Session length
Psychotherapy codes have ranges of time. 90832 16-37 minutes. 90834 38-52. 90837 53 and up. The note must support the code, never the other way around.
Billing for Outpatient Behavioural Health
Outpatient Behavioural Health Billing Service
Session billed 90837, 45 minutes. An add-on code with no separate time for therapy in the note. A claim submitted to the medical plan where the benefit is owned by a behavioural health vendor. They add up quickly on a full caseload, and each one costs a practice a denial.
Mental Billing provides therapy, psychiatry, testing and integrated practices with eligibility checks, coding review, claim submission, denial work, payment posting and A/R follow up. We cover things related to your practice.
- Workflows designed for behavioural health
- Checks on payers' claims.
- Simple A R follow up
Talk to us first
One team one workflow.
For your outpatient services, everything from eligibility, coding, claims, posting and follow-up is integrated.
✓ Benefit and eligibility checks
✓ coding and claim review
✓ denial and A/R follow-up
✓ posting and reconciliation
What makes this speciality unique
There’s a playbook for billing behavioural health
Payment depends on what was done, how long it lasted, who did it, which plan covers it and where the claim has to go. Make one of those mistakes and a pretty-looking claim can still remain unpaid.
Different codes for different visits
Intake evaluations, therapy, medication management, testing, group sessions all have their own coding & documentation rules.
Authorization and Visit Limits
Active coverage of approved sessions does not mean more visits are approved. Many plans cover a certain number of sessions or a time period and additional care may not be reimbursed.
Separate benefit administrators
Some employers and insurers will outsource mental health benefits to a vendor, such as Optum, Carelon or Evernorth, each with their own payer ID, portal and claim rules.
Enrollment Information
Each payer’s participation record must match the billing and rendering provider on the claim including taxonomy codes and licence type.
Telehealth and multiple plans
Place of service, modifier 95, covered services and coordination of benefits vary from one payer to the next and sometimes from one program to another.
The rules vary depending on the type of payer and clinician, so what works for one practice may not work for another.
1. Spot repeat denials faster
Scheduled reviews show you the payers and codes that keep coming up so you can fix them once and for all.
Where payments slow down
Common Billing Problems in Behavioural Health Practices
One bad claim usually doesn’t matter. A load of them do, through late payments, repeat work, and ever growing receivables.
Visits limited and approvals expired
We log the number of sessions that are approved for each plan and for what dates and then flag when reauthorisation is due, before the next claim is submitted. The payer still makes the coverage decisions.
Time and add-on code issues
A 45 minute note billed as 90837 can get a denial or recoupment. Codes 90833, 90836 and 90838 require documentation of psychotherapy time separately from the medical work and are above and beyond an E/M visit. We compare the note to the code and send mismatches to the clinician
Claims sent to the wrong address
If a plan carves out behavioural health, the claim goes to the vendor’s payer ID, not the medical plan. Instead of guessing, we read the instructions for each plan.
Credentialing and taxonomy challenges
An NPI is not proof that a clinician is credentialed with a plan. We verify the enrolment status, effective dates and taxonomy with what the claim states.
Telehealth claim mistakes
Place of service 02 or 10, modifier 95 and covered-service lists are payer and program specific. We don't try a single combination everywhere, but we do check the current policy for each plan.
Underpayments and Aged Balances
Payments are posted against contract rates and remittance and then unpaid claims are worked by age. Some differences are valid corrections, some old balances are uncollectable.
From the first call to the final payment
What our outpatient behavioural health billing services include
We track every claim from the first benefit cheque to the final reconciliation. The exact amount depends on your service contract.
Service 01
Verify Eligibility and Benefits
We verify active coverage, outpatient mental health benefits, copays and deductibles, authorisation rules and whether the benefit is managed by a separate vendor. The result is what the payer reports that day. That is not a guarantee of payment.
02 Service
coding and charge review
We review the note, diagnosis, procedure code, provider information and claim data. We review evaluations, therapy, testing and medication management separately and ask clinicians if a note could support a more specific diagnosis than what was billed
Service 03
Claim preparation and submission
Claims are validated against payer edits and provider data before submission and followed up until paid or denied. Front-end work is done carefully, but will not guarantee clean claims or approval.
Service 04
Denial management and appeals
We read the payer’s reason, find the cause, fix what we can fix, gather records and appeal when the facts support it. Rejections and denials require different remedies and payer rules determine results.
Service 05
Payment Posting and Underpayment
Review Payments, adjustments and patient balances are posted to the appropriate claim and line. With contract rates on file, we compare them to what has been paid and chase gaps against the remittance.
Service 06
A/R follow-up
We work aged claims, status checks, outstanding record requests and filing or appeal deadlines. All open items have a note and balances are sorted by age and payer.
Service 07
Coordination of Benefits
We keep accurate coverage information and payer order for patients who have more than one plan, including those who have both Medicare and Medicaid. Secondary claims are dependent on the primary payment.
Don't know how your billing is split?
We’ll review your current process, payers, systems and those claims that never seem to close.
Get your free reviewMatched to the service provided
Outpatient services we provide billing
Billing rules differ from service to service. The claim has to be consistent with the note, the clinician’s licence and the payor’s policy.
Therapy and Counselling
Individual (90832, 90834, 90837), Family (90846, 90847), and Group (90853) are reviewed for time, attendees and clinician license. The note needs to support the interactive complexity add-on (90785) separately.
Psychiatric evaluation and medication management
Intake evaluations (90791, 90792) and E/M visits have different rules than therapy. If an E/M is combined with 90833, 90836 or 90838, the note must indicate separate time for the psychotherapy.
Testing and assessments
For claims in the 96130 to 96139 range and brief screening (96127), you’ll need to document time, who did the test and the supporting report. Some plans want to have testing authorised first.
