MBC: Best-in-Class Behavioral Health Billing Company

Behavioral health billing is quite challenging as various factors affect the billing process. The length of the session, the approach to therapy, and the willingness of the patient to partake make it far more difficult to standardize treatment and billing. Moreover, how insurance carriers look at behavioral health is noticeably unlike the way they look at more traditional medical practices. For example, insurance carriers determine how long treatments are allowed to take and how many sessions can take place each day, making it challenging for behavioral health practitioners to balance effective billing with adequate patient treatment. In such challenging billing conditions, behavioral health practitioners can benefit from assistance from the medical billing company. Medical Billers and Coders (MBC) is a best-in-class Behavioral Health Billing company providing complete behavioral health services. With our help, you can focus only on patient care while we deal with government and private payers along with their constantly changing billing guidelines and reimbursement policies.

The most Common CPT Codes used for Behavioral Health Billing

Here are some of the most common CPT codes used for behavioral health billing:

  1. 90791 – Psychiatric diagnostic evaluation
  2. 90832 – Psychotherapy, 30 minutes with patient and/or family member
  3. 90834 – Psychotherapy, 45 minutes with patient and/or family member
  4. 90837 – Psychotherapy, 60 minutes with patient and/or family member
  5. 90839 – Psychotherapy for crisis; first 60 minutes
  6. 90846 – Family psychotherapy (without the patient present)
  7. 90847 – Family psychotherapy (with the patient present)
  8. 90853 – Group psychotherapy (other than of a multiple-family group)
  9. 96127 – Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale)
  10. 96152 – Individual psychophysiological therapy (e.g., biofeedback) with evaluation and reprogramming of the device

These codes are used to bill for various behavioral health services, including diagnostic evaluations, psychotherapy sessions, family therapy, group therapy, and psychophysiological therapy, among others. It’s essential to use the appropriate code based on the specific service provided during the patient encounter.

What Makes MBC a Best-in-Class Behavioral Health Billing Company?

Verifying Patient Demographics

We cross-check patient demographics and insurance information submitted by behavioral health practices. Our team cross-checks patient demographics like name, date of birth, and address, along with insurance information. Inaccurate patient and insurance information is the prime reason for claim rejections. Rejected claims are claims with inaccuracies that are stuck in billing software and can’t reach to payers’ system unless they are corrected. Verifying patient demographics ensures timely payments and acts as a base for benefits verification & prior authorization activities. Throughout the billing process, our team ensures that data is transferred through secured channels and complies with HIPAA standards.

Insurance Coverage and Prior Authorizations

Patients’ benefits and coverage requirements might vary based on services rendered and individual/group policy. For us, it’s critical to check insurance coverage and prior authorization requirements for every patient visit. We share comprehensive insurance coverage reports with behavioral health providers, and also notify if any procedure code/s or planned service/s are not covered in any patient’s plan. Such notification helps providers’ front office to contact the patient for alternate insurance or inform them about patient responsibility. Our team is well versed with state-specific and payer-specific behavioral health prior authorization requirements. Whenever applicable we submit the prior authorization request and take the reference number to be mentioned in the claim. Denials received for prior authorization are considered as ‘hard denials’ i.e. they are hard revoked by payers.

Clean Claim Submission

A clean claim is submitted claim without any errors or other issues. Clean claim submission ensures timely payment from insurance carriers. We stay on top of the yearly changes in the CPT codes and have a deep understanding of HBAI codes’ usage while billing for behavioral health services. We ensure prior authorization of the patient’s eligibility & benefits with behavioral health insurance to avoid denials in the long run. Our team of medical billers and coders instantly know the ICD codes for behavioral and mental health. All these help us to submit clean claims.

Denial Management Team

Our team keeps regular track of submitted claims to catch and resolve denial issues without exceeding the time limit. We constantly follow up on claims within 30 days to avoid insurance aging. To track and appeal denials, our denial management team consists of experts from various fields like Accounts Receivable (AR), coding, quality, and billing. We include providers also in our process of denial analysis and resolution process. Our AR experts, connect with payer representatives to discuss the nature of denial and possible resolution in such cases.

Billing Various Payers

Medical Billers and Coders (MBC) has been in the medical billing industry for more than 15 years. We are successful in processing medical claims with most standard commercial insurance carriers including UHC, WellPoint, Aetna, Humana BCBS, and Anthem, and government payers such as Medicare. Our expertise is also in working with Medicaid and we have a deep understanding of state-specific Medicaid policies. Our expertise with various insurance carriers helps our customers to receive accurate and timely reimbursements.

Provider Credentialing

Provider credentialing and enrolment are crucial for any behavioral health practice’s financial sustainability. However, provider credentialing and enrolment is a very long and tedious process. At the time of starting a practice, most behavioral health providers submit applications for various insurance carriers but later lose their focus due to patient care. This might lead to submitting claims to insurance carriers without enrolling with them resulting in denied payments. Under our credentialing services, we complete thorough research on provider credentialing and enrolment status. And as per inputs from a provider, start filling or following up on credentialing status for various providers. Our credentialing team tries to get your facility, group practice, and providers in-network with insurance panels as quickly as possible.

Small Practices

The differences between medical billing and behavioral health billing are magnified by office budgets. A large group practice might hire dedicated employees to focus completely on medical billing, but with behavioral health, it’s more commonplace to have a small group or solo practice with limited administrative support for billing and other office duties. Some providers will even try to do the billing themselves but sooner or later, this will become overwhelming and produce time management problems, not to mention lost income. We customized our behavioral health billing services to match the unique billing requirements of small/solo or group practices. Being medical billing experts, we take complete ownership of medical billing responsibilities and ensure providers are not keeping any money on the table.

Our constant efforts toward clients’ satisfaction help us to become and stay a best-in-class behavioral health billing company. If you are still not sure about how we can completely manage your behavioral health billing, contact us directly at: info@medicalbillersandcoders.com or call us at 888-357-3226.