Top 6 Differences Between Psychiatric Billing & General Medical Billing Services

With the increasing awareness of mental health, psychiatrists & mental health practitioners remain overwhelmed due to work stress. In order to get better financial support, they should get specialized psychiatric billing services purpose-built to meet the unique billing requirements of mental health providers.

It is a wrong perception that general methods of medical billing services also apply to mental health practitioners and psychiatrists. The complicated coding rules of psychiatric billing services are ever-changing making the medical billing process slow and frustrating.

Besides these regulations, there are several other differences between general medical billing and psychiatric billing services. I have outlined 6 top unique elements of psychiatric billing services as follows;

Session Length

Mental health and psychiatrists provide variable sessions to their patients. On the other hand, a medical care bill a current procedural terminology (CPT) codes based on the services taken for a specific time.

For example, CPT code 36415 is used for blood draws or code 99385 for a well-woman visit for a new patient ages 18-39

However, different mental health visits take a variable amount of time. Therefore, these visits are coded according to the standard codes used to bill the closest amount of the time spent on the patient.

For example;

90832: 30 minutes of individual psychotherapy (fits for sessions 16-37 minutes)

90834: 45 minutes of individual psychotherapy (fits for sessions 38-52 minutes)

90837: 60 minutes of individual psychotherapy (fits for sessions 53+ minutes)

90846: 50 minutes of family psychotherapy without the patient/client (fits for sessions 26+ minutes)

90847: 50 minutes of family psychotherapy with the patient/client (fits for sessions 26+ minutes)

Appointment Limits

Usually, most healthcare providers apply to how many mental health sessions or services could be provided to the patient in a specific time period. For example, some insurance companies may only allow one session per day or week.

Therefore, it’s important to evaluate the insurer’s appointment limit during patient registration and eligibility verification. Otherwise, if psychiatric bills are not prepared using this information then it could lead to claim denials and revenue loss ultimately.

Although, there could be different appointment limits for diagnostic centers and healthcare offices.

Prior Authorization/ Pre-Authorization

Prior authorization or medical necessity is the most integral factor in your medical bills. If there would be any mistakes during the validation of mental health services that are going to be provided to the patient then there are high chances that your claims would get denied.

For every other medical treatment, it is essential to validate prior authorization to deliver any medical therapy or diagnostic services. For psychiatrist services, it isn’t essential to proceed with prior authorization for the initial visit except for psychiatric testing procedures.

To provide additional care, an insurance company may require prior authorization after a certain number of patient visits.

Service Location (Telehealth)

After the COVID-19 pandemic, more psychiatrists are providing mental care services via telehealth. In some cases, a clinician can get CPT codes for telehealth as they would for in-person visits. However, they should add a modifier to the code.

95 modifier: This modifier is added to a code if the interaction is real-time (not recorded) but done virtually via a telecommunications system (such as a video chat).

02 modifier: This code shows that the point-of-service (POS) for the interaction was a telecommunication system. On the other hand, 11 POS code is used for an in-office visit.

Also, there are different Healthcare Common Procedural Coding System (HCPCS) telemedicine billing codes used for mental and behavioral health practitioners. Sometimes, these codes start with the letter “G” rather than a number. For example,

G2010: Remote evaluation of an established patient’s recorded video

G2012: Virtual check-in or short, patient-initiated visit

Other HCPCS telehealth codes can include:

99421: Online evaluation and management with an established patient; five to 10 cumulative minutes over seven days

99422: Online evaluation and management with an established patient; 11-20 cumulative minutes over seven days

99423: Online evaluation and management with an established patient; 21+ cumulative minutes over seven days

Superbills

A Superbill is an itemized list of all services provided to the patient during the visit. A superbill is used by healthcare providers as a primary source of data for creating medical claims.

Usually, mental health providers are out-of-network, therefore they often use superbills to claim their payments from insurance companies. It helps them expedite their psychiatric revenue cycle management and reimbursement collections. The newly started psychaitrics can use superbills as an alternative to joining an insurance panel and becoming an in-network provider.

Changing Regulations

With mental health becoming a major concern for the public, billing rules and regulations are always changing. Also, due to the ever-changing billing rules and regulations, it’s becoming quite difficult for practitioners to manage their payments, business operations and medical bills. However, the Cenetsr for Medicare and Medicaid (CMS) continues to update its telehealth fee schedules.

Therefore, psychaitarists should deploy seamless telehealth solutions and medical billing solutions that help you cater to the needs of larger patient base at remote locations.

However, if you’re not fully aware of billing changes or cutting-edge solutions that can help you streamline your business operations then consult with a professional psychiatric billing company. It will help you get insights from the professional psychiatric billing company and get benefits from their years of experience.

Also, their psychiatric billing specialists can suggest your about medical billing and revenue cycle management solutions. So you can digitize your business operations without any hassle.

Conclusion:

Psychiatry is a unique field of the healthcare industry with different medical billing and coding requirements. Therefore, only specialists who are well-versed in the medical terminology of mental health would be able to provide reliable mental health billing services.

Looking for a specialized team of psychiatric medical billing and coding services? CureCloudMD is the most professional, reliable, and well-established mental health billing company that offers the most cost-effective mental health billing services.

Schedule a free medical billing audit with our psychiatric billing specialists from the following link: https://curecloudmd.com/contact-us

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