{"id":24428,"date":"2022-04-12T10:59:27","date_gmt":"2022-04-12T14:59:27","guid":{"rendered":"http:\/\/www.carecloud.com\/continuum\/?p=24428"},"modified":"2025-06-25T17:18:48","modified_gmt":"2025-06-25T17:18:48","slug":"medical-billing-options-for-behavior-health-specialists","status":"publish","type":"post","link":"https:\/\/carecloud.com\/continuum\/medical-billing-options-for-behavior-health-specialists\/","title":{"rendered":"Medical billing Options for Behavior Health Specialists"},"content":{"rendered":"<p><span data-contrast=\"auto\">Behavioral health centers will face unprecedented challenges in 2022, especially larger health groups. With the rise of <a href=\"https:\/\/www.carecloud.com\/telehealth\/\">telehealth<\/a> services, many centers are expanding beyond state borders<\/span><span data-contrast=\"auto\">,<\/span><span data-contrast=\"auto\"> and the more payer types folded into a revenue stream, the more complex the revenue cycle management (RCM) becomes. Self-pay has become one of the easiest and largest pay methods for behavioral health; however<\/span><span data-contrast=\"auto\">, Medicaid, Medicare, and private insurers all have unique rules, requirements, and guidelines to consider. The mere volume you do, the more requirements and guidelines you need to track and follow.\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:1,&quot;335559739&quot;:160,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span data-contrast=\"auto\">Behavioral health and substance abuse facilities have two basic options when it comes to RCM, in-house billing and outsourced<\/span><span data-contrast=\"auto\">,<\/span><span data-contrast=\"auto\"> or <a href=\"https:\/\/www.carecloud.com\/rcm\/\">co-sourced<\/a><\/span><span data-contrast=\"auto\">,<\/span><span data-contrast=\"auto\"> billing. The model you choose depends greatly on your business model.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:1,&quot;335559739&quot;:160,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n<h2><b><span data-contrast=\"auto\">The in-house billing method<\/span><\/b><span data-ccp-props=\"{&quot;201341983&quot;:1,&quot;335559739&quot;:160,&quot;335559740&quot;:240}\">\u00a0<\/span><\/h2>\n<p><span data-contrast=\"auto\">With staffing being one of the biggest challenges of 2022, this may not be a sustainable model. If you choose this model, it is important to remember that there are four separate parts to RCM: front-end operations, collections, credentialing and contracting. You need people on your team who are experts in each of these areas.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:1,&quot;335559739&quot;:160,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b><span data-contrast=\"auto\">Insurance denials fall into five buckets:<\/span><\/b><span data-ccp-props=\"{&quot;201341983&quot;:1,&quot;335559739&quot;:160,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n<ul>\n<li><b><span data-contrast=\"auto\">Enrollment<\/span><\/b><span data-contrast=\"auto\">: <\/span><br \/>\n<span data-contrast=\"auto\">Providers who were not properly credentialed<\/span><span data-ccp-props=\"{&quot;201341983&quot;:1,&quot;335559685&quot;:360,&quot;335559739&quot;:160,&quot;335559740&quot;:240,&quot;335559991&quot;:360}\">\u00a0<\/span><\/li>\n<li><b><span data-contrast=\"auto\">Justification<\/span><\/b><span data-contrast=\"auto\">: <\/span><br \/>\n<span data-contrast=\"auto\">Submitted claims that are not perfectly clean when they are sent off for payment<\/span><span data-ccp-props=\"{&quot;201341983&quot;:1,&quot;335559685&quot;:360,&quot;335559739&quot;:160,&quot;335559740&quot;:240,&quot;335559991&quot;:360}\">\u00a0<\/span><\/li>\n<li><b><span data-contrast=\"auto\">Coding<\/span><\/b><span data-contrast=\"auto\">: <\/span><br \/>\n<span data-contrast=\"auto\">Submitted claims that are not coded correctly or coded for medical necessity<\/span><span data-ccp-props=\"{&quot;201341983&quot;:1,&quot;335559685&quot;:360,&quot;335559739&quot;:160,&quot;335559740&quot;:240,&quot;335559991&quot;:360}\">\u00a0<\/span><\/li>\n<li><b><span data-contrast=\"auto\">Coverage<\/span><\/b><span data-contrast=\"auto\">: <\/span><br \/>\n<span data-contrast=\"auto\">Patient not eligible or billing for a service not specified in payor contract<\/span><span data-ccp-props=\"{&quot;201341983&quot;:1,&quot;335559685&quot;:360,&quot;335559739&quot;:160,&quot;335559740&quot;:240,&quot;335559991&quot;:360}\">\u00a0<\/span><\/li>\n<li><b><span data-contrast=\"auto\">Authorization<\/span><\/b><span data-contrast=\"auto\">: <\/span><br \/>\n<span data-contrast=\"auto\">Authorization required is missing or invalid<\/span><span data-ccp-props=\"{&quot;201341983&quot;:1,&quot;335559685&quot;:360,&quot;335559739&quot;:160,&quot;335559740&quot;:240,&quot;335559991&quot;:360}\">\u00a0<\/span><\/li>\n<\/ul>\n<p><span data-contrast=\"auto\">If you are going to manage your RCM in-house, you need to have enough resources<\/span><span data-contrast=\"auto\">,<\/span><span data-contrast=\"auto\"> so your staff can focus on complex billing guidelines. You should also have a strong EHR billing system, specific to behavioral health, that minimizes<\/span><span data-contrast=\"auto\">\u00a0risk of human error. If you do not have these two supplements, you should consider outsourcing your billing to a billing company with expertise specific to your specialty.