Behavioral Health Billing: Why It’s So Much Different than Traditional Medical Billing

You’ve heard us say it before — each medical specialty comes with its own set of rules and requirements that make billing tedious and complicated. Behavioral health is no exception to this. Revenue cycle teams who work in the behavioral health space are constantly facing new challenges with payers, making it difficult to maximize reimbursements.

In this blog, we’ll dive into the specifics of the behavioral health space, billing challenges, and how technology can help.

The Behavioral Health Space

Behavioral health is a broad specialty that encompasses a wide array of mental and emotional well-being services. This can include (but is certainly not limited to):

1. Mental Health: Typically focused on diagnosing, treating, and managing conditions like depression, anxiety, bipolar disorder, schizophrenia, and other mood or thought disorders. These services are often provided by psychiatrists, psychologists, counselors, and social workers.
2. Addiction & Substance Abuse Disorders: Focused on providing treatment and support for those struggling with alcohol, drugs, or other forms of addiction, such as gambling. These services can include detox programs, rehabilitation, counseling, and harm-reduction strategies.
3. Behavioral Medicine: Typically addresses the psychological factors involved in physical health conditions, such as chronic pain, obesity, diabetes, or heart disease. These services focus on changing behaviors to improve physical health outcomes.
4. Trauma and PTSD: This involves specialized care for individuals suffering from the effects of trauma, including post-traumatic stress disorder (PTSD). These services are often provided by clinicians trained in trauma-informed care.‍
5. Child and Adolescent Behavioral Health: This involves specialized care for children and adolescents dealing with mental health issues, developmental disorders, or behavioral problems. Typically, these services include collaboration with families, schools, and pediatricians.

As you can see from this list, treatments can include anything from counseling, to medication management, detox programs and rehabilitation, and so much more. Because of this range of services, coupled with the fact that not all payers will reimburse for these services, billing is incredibly nuanced.

Coding complexities

As demonstrated above, behavioral health often includes a wide range of services, providers, and unique regulations around mental health, which makes billing incredibly complex. Here are some of the factors that increase the complexity:

1. Diverse Provider Types and Locations: Services can be rendered by a range of providers, such as  psychiatrists, psychologists, social workers, licensed professional counselors, and addiction specialists, who each have their own coding requirements. On top of that, the location where services are rendered plays an important role in coding as well. It’s important to note that services can be provided in outpatient clinics, inpatient facilities, telehealth settings, or even through home health programs, and each setting has different reimbursement rates, billing rules, and documentation standards.
2. Compliance With Regulations and Payer Policies: As a part of the mental health parity act, payers are required to cover behavioral health services similarly to physical health services. Payers, however, often vary their approach to these requirements, so it’s important to stay abreast of payer-specific policies that impact the way services are reimbursed. Behavioral health services may also be governed by federal or state regulations that dictate things like documentation requirements, treatment limitations, and more. 
3. Time Based Billing: Behavioral health codes are driven by time spent with the patient, which differs from other specialties that rely on procedural codes. Services are billed in increments of time, so documentation is crucial. Additionally, services can be bundled and billed together, or billed separately on a case by case basis. 
4. Overlap with other Specialties: In behavioral health, certain diagnoses or treatments may overlap with other specialties, such as primary care or neurology, which requires coordination between billing teams. Navigating billing for integrated care requires a deep understanding of how to avoid claim denials due to unbundling issues or duplicate billing.

These are just a few of the challenges that make billing in behavioral health increasingly complex. Revenue cycle teams need a tool that can help them manage this complexity and maximize reimbursements.

Revenue Cycle Tech in Behavioral Health

Technology like Adonis Intelligence and Adonis Billing can help revenue cycle teams in behavioral health combat complexity and recover the revenue they deserve. With Adonis’ suite of revenue cycle technologies, teams can:

1. Track and adapt to changes in billing and coding requirements, ensuring that all patient services are accurately reimbursed by payers.
2. Predict which claims are most likely to be denied based on patterns in payer behavior and claim data and recommend corrective actions before the claim is submitted.
3. Consolidate actions and tasks in one place, helping teams track claims awaiting rework or follow-up to ensure no outstanding revenue gets missed.

With Adonis, teams in behavioral health are getting the most out of their claims, recovering revenue faster and more effectively. Learn which Adonis product is right for your team, here.