If you are wondering whether you can bill psychological services under a medical doctor, then you are in the right place. Here we have mentioned all the basic considerations, aspects, and factors that you need to understand regarding the billing system. So, read the article further to get a complete idea.
A behavioral medicine specialist, either working on referral or on-site, can improve patients’ mental health. By using different behavior-changing practices, psychologists can help people learn self-management methods to control severe health conditions, such as cardiovascular disease, cancer, and diabetes. They help your patients deal with the emotional responses that occur due to situational stress and health problems.
A psychologist can teach methods to patients that they need to use along with the physician’s or other doctor’s treatment plan. Hence, patients can also cope with the stress that occurs due to several illnesses. Psychologists working under the primary care unit can provide consultation and intervention for psychological conditions.
They can also help patients referred by a physician and other health care providers. These health specialists also help assess and treat patients and their families struggling with difficult relationships, behavior problems, and other problems that interfere and affect patient’s health. There are several other reasons to take help from a psychologist for the sake of your patient’s health.
Before knowing if you can bill psychologist services under a medical doctor, you need to know about the mental health billing process. The way insurance providers and patients look at psychological health greatly differs from the way they look at traditional health care practices. Not to mention, costs and expectations are also significantly different between the two. Therefore, psychiatry billing services are completely different than traditional medical health care industry billing. This has lead to many challenges in recent years.
The insurance provider has separate rules for psychologists. They offer a certain time period for consultation for each patient. Additionally, the medicines and how many appointments a doctor can take in a month also greatly depend on the insurance providers. This not only brings billing challenges, but also psychologists find it difficult to treat their patients in limited time. You should know that financial demands and unique rules make billing for mental health providers a completely different process compared to general health care billing systems.
Do you know only 85% of behavioral and mental healthcare claims get approved? There are several reasons why mental healthcare providers face this problem. The most common problem is the lack of knowledge of managing and dealing with the billing system. This is why most health care providers outsource their billing services to professional teams like Likes James Medical Billing Expert. Since these professionals have in-depth knowledge to handle issues, there is less chance of problems leading to reimbursement processes.
Yes, you can bill psychological services under a medical doctor. However, as we have discussed billing process for psychologists is comparatively complex and challenging, and you will face problems in the process.
Provider reimbursement and patient billing for psychologists operating in primary care greatly depend on the service delivery model. For instance, psychologists may be working as staff in the primary care institution and getting a salary. Or they may be simply operating independently, managing their own billing system, and seeing patients on referral. However, in the case of integrating primary care and behavioral health, the billing process will come under the medical doctor.
Although many health specialists enjoy the benefits of using an integrated approach, reimbursement for services is still one of the most challenging tasks. The 21st Century Cures Act and The Mental Health Parity and Addiction Equity Act of 2008 are policies made by Congress to deal with the lack of coverage for mental health services and to maintain coordination between primary care and behavioral health.
These laws ask health plan providers and insurers to offer equal services to mental health patients as other general patients. This also helps in lowering the reimbursement barrier because commercial and government payers need to establish payment methodologies that will help them to reimburse health care services offered in an integrated setting.
Moreover, health care providers need to establish health care models that can help them maximize financial sustainability by considering the license of the entity where the integrated mechanism will run. You also need to consider the billing codes that you need to use for behavioral and mental health services and reimbursement requirements present in their payer contacts.
The following are factors and tips you need to consider while establishing a financially sustainable integrated model.
You can provide the integrated care model in different settings. But the services you provide can impact the reimbursement process. Community Mental Health Centers or CMHCs get the license from the state institutes that govern the mental health services. They have to provide the right medical care services to mental health patients. These centers mostly get funds from the Medicaid grants and contracts. Additionally, all the federally qualified centers need to meet certain criteria to get payment systems under Medicaid and Medicare.
Hospital-based outpatient programs, substance use treatment institutes, and other types of health care facilities need a separate license to establish an integrated setting. For the billing system, the health facilities need to check their license regulations to decide which billing methods are applicable to their condition.
Understanding and knowing the billing codes for integrated settings is the most important thing for financial sustainability. Medicaid and Medicare billing codes for psychological services come under the Evaluation and Management as well as the Medicine of CPT codes.
Additionally, the billing codes of the commercial payers can greatly vary. You also need to know that some commercial payers reimburse for brief intervention, alcohol, and drug screening, and referral to treatment facilities when a credential provider bills them. In certain cases, some may reimburse when facilities choose the right codes associated with time criteria and standard components in the contract with the commercial payer.
You also need to know that some commercial payers will develop special health care programs for some common issues like depression. They will have to follow different billing codes for this purpose. For these reasons, you need to know about all codes that will allow you to reimburse for an integrated setting.
The following are some factors that may affect the billing process. You need to have all the knowledge about the billing conditions and methods, so you can reimburse money at the right time with the appropriate technique.
Constantly Changing Billing Methods and Rules
The primary reason billing psychological services under a primary doctor is challenging for health facilities is the constantly changing billing methods and rules. This is when you need a professional’s help. Experts like Lokesh James Medical Billing Expert can track the changes so you can claim for the money that you should get.
You also need to know that insurance policies eventually lapse. If your facility doesn’t make an effort to check these issues regularly, you will find yourself dealing with a lot of paperwork. Not to mention, mental and medical health practitioners usually get notifications later when changes or problems occur.
This entire process becomes even more complex when the rules that dictate the method to operate the billing process also shift or change. In the meantime, you also need to follow coding systems, compliance regulations, and other things. If you don’t track these changes, your problems will only increase. An expert does not only keep up with these changes but also checks the patient’s insurance provider to ensure the right billing process.
Expenditures are the most common problems for behavioral and mental health facilities. For this reason, many organizations hire less staff in the administrative department. Cutting costs this way only puts pressure on your staff to do double work. This, in return, increases the chances of billing problems and lack of tracking of billing method changes.
To avoid this problem, you need to hire full-time staff for the behavioral health billing system. Of course, this means you need to pay more money than before. Another method health provider institutions opt for is outsourcing their billing department. In this case, they don’t have to spend money on the big billing department. Hence, it also reduces rejected claims, late payments, and improper coding issues.
If you want to bill psychological services under a medical doctor, then you need to consider all the factors mentioned above. Make sure that your staff has a better understanding of the billing system. In case you have any concerns, it’s better to hire a professional team like Lokesh James Medical Billing Expert. They not only reduce the chances of any possible problems but also give better solutions for your billing problems.