The line between medical billing and behavioral health billing is often blurry, with billable charges for each episode of care varying widely based on the services rendered, service provider, payer, and treatment plan. Without a proactive approach to behavioral health practice revenue cycle management (RCM), practices take on significant revenue leakage that can quickly snowball into a major threat to profitability. The key to avoiding a financial crisis is to set your revenue cycle up for success starting from step one, leveraging diligent oversight behind the scenes to ensure a smooth transition from revenue capture to reimbursement.

Top 3 Best Practices for Behavioral Health Billing

Every billing department understands how to assign codes, create claims, and process payments for healthcare services. This process becomes exponentially more complex in behavioral health practices, where billing teams must navigate the complexities of mental health care and carefully walk the line between medical and behavioral health billing rules. Ensure your revenue cycle is positioned for full and timely reimbursements by implementing these three best practices:

1. Keep track of shifting payer rules. The behavioral health specialty is home to continually evolving billing requirements as payers and regulators ensure providers receive proper reimbursement, and, more importantly, that patients can access these much-needed services. In the 2024 Medicare Physician Fee Schedule, the Centers for Medicare and Medicaid Service (CMS) took major steps to make behavioral health care more accessible by covering services from non-physician practitioners (NPPs), including marriage and family therapists and mental health counselors.¹ While this is good news for behavioral health practices, billing teams must rapidly adapt to these changes to capitalize on new revenue streams — without overstepping regulatory boundaries and risking non-compliance. 

2. Stay current on coding guidelines. Coding changes are an administrative hurdle in any specialty, but behavioral health billing teams must process a longer list of changes as mental health services evolve to match industry demands. In January of 2024, the American Medical Association (AMA) implemented new coding changes for behavioral health, primarily targeting telehealth services and evaluation and management (E/M) visits, with new rates to accommodate different sites of services, providers, and standard services.² Keeping up with changes like these is a must for your billing office, as accurate coding serves as the bedrock for comprehensive revenue capture, full reimbursement, and, ultimately, a successful practice.

3. Ensure end-to-end regulatory compliance. Coding and payer updates represent a two-fold challenge. As payers expand their coverage to include NPPs and services that do not strictly fall under a “medical” category, practices must simultaneously incorporate new requirements into their billing workflows while ensuring their billing department aligns these changes to regulatory requirements. This is especially complex when billing for NPPs, as each payer and regulatory body operates on different frameworks, especially when defining split/shared and “Incident to” services. Watch the on-demand webinar from a healthcare compliance officer to hear an expert’s perspective on mastering the NPP billing landscape while staying compliant with shifting behavioral health billing regulations.

Simplify Behavioral Health RCM With the Right Partner

Getting behavioral health claims right the first time is nearly impossible with an overburdened and inexperienced billing team. By partnering with an experienced RCM company that specializes in behavioral health billing, your practice can bypass many of the roadblocks and hurdles that stand in the way of full revenue capture and timely reimbursement. For countless behavioral health practices, Med USA is the RCM partner that has opened the door to a more profitable, efficient, and scalable practice. With compliance at the center of our revenue cycle solutions, Med USA stays ahead of regulatory waves by implementing new changes and the necessary billing optimizations as soon as possible to ensure behavioral health practices capture every dollar possible so they can focus on what truly matters: their patients.

Ready to Build a More Profitable and Compliant Behavioral Health Revenue Cycle?

Talk to a Med USA representative today!

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Sources

1. CMS Finalizes Physician Payment Rule that Advances Health Equity. (2023, November 2). U.S. Centers for Medicare & Medicaid Services. https://www.cms.gov/newsroom/press-releases/cms-finalizes-physician-payment-rule-advances-health-equity 
2. Medicare Physician Fee Schedule Final Rule Summary: CY 2024. (2023, November 22). Medicare Learning Network Matters. https://www.cms.gov/files/document/mm13452-medicare-physician-fee-schedule-final-rule-summary-cy-2024.pdf