Credentialed but Denied? Solving Common Coding Errors That Impact Claims

Healthcare providers often invest significant time in credentialing with payers, only to encounter the frustration of claim denials. Even with proper credentials, inaccuracies in coding—particularly in behavioral health—can lead to payment delays or denials. To maintain financial health, it's crucial to understand accurate behavioral health coding and implement effective revenue cycle management in healthcare.

The revenue cycle encompasses the entire patient journey, from appointment scheduling to final payment collection. In behavioral health, this includes verifying insurance, delivering care, precise coding, submitting claims, and managing denials. Errors in coding or documentation can result in unpaid claims, underscoring the need for robust revenue cycle management systems across all healthcare settings.

A common pitfall in mental health billing is the improper use of CPT code psychotherapy entries. These codes denote the type and duration of therapy provided. For instance, code 90832 represents a 30-minute session, 90834 for 45 minutes, and 90837 for 60-minute sessions. Selecting a code that doesn't align with the documented session length can trigger denials or audits. Ensuring that documentation supports the therapeutic interventions and time billed is essential.

Beyond time-based psychotherapy codes, accurate use of diagnostic and testing codes is vital. Code 90791 is used for psychiatric diagnostic evaluations, while codes like 96130 and 96136 pertain to psychological testing evaluations and test administrations, respectively. These codes must be accompanied by thorough progress notes and clinical justification. Additionally, the correct application of modifiers, especially for telehealth services, and accurate place-of-service codes are critical to prevent reimbursement issues.

Credentialing alone doesn't guarantee seamless billing processes. Inaccurate or incomplete coding remains a leading cause of denials in behavioral health services. Comprehensive revenue cycle management strategies should encompass coding audits, staff training, and denial management systems.

To mitigate these challenges, healthcare practices should develop internal processes to identify errors before claim submission. Utilizing practice management software with claim-scrubbing capabilities can flag potential issues. Training clinical staff to understand how their documentation supports coding decisions is also beneficial. Regular audits can reveal denial trends, allowing for targeted improvements.

Collaborating with credentialing and billing professionals specializing in mental health services can further enhance compliance and reimbursement rates. By focusing on accurate behavioral health coding and robust revenue cycle management, practices can reduce denials, optimize reimbursements, and ensure financial stability.

Precision Hub offers professional medical billing services for small practices. We specialize in helping healthcare providers manage their billing, front office, and back office tasks efficiently.