BEHAVIORAL HEALTH BILLING
BEHAVIORAL HEALTH BILLING
Team Infallibill started in 2004 in the Behavioral Health space. Our Main Director built a directory that guided folks to the information they needed to find a facility that best fit their treatment modalities needed for their circumstance. The directory became so popular that the largest practices at that time were using its real estate and still do to this day! They went on to build out sophisticated systems for Call tracking and software for CRMs and API integration systems for connecting different platforms together that in no ways could connect. This allowed our directors to connect with some awesome folks and today have quite an amazing archive of information passed on from generation to generation will in millennial generation talk!
Behavior health professionals have completely different procedures, evaluation and explanation models than most practices and due to that billing has to nine times out of ten rely on proper clinical evaluation and set standard practice FAQs to make sure the practice gets paid by providers. Today it has become a wild, wild west for up and comers to “think” that they can get in where they fit in however as they will quickly see the GOLD rush is over and Insurance companies are coming privy to the many different schemes that became common place in the mid to late 2000s and have started to separate sophisticated and unsophisticated.
Most behavioral health groups will find that the squeeze is real and that without innovation, and proper workflow guides and real time Accounts receivables audits most practices can not properly adjust their futures business! Let’s be honest getting clinical to use systems and organize notes is a never ending battle. Infallibill can help with system integration and get everyone on the same page right from the start saving the practice millions in losses over the course of the life of the company.
1. Are you seeing reimbursements below 48%
If your practice is seeing claims being paid out below 48% there is a serious issue with how the claims are being submitted and or for what services, or the follow up is weak.
Answer: Infallibill has been working with Treatment centers and Detoxes for over 16 years.
Usually the larger private insurance companies: Cigna, Aetna, Blue Cross, and United Behavioral Health (and many more) pay well when it comes to reimbursements (we know this may sound strange to you) However regardless of the reimbursement rate the imperative factor is always the time limit provided in a service’s CPT code. We have found that when a practice is billing for a 45 minute psychotherapy session then 45 minutes is what the claim for reimbursement should state another thing to consider is that packing up books, cleaning and arranging chairs is not part of the session and should not be added.
We have seen many practices billing for multiple sessions on the same day. This is not usual and customary. However Infallibill typically calls and gets pre-auths for multi-sessions. Our clients may be able to receive authorization for more than one service per day based on these pre-auths.Food for Thought: if you have a psychiatrist on staff, psychiatrists can provide one service and the counselor can provide another service.
3. What is typical for reimbursement times?
Standard reimbursement times for Behavioral Health Billing is 30 business days from the date the insurance company received the claim until the payout is received. But it does not always take that long. For example, Blue Cross in Colorado and Massachusetts normally pays their claims within 2 weeks, and Aetna takes three weeks for most states. Infallibill has also found that there are around 200 employer policies statewide that pay within 10 business days.
4. Time for Submitting claims?
This is variable and depends on the insurance company. So it is always good to check with the insurance companies that you submit claims to. Infallibill does not like to wait and typically will train our new clients on how to get everyone to expedite this part of the many processes that behavioral health billing has. In some cases, time is of the essence, Aetna normally allows 90 days to file a claim. With other companies, you may have more than a year. We have a list of data and providers that we have compiled on when and how long we have to submit claims, we can share even if your not a client just give us a call 888-394-3332
5. How come Behavioral Health Billing has become so technical?
Behavioral health billing has technical mandates that have been installed by providers due to the huge amounts of fraud that have occured the past 6 years or more. For most practices and healthcare providers, time distribution is key. It takes time to learn what diagnosis codes work, and even where and how to submit each claim it takes time to study the rules of engagement being used by most providers to disable fraudulent activities.
Behavioral health billers find that insurance companies often have many different addresses for each department even filing electronically different portals can and should be used or you could lose out on 10s of percents. If you happen to send the claim to the wrong department, they will reject, If you use the wrong portal, it will be rejected. If you submit a claim to an insurance company that has decided to outsource its handling of behavioral health services to another company, the claim will be rejected. So staying up on the process and flow is key, that’s what Infallibill is paid to do daily. Stay on top of it so you do not have to. Even if you are not a client yet and just looking for us to share with you some of our content give us a call WE ARE willing WE ARE INFALLIBILL.