Insurance billing and revenue cycle management (RCM) are among the top issues affecting a behavioral health agency’s profitability. Collecting payment for behavioral health treatment can be complicated, influencing the agency’s revenue. Insurance claim denials prevail, making it a challenge for the clinic to collect due payment.
Dealing with claim denials and rejections is time-consuming and often complicated. To prevent problems with insurance companies, it’s imperative to avoid common billing mistakes.
Let’s take a closer look at errors you can avoid at the billing stage in order to prevent reimbursement battles.
1. Providing Faulty Documentation
Insufficient or faulty documentation is one of the most common causes of claim rejections. These errors tend to occur due to missing notes, untimely orders, problems with timesheets, lack of evidence that a certain procedure was performed, and the like.
Before a biller submits an insurance claim, it’s imperative to check if it meets all the documentation requirements. The culprit of faulty documentation is often a pre-populated EHR template. To make sure you aren’t sharing the wrong information, each form needs to be double-checked for:
- Incorrect patient information
- Incorrect provider information
- Incorrect insurance provider information
- Incorrect codes
- Mismatched codes
Many agencies struggle with appropriate coding for time spent in therapy. Billing for a 30-minute session when it only lasted 15 minutes could lead to denials. While appeals are always possible, they can be extremely time-consuming. Triple checking your documentation takes much less time.
2. Failing to Stay Up to Date with the ICD-10 Codes
When it comes to behavioral health and substance abuse billing, ICD-10 has thousands of billing codes. These codes change all the time, with new ones cycling. It can be tough for in-house financial departments to monitor all ICD-10 code changes; especially when missing just one could lead to claim denials and a lengthy appeal process.
It’s imperative to remember that insurance companies readily deny any claim no matter how small an error is. A serious problem like a wrong code could delay payment substantially. Many insurance providers are on track to pay out less in reimbursements, making them highly attentive to any error types. An invalid or outdated code equals an instant denial.
3. Upcoding and Undercoding
Upcoding happens with a behavioral health patient is billed for more procedures than the clinic provided. It can also occur when the clinic bills a patient for a service that they never received. Undercoding happens when a code is mistakenly left out of the patient’s bill.
Such problems occur when a doctor doesn’t provide precise information or the billing department makes an error when entering treatment codes.
In-house specialists with minimal billing experience with your specialty are well-known for both upcoding and undercoding. Unfortunately, even if the nature of such errors is accidental, they can result in administrative, civil, or criminal liability. This is why it’s a good idea to entrust your revenue cycle management to specialized billing experts who can anticipate these problems and intercept.
4. Duplicate Billing
In the COVID-19 environment, behavioral health treatment procedures and consultations are often rescheduled and canceled. This factor combined with the complexities of claims can lead to duplicate billing. However, just like upcoding, it could result in a fine for a clinic.
It’s possible to avoid duplicate billing issues by taking advantage of a comprehensive practice management system fully integrated with your treatment features like MAT or eprescribe.
5. Forgetting to Verify Insurance
Another common mistake behavioral health agencies make is they fail to verify insurance coverage. If a patient receives treatment regularly, the staff member can assume that they continue using the same insurance.
However, people change insurance all the time. Meanwhile, insurance providers tend to change their coverage. Failing to verify eligibility before each visit could cause claim rejections.
By making regular insurance verification an integral part of the billing process, it’s possible to identify issues like terminated coverage and unauthorized or not-covered services.
6. Failing to Meet the Filing Deadline
Health insurance companies set filing deadlines for claims. These deadlines vary tremendously. For example, Medicare claims must be filed within 12 months after the date of service. Meanwhile, private insurance companies like Blue Cross Blue Shield can demand the claim to be filed within 90 days.
Many smaller clinics fail to check the provider manual to find the filing deadline. While trying to submit a claim as soon as possible is excellent practice, it’s imperative to know each company’s deadline requirements.
7. Struggling with Telehealth Coding
Telehealth is currently an integral part of behavioral health treatments. Treating remotely doesn’t just help adhere to rules set due to the pandemic. It gives patients access to top-notch specialists without incurring travel expenses.
However, telehealth options come with special insurance codes, complicating the billing process. Failing to follow telehealth claims coding requirements could lead to claim denials.
8. Relying on Only a Single Biller to Support Your Organization
Substance abuse insurance billing is a complex process that doesn’t just involve collecting proper documents. It requires continuous industry monitoring, an in-depth understanding of the latest code changes, and meticulous claim reviews.
Many agencies that rely on a single in-house biller to do insurance billing end up with denials, or worse under-payments. By outsourcing billing to an experienced billing specialist or an RCM service provider, it’s possible to avoid the majority of errors while gaining extra time to focus on core tasks.
Preventing Mental Health & Substance Abuse Insurance Billing Mistakes
With more than 80% of medical bills containing errors, insurance companies are especially strict about reimbursements. When it comes to behavioral health services, agencies must pay extra attention to avoiding common mistakes. A simple typo could lead to a claim denial, thus negatively affecting your cash flow.
By outsourcing RCM to TenEleven, you can avoid billing issues, thus improving your practice’s profitability. Contact us for more information about streamlining substance abuse insurance billing or revenue cycle management services.