Mental health billing is a highly complicated procedure. It’s more complex than other types of medical billing and, as such, it’s more likely for mistakes to pop up during the billing process. Understanding what these mistakes are gives you a better chance at avoiding them in the future. That’s why, today, we’ll be examining mistakes that can happen during mental health billing.
Bringing Up Outdated Codes
CPT and ICD codes get updated all of the time. This makes keeping up with the most current codes rather difficult. While a grace period does exist while codes are being updated, payers will still expect billers to use the most current codes during submission. When you don’t use updated codes, claim rejections and denials can occur.
Unbundling Your Medical Codes
In the field of mental health billing, codes typically get bundled when appropriate, and this lowers the cost that patients are required to pay for the services that they receive. When you unbundle medical codes, it inflates the costs of services and it’s a big warning sign for your auditing team. Unbundling is typically seen in a bad light, as it’s associated with abuse and fraud.
Deciding to Use Up-Coding
Up-coding is another way to get higher claims for medical facilities. When a practice uses up-coding, it means they use a single code that costs the patient more money than what they should be paying. Much like with unbundling, up-coding is a procedure that’s typically associated with fraud. To avoid being inspected for fraud, you’ll want to know which claims are the most appropriate for each patient so that you don’t upcharge them.
Not Using the Right Modifiers
Modifiers give payers additional information, such as how and where services were provided. When selecting modifiers, it’s important to pick the correct ones. When modifiers aren’t used properly, claim denials and rejections can occur, and you may even be inspected for potential abuse or fraud if you regularly use the wrong ones. If you want to avoid these issues, it’s best to study different modifiers and make sure that you’re using them in the right manner. If you’re not sure if a modifier is appropriate, it’s probably best not to use it.
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