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:1,&quot;335559739&quot;:160,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><b><span data-contrast=\"auto\">The outsourced\/co-sourced billing method<\/span><\/b><span data-ccp-props=\"{&quot;201341983&quot;:1,&quot;335559739&quot;:160,&quot;335559740&quot;:240}\">\u00a0<\/span><\/h2>\n<p><span data-contrast=\"auto\">Since RCM is so complex, many practices benefit from outsourcing. A great deal of specialized knowledge is required for behavioral health RCM, and many facilities have come to realize that their in-house teams don\u2019t have the necessary training, or they don\u2019t have the appropriate number of resources, to handle the volume and maximize revenue.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:1,&quot;335559739&quot;:160,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<h3><span data-contrast=\"auto\"><b>Selecting the right vendor<\/b><\/span><\/h3>\n<p><span data-contrast=\"auto\">Behavioral health and substance treatment facilities <\/span><span data-contrast=\"auto\">should<\/span><span data-contrast=\"auto\"> choose a vendor with specific knowledge and experience in the behavioral health field<\/span> <span data-contrast=\"auto\">\u2013<\/span> <span data-contrast=\"auto\">a vendor that understands how the revenue cycle works specifically to this space.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:1,&quot;335559739&quot;:160,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n<p><strong>These are the elements that a skilled behavioral health billing service can handle for you:\u00a0<\/strong><\/p>\n<ul>\n<li><span data-contrast=\"auto\">Submitting and resubmitting claims<\/span><\/li>\n<li><span data-contrast=\"auto\">Working rejections and denials<\/span><\/li>\n<li><span data-contrast=\"auto\">Posting payments<\/span><\/li>\n<li><span data-contrast=\"auto\">Working accounts receivable (A\/R)<\/span><\/li>\n<li><span data-contrast=\"auto\">Preparing and sending client statements<\/span><\/li>\n<\/ul>\n<p><strong>Additional tasks that can be handled by a billing service:\u00a0<\/strong><\/p>\n<ul>\n<li><span data-contrast=\"auto\">Eligibility Verification<\/span><\/li>\n<li><span data-contrast=\"auto\">Prior Authorization Retrieval (if required)<\/span><\/li>\n<li><span data-contrast=\"auto\">Coding<\/span><\/li>\n<li><span data-contrast=\"auto\">Contract Negotiations<\/span><\/li>\n<li><span data-contrast=\"auto\">Credentialing<\/span><\/li>\n<\/ul>\n<p><span data-contrast=\"auto\">If you have a strong internal team in place, you may be able to handle credentialing, prior authorizations, and contract negotiations yourself. If you have a strong EMR, the initial coding could be handled by the providers<\/span><span data-contrast=\"auto\">,<\/span><span data-contrast=\"auto\"> and your billing partner can focus on reviewing coding for errors. Keep in mind that, in most cases, it\u2019s wise to outsource the management of claim denials. Experts in RCM denial management know who to talk to, what questions to ask, and what language to use when speaking to insurance companies. This knowledge will increase your chances of gaining approval.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:1,&quot;335559739&quot;:160,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Regardless of which model best fits your practice, select a <a href=\"https:\/\/www.carecloud.com\/rcm\/\">partner<\/a> who will come alongside<\/span><span data-contrast=\"auto\">\u00a0you and provide you with the solution you need.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:1,&quot;335559739&quot;:160,&quot;335559740&quot;:240}\">\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Behavioral health centers will face unprecedented challenges in 2022, especially larger health groups. With the rise of telehealth services, many centers are expanding beyond state borders, and the more payer types folded into a revenue stream, the more complex the revenue cycle management (RCM) becomes. Self-pay has become one of the easiest and largest pay [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":32787,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[41],"tags":[],"class_list":["post-24428","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-billing"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Medical billing Options for Behavior Health Specialists - Continuum<\/title>\n<meta name=\"description\" content=\"Behavioral health centers will face unprecedented challenges in 2022, especially larger health groups. 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