a day or week, which greatly limits patients who may need to exceed that limit to receive proper treatment.

Outsourcing Medical Billing

Due to the complexity of mental health billing, outsourcing is often the best option for mental health practitioners. It’s important, however, to hire a firm that knows how to work with your specialty, especially one as complex as mental health services. Contact us to learn more about our outsourced medical billing services.