How to Get Credentialed with Insurance Companies Mental Health

Billing for behavioral health services is an integral function of any organization that provides services for mental health or addiction recovery. As the primary mechanism for receiving payment from insurance carriers, billing must adhere to payer compliance requirements. The result of not adhering to the rules of the billing process may cause the payer to:

• Deny the claim, putting the facility at risk of not receiving payment
• Request an audit on the provider
• Require the organization to make payments back to payer

For these reasons and more, it is crucial to understand exactly how to bill for behavioral health services.

About Behavioral Health Billing and Coding

It is important to understand the difference between behavioral health billing and medical billing. First off, know that insurance payers impose greater restrictions on billing practices for behavioral health versus mental health. In addition, the coding itself is far more complex for the billing of behavioral health services.

The behavioral health billing and coding process is based on something called Current Procedural Terminology (CPT). These are billing codes used for services related to behavioral health screening, treatment, and preventative services. Assigning the precise code for the service rendered is critical for claims to be paid.

Types of CPT Codes

The American Medical Association provides CPT codes that pertain to the behavioral health continuum of services. The codes are broken down in to detailed descriptions of services. Examples include the length of a psychotherapy session, or a psychiatric diagnostic evaluation with or without medical services.

These four categories of CPT codes include:

• Category A: Counseling Risk Factor Reduction and Behavioral Change Interventions. These include various codes for:
  • Preventative Medicine
  • Behavioral Change Interventions
• Category B: Do Not Require Larger Collaboration Outside of Practice. These include various codes for:
  • Psychotherapy
  • Developmental Behavioral Screening
• Category C: Increased Collaboration Under Integrated Care. These include various codes for:
  • Adaptive Behavior Services
  • Health Behavior Assessment and Intervention
• Category D: Most Comprehensive Code for and Expansive Coordination Model. These include various codes for:
• • • General Behavioral Health Integration Care Management
    • Psychiatric Collaborative Care Management
    • Cognitive Assessment and Care Plan Services
    • Inter-Professional Digital Services
    • CoCM General Management  (Medicare)

Guide to Billing for Behavioral Health Services

Behavioral health billing can be time consuming and confusing. However, the process can be broken down into the following four basic steps:

1. Collect Client Demographic and Insurance Information. To initiate the insurance claim process, you must first collect the required patient demographic and insurance information. Some insurance plans restrict the number of sessions delivered per year by mental health or addiction treatment provider.
2. Checking Patient Eligibility and Benefits. Once the intake data is collected, you will call the patient’s insurance carrier to verify eligibility and benefits. After you have received this information, you can inform the patient of their coverage for services.
3. Code and Submit Claims for Services Rendered. You will then need to assign a CPT code or codes to the claim form. It is important to be very careful in selecting the correct CPT code to avoid any errors in the claim process. This coding pertains to the type of service being rendered. In addition to the CPT, you must select the appropriate ICD-10 diagnostic code (specific coding for behavioral health diagnoses). The ICD-10 refers to the patient’s specific disorder.
4. Handle Claim Denials and Appeals and Submit Corrected Claims. A claim may be rejected at one of two junctures: the Clearinghouse level or at the insurance carrier level. Claims are denied for the following reasons:
   • Terminated coverage
   • A coordination of benefits issue
   • Unauthorized treatment sessions
   • Untimely filing

Correct the errors and re-file the claims. Claims that cannot be resolved must then go through the appeals process.

Common Problems in Billing for Behavioral Health Services

As careful as you are when billing for services, errors or unforeseen problems may cause the claim to be denied. Here are some common challenges for behavioral health billing – or how not to bill for behavioral health services:

• Choosing the wrong codes. A CPT or ICD-10 is selected that doesn’t reflect the actual services performed or patient diagnosis. This results in denial of claim.
• Upcoding or unbundling. Upcoding refers to inappropriate billing practices that use higher-level codes than the actual service provided. Unbundling refers to billing for services separately that should be bundled.
• Insufficient documentation. This is the case when clinical notes to support the billed services are not provided to the insurance company. Also, not including the correct patient data will also lead to delays or denials of processing claims.
• Not adhering to payer requirements. Each insurance company has very specific billing guidelines that providers must follow. Not adhering to these rules results in claim denials, or even being dropped from the network.
• Not obtaining pre-authorizations. Insurance companies often require a pre-authorization is obtained prior to initiating the service.

Benefits of Outsourcing Behavioral Health Billing

In some cases, usually with a large organization, the provider has an employee who is solely dedicated to managing the billing. That is their full-time job. However, chances are it’s the clinicians or office personnel pitching in to handle billing, which is when errors happen.

A behavioral health billing service can eliminate many of the problems associated with the tedious job of billing insurers. This third-party service provider has the expertise to streamline the entire billing process. These billing professionals help providers stay current on insurance credentialing and billing requirements. This frees up the provider from this time-consuming work, allowing them to care for patients.

Some of the many benefits of utilizing a behavioral health billing service include:

• Maximizing reimbursements and minimizing claim denials
• Ongoing compliance monitoring
• Navigating the unique billing challenges in the behavioral health sector
• Optimizing revenue cycle management
• Providing customized reporting and analytics
• Providing insights into the facility’s overall financial health

So, you are now informed about how to bill for behavioral health services. You might agree that handing this demanding task over to a billing professional might be worth considering.

Mint Billing Expert Billing Services for Behavioral Health Facilities

Mint Billing offers billing solutions for providers of behavioral health treatment services. To learn more about how our billing service can benefit your facility, please reach out today at (877) 715-7919.

Why Parity Standards Now Shape Behavioral Health Billing

Billing for behavioral health services has become inseparable from federal parity compliance. The Mental Health Parity and Addiction Equity Act (MHPAEA) requires that the financial requirements and treatment limitations payers apply to mental health and substance use disorder benefits be no more restrictive than those they apply to comparable medical/surgical benefits. The U.S. Centers for Medicare & Medicaid Services MHPAEA guidance explains that non-quantitative treatment limitations (NQTLs) — such as concurrent review requirements, medical-necessity criteria, and provider documentation rules — must be applied “no more stringently” than comparable medical/surgical limits. The U.S. Department of Labor’s MHPAEA enforcement reports regularly identify concurrent-review denials and inconsistent medical-necessity documentation among the most common violations.

HCPCS Codes, ASAM Documentation, and Clean Claims

Behavioral health billing turns on a small set of high-revenue codes — H0010 (sub-acute detox), H0011 (acute detox), H0019 (long-term residential), 90791 (diagnostic evaluation), 90834 and 90837 (psychotherapy), and 90853 (group therapy). Each carries its own authorization, documentation, and concurrent-review burden. The ASAM Criteria remain the most widely-accepted multidimensional framework for placement and continued-stay decisions in addiction treatment, and most commercial payers reference ASAM directly in their medical-necessity policies for residential and intensive outpatient levels of care.

The practical implication for billing teams is that every claim should be traceable to a dimensional ASAM assessment at admission and a refreshed assessment at each continued-stay review point the payer requires. That documentation discipline is what separates clean claims that pay on first submission from claims that age into A/R and surface in NQTL self-audits.

This article is provided for informational purposes only and does not constitute legal advice. Behavioral health programs should consult qualified healthcare counsel for guidance on payer contract interpretation, appeals strategy, and parity compliance obligations.