6 Steps to Successful Mental Health Billing for Clinics

Getting Started

As a busy medical professional, you understand the importance of giving your patients the care they need while ensuring your practice runs efficiently and cost-effectively. Mental health treatments are complex and require significant investment on behalf of the practice.

Applied Behavior Analysis (ABA) is a good example. ABA is a treatment that uses theories and techniques relating to operant conditioning. Operant conditioning focuses on observable behavioural cues and symptoms to help mental health professionals treat psychological disorders. ABA is a vital aspect of achieving this critical balance, and that’s where ABA billing comes into its own.

Our six-step guide will outline how to help you verify insurance coverage, patient information, proper authorization for services, submit claims, follow up on claims, and monitor payments. Following these steps allows you to manage your mental health processes efficiently, allowing your practice to remain in the black while providing the vital care your patients need.

The importance of proper mental healthcare billing should not be underestimated. Healthy finances are the bedrock of any healthcare practice; with sound financial practices, you can offer the best service to those who need it most.

This post will cover verifying insurance coverage and gathering accurate patient information. We detail authorization services and how to submit and follow up on claims. Monitoring payment is essential, and you should double-check all information to ensure nothing slips through the net.

Verify Insurance Coverage

To offer consistent quality mental health services, you must verify that your patient has the relevant insurance coverage before providing any care. Verification helps prevent billing issues, enables quality care, and avoids unexpected financial burdens further down the line.

To verify insurance coverage efficiently, remember a few helpful tips.

Ensure patients have provided their insurance information before an appointment, no matter how informal or exploratory the first appointment appears. Put time aside to check the patient’s details. To do that, you must know the following:

1. Patient’s full name and date of birth.
2. The name of the insurer.
3. The insurer’s name and address and any other relevant details.
4. The name of the primary plan holder and their relationship to the patent (if applicable).
5. The patient policy number or group policy ID.

The above may seem like common sense, but verifying the information beforehand avoids confusion and delays in a stressful time for the patient and their family. Alternatively, you can use a digital system that allows instant real-time access to all the relevant information, instantly reducing the risk of errors.

Verify Authorization for Services

Most health insurance plans require pre-authorization, meaning patients must get relevant permission before receiving some mental health services. Not all policies are underwritten to cover all aspects of mental health services.

By undertaking pre-authorization and verification, you can ensure your patient’s treatment can start immediately. The following is valuable information to speed up pre-authorization for mental health services:

1. Keep clear records and create a list of services that require pre-authorization.
2. Record denial reasons and regularly document and check data.
3. Keep on top of payor changes and changing industry standards.
4. Make one person responsible for best practices and keep authorization central.
5. Educate your patients on the pre-authorization process and advise them on turnaround times.
6. Embrace technology.

Remember, your patients like transparency, which makes tip five crucial for more reasons than pre-authorization.

Submitting Claims

By submitting an accurate claim, you speed up the payment process. Errors in the mental health billing system hinder speedy settlements. Errors occur for many reasons, including submitting inaccurate documentation in the first instance; no matter the mistake, incorrect claims will delay reimbursement or could result in non-payment.

If you’re submitting your claims manually, don’t! But if you insist on resisting technology, here are some tips for submitting claims efficiently:

1. Pay attention to the pre-claim procedures the payor requires; each insurance company may require a different submission method.
2. Make your internal claims. submission process seamless by taking control and making one person responsible for all claims.
3. Ensure your submission staff are well-trained and retrained as necessary.  
4. Invest in a data management or claim submission platform.

How to Follow Up on Claims

A speedy follow-up can prevent financial gaps if you have submitted your claim but have not heard anything. Often, claims are kept pending over their due date. Generally, the reason is the lack of accurate information submitted in the first instance.

A proper follow-up can prevent gaps in the billing cycle and keep a smooth flow of finance.

Here are some useful tips on how to follow up on your billing claims:

1. Follow up quickly, within 7–10 days of the claim’s due date.
2. Make sure you have the allocated claim number.
3. Don’t get fobbed off. Diarise your follow-up and keep track of the details.
4. Use a digital system to remind you of the follow-up procedure.

Monitor Payment

Accurate and up-to-date financial records are vital in ensuring your accounts are paid on time. You need accurate information to run a properly funded healthcare facility. There’s nothing more infuriating and unprofessional than wasting time chasing insurers who have paid and ignoring those who haven’t.

If you know what payments are coming in and out, you are better placed to offer the quality mental health services your patients deserve. If you follow this six-step guide and invest in a decent billing service, the rest will follow.