Integrated and collaborative care
Practices that integrate therapy, prescribing, testing and groups need one workflow for all services, but each service needs to be treated on its own terms. Collaborative care codes (99492-99494) require monthly time tracking and registry requirements.
The way the work moves
Our Behavioural Health Billing Workflow in Action
This is a normal order of things. The stages you go through are based on your practice and services in your agreement.
01. Stroll through your process
Review current billing, payer mix, systems, and ongoing issues.
02. Check benefits and approvals
If provided, check coverage, visit limits and payer details.
03. Review coding and claim data
Compare the claim with the note and payer rules.
04. Build & Submit Claims
Route each claim to the correct payer or behavioural health vendor.
05. Track claim status
Track rejections and denials and note the reason.
06. Record and reconcile payments
Record payments and adjustments and look for gaps.
07. Work A/R
Work open balances, record deadlines, and unresolved items.
08. Review trends
Use denial and ageing reports to identify repeat issues.
Stick with your current platform
Practice management and EHR systems we work with
We work within the platforms behavioural health practices already use. What is important is that the charges, diagnoses, provider data, payer information and payments are consistent between our system and yours.
SimplePracticeTherapyNotesICANotesValantQualifactsAthenahealth
What we can do depends on your platform, access permissions and clearinghouse setup. All these we verify during the review.
Built on behavioural health
Why practices love working with Mental Billing
Often practices look for speciality help when a general setup for billing does not capture behavioural health details. We build our follow-up around them.
Speciality focus
All accounts are reviewed for time-based codes, carve-outs, visit limits and clinician enrolment.
Eligibility & Approval Tracking
Benefits and approved sessions are documented at intake and reviewed as treatment progresses.
Review before submission
Coding and claim data are verified before a claim is submitted.
Cause followed up by denial
We break down denials by root cause and track by payer.
Reconciliation and post
Assign each payment to a claim and identify any gaps.
Ageing A/R in sight
Unpaid claims are categorised by age and payer, with deadlines highlighted.
Support for Service Types
This same workflow works for a small therapy practice or a group with prescribers, testing and group programs.
What we can and cannot promise
The results are driven by payer decisions, documentation and the mix of your patients. We do not guarantee no denials or a collection outcome. Our speciality is billing and we give you a clear picture of the status of each claim.
Privacy matter und Documentation
Behavioural Health Billing: Documentation and Compliance
A billing team cannot substitute for clinical documentation or a clinician's compliance responsibilities. It can catch places where the note and claim don't match up.
Codes that fit the note
Confirm that procedure and diagnosis codes are true representation of information in the record.
Time-based services
Compare the documented minutes to the billed code and to current CPT guidance.
Provider and Payer Information
Maintain taxonomy, enrolment, payer and claim information as per each payer’s requirements.
HIPAA & 42 CFR Part 2
Safeguard patient information at every step. Psychotherapy notes maintained separate from the main record receive additional HIPAA protection. Substance use disorder records subject to 42 CFR Part 2 have more stringent consent rules.
Payer Policy and Parity
Comply with federal and state regulations and payer policies. The Mental Health Parity and Addiction Equity Act generally requires that financial requirements and treatment limits on mental health benefits be no more stringent than those on medical benefits, depending on the type of plan.
Common questions
Questions about billing outpatient behavioural health
Common questions answered about scope, payers, approvals, coding and follow-up.
1.What are outpatient behavioral health billing services?
They’re outpatient mental health practice revenue cycle services. They manage eligibility verification, code review, claim submission, denial management, payment posting and A/R follow-up. The scope differs by agreement.
2 What is different about mental health billing than general medical billing?
Payment is often based on logged hours of the session. Visit limits are common. A separate vendor may administer the benefit. A clinician's licence and taxonomy can determine how a claim is processed. Add a layer for telehealth rules.
3. Why do outpatient behavioral health claims get denied?
There are a few reasons that outpatient behavioural health claims get denied.
Some of the more common are: expired approvals, session limits, billed code that does not match documented time, claims sent to the wrong payer, enrollment/taxonomy mismatches, telehealth coding errors, and coordination of benefits. The next step depends on the payer’s reason for denial.
4. What is a behavioural health carve-out?
A carve-out is a contract between a health plan and a separate managed behavioural health company to administer the plan’s mental health benefits. Claims could go to that company's payer ID, not the medical plan's. They check every plan because they have different plans and different arrangements.
5. How do you deal with authorisation limits?
When verifying, approved visit counts and date ranges are documented and compared against upcoming claims to identify reauthorisation. Monitoring the process helps, but does not ensure approval or payment.
6. Do telehealth claims get billed differently?
They may be. Place of service, modifiers, covered services and documentation rules vary by payer, program, and service. We review the payer’s existing policy before billing.
7. Can a billing company detect underpayments and unpaid claims?
Payment posting can show differences from contracted rates and A/R follow-up tracks claims that haven’t paid. Each difference is compared to the contract, claim and explanation of benefits. Not all open balances are collectible.
Your drill. Your payers. Your flow of work.
Review of outpatient behavioural health billing
The first step is to take a moment to think about what you want to say. This will help you organise your thoughts and make sure you are clear about what you want to communicate. It’s important to be aware of your audience and tailor your message to their needs. Once you have a clear idea of what you want to say, you can begin to write. It’s important to be concise and to the point. Don’t use jargon or complex language. Use simple words and short sentences. If you are writing a letter :
A review can serve as a launch point for practice owners, billing managers and clinical directors who are dealing with repeat denials, gaps in approval, carve-out routing, coding questions, underpayments or ageing receivables. Good billing support is built around your payers, clinicians and service mix.
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