Mental Health Billing Errors and Coding Complexities

Mental Health Billing Errors and Coding Complexities – Let’s Just Get Rid of Them!

Back in 2010, the Office of the Inspector General (OIG) found that 42% of Medicare claims had coding mistakes. Such billing errors can lead to denied claims, causing healthcare providers to lose money. Especially, undercoding can impact providers' finances by reducing their payments.

Mental health providers need to be paid fairly for their services. To make sure everything runs smoothly, it's important to use the right medical codes and avoid mistakes in coding. This helps healthcare practices succeed.

AMA treats medical coding errors as “fraud” and “abuse”. That's why accurate and ethical medical coding is so important.

The majority of the errors in medical coding were attributed to insufficient documentation, inaccuracies in coding and modifiers, unbundling of services, and a lack of familiarity with coding guidelines, anatomy, and medical terminology. Mitigating these errors can be achieved through comprehensive training programs covering coding guidelines, robust auditing and monitoring procedures, and the imparting of knowledge in medical terminology, anatomy, physiology, medical abbreviations, and diagnosis. While coding and billing errors are avoidable, a proactive approach involving an understanding of the root causes behind these errors is essential to work out on reducing and controlling them.

What makes Mental Health Billing and Coding so Hard?

Billing and coding for mental health is tricky because it involves understanding reimbursement rules, terms, and the rules of the insurance contracts. Mental health services are closely regulated by federal laws, Medicare and Medicaid policies that can vary by state, practice rules, and the billing guidelines of private insurance companies. Getting the coding and billing right is really important to report services accurately, to avoid scrutiny from auditors and make sure you get paid.

Top Mental Health Coding Errors to Avoid

Usage of Wrong CPT Code

This is always a possibility because procedural codes are very specific and choosing the right one can be ambiguous. Failure to trace out the subtle difference can lead to a denied claim. Therefore, there is no substitute to a thorough understanding of the most common codes.

Usage of Outdated Codes

Outdated codes in metal health billing can lead to underbilling or overbilling. These mistakes can lead to claim rejections, underpayments, and audits. A common error is assigning codes based on assumptions instead of documentation. Make sure the codes assigned accurately reflect the services provided and are supported by the documentation to avoid inaccurate billing and legal issues.

Unbundling codes

Unbundling in mental health billing is the use of numerous procedure (CPT) codes for the separate stages of a treatment, either due to misunderstanding or to boost payment.

It occurs when a coder charges for two services when the code for the primary service thinks that the lesser service is offered as well. It also results in overbilling since two charges result in a bigger bill than a single complete charge. Repeated unbundling can raise a red flag and may result in an external payer audit.

Upcoding

Upcoding is a widespread procedure in the mental healthcare industry. It is typically seen as an attempt to push the insurer to pay more than what is owed. Time spent with a psychotherapist is an excellent example. With the use of code 90837, a 30-minute psychotherapy session can sometimes be passed off as a 60-minute session. It is very risky to upcode in this manner, as the nature of the condition will indicate whether or not a 60-minute session was required. If contrary evidence exists, your practice may be penalized.

Using modifiers incorrectly

Improper modifier implementation can result in a denial and, eventually, a halt to reimbursement. Furthermore, some modifiers are required by some insurance providers in order to be reimbursed. Some terms, such as PT and 33, have similar meanings but must be chosen based on the payer.

Documentation errors

Solid documentation in mental health billing makes getting paid easier and faster. Inadequate or missing paperwork might result in claim denials or issues proving the medical necessity of a procedure. Missing or incomplete patient charts, a lack of evidence of medical necessity, failure to provide thorough procedure notes, or insufficient medical history documentation are all examples.

Incomplete records frequently omit critical information such as the patient's medical history, the purpose of the visit, or the services provided.

In Conclusion

Much of these mental health billing errors can be eliminated by following a definite process for coding and billing. The first thing is to make sure you're as accurate as possible. Building a quality control process is the best way to reduce simple to complex coding errors. Keeping your team updated on CPT changes and making it mandatory to read the AMA's manual are some of the best ways to ensure you use the right codes.

The most flawless way is to have a dedicated team to meticulously check all the notes and included with the codes. This can fetch you a maximum and truncated reimbursements.

mental health billing service provider committed to transforming the healthcare industry by delivering full medical billing support services to healthcare professionals across the United States.

We have a dedicated team of mental health billing experts ensuring that every single procedure is coded appropriately without unbundling the codes.

Get introduced to your Mental Health Billing and Coding expert now!