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What makes Medical Billing and Coding services for Behavioral Health different?

Behavioral health refers to how a person’s daily cognitive habits affect that person’s behavior. Behavioral health providers guide patients in keeping up with their emotional, social, and psychological health. Often the term Behavioral health is interchangeably used with the term Mental health. It is important to know that behavioral health is a bigger blanket that consists of Mental health as well. There are different types of Behavioral health.

  • Psychiatry
  • Rehabilitation
  • Marriage and Family counseling
  • Addiction Treatment
  • Intellectual or Developmental disabilities and
  • Mental health

Medical Billing and coding services for Behavioral health are complex due to several changing variables. Behavioral health providers service in a unique environment where the type of treatment is often customized by identifying patient needs at the time of providing care. When it comes to Medical Billing and Coding for Behavioral health there are some higher levels of understanding required to maximize collections.

Eligibility and pre-authorization play a major role when it comes to Medical billing and coding for Behavioral Health. As this is a type of specialized care many of the payers demand prior authorization. Another major denial factor when it comes to Behavioral health is missing verification of benefits. It is important for the provider’s office to confirm coverage of the said services prior to the patient’s appointment. Denials related to eligibility are often high in this specialty due to the non-coverage of this type of service in some payer plans.

The process of Medical coding for behavioral health is what makes this specialty quite different from others. There are different types of Behavioral Health service providers and coding for each one of them is different. Some of the prominent types of service providers are,

  • Psychiatrists
  • Psychotherapists,
  • Counselors,
  • Clinical Social workers,
  • Marriage and family therapist
  • Licensed behavior analyst
  • Nurse practitioner
  • Clinical nurse specialist
  • Physician assistant

The CPT codes for services offered by different service providers vary and it is important to understand the differences in the modifier used against each type of service provider against the different CPTs and that’s where Quintessence’s expertise is all you need!

When visiting a general physician there is usually a routine method of check-up/diagnosing procedure that is followed by treatment. This is however not the case with Behavioral health. Providers often have to assess and decide with an on-the-spot type of approach for the treatment, which is dependent upon the time of the session, the age of the patient, their ability to corporate with the treatment, etc. High proficiency is required to be able to understand the environment of patient care which is essential for an efficient Medical Billing and Coding process.

The Behavioral health industry was valued at 90.5 Billion USD in 2020 and is set to reach a size of 132.4 Billion USD by the year 2027 with a CAGR of 5.3% from 2021 to 2027. With changing ways of life, the need for Behavioral health has become an inevitable essential type of care. With an increasing number of patients, providers cannot juggle between taking responsibility for their medical billing and coding needs and focusing on patient care, and that’s where Quintessence comes to the rescue. We understand that by ensuring our providers’ RCM is taken care of, we play a major role in helping them find their peace of mind. Quintessence believes that quality of care is not just the providers’ responsibility but the medical billing and coding industry too, plays a major stake in it by ensuring the highest revenue for the care provider.