How Is Mental Health Billing Different From Medical Billing?

How Is Mental Health Billing Different From Medical Billing?

For any typical practice, medical billing is almost assuredly a time-consuming, labyrinthian, and frustrating process with plenty of room for errors. Often, the paperwork required to run a sustainable practice can quickly become overwhelming without the proper help. Medical specialists either build themselves a full team to handle billing concerns or outsource the work to medical billing companies.  While these issues hold true for both standard medical practices as well as mental health practices, the bureaucratic needs are often more severe and harder to manage for the latter.

Why is Mental Health Billing so Different From General Medical Billing?

Insurance companies dictate much of how mental health services are provided as well as how often.  The limit on therapy sessions, for example, creates a financial ceiling that doctors performing ear exams or x-rays don’t experience. These burdens can severely limit a practice. To use a case-study: It was found some years ago that pediatricians were typically able to bill up to 10 different billing codes for medical visits, but only 1 code for behavioral health visits.


Mental health practitioners are also operating with smaller staff and leave quite a bit more money on the table due to their inability to properly manage all of their billing needs. Some estimate that as much as over 80% of the money owed to mental health practitioners by insurance companies goes uncollected. Looking at those numbers, It makes sense that mental health billing and behavioral health billing needs are beings outsourced more often than ever these days.

The Value of a Simpler Billing Process
There are a lot of ways that simplifying the billing process with medical billing companies benefit medical and mental health practices. Most understand that less time spent dealing with billing means more time spent with patients and growing a practice, but a more straightforward billing process also avoids insurance companies rejecting a medical claim.. Some estimates claim that around 80% of medical bills contain some error. Even small mistakes can lead to a rejected billing claim.

Insurance Companies Look at Mental Health Differently

The way in which insurance companies, as well as patients, look at mental health is dramatically different than the way they look at more traditional medical practices. Expectations and costs are much different between the two. These differences go back decades and are likely inherent in the current culture. The result is that specialized psychiatry billing services entirely separate from the standard medical industry have arisen to handle the issues unique to the growing mental health sector.


In private practices, psychiatrists generally handle their own billing since their ability to hire multiple staff is less common. These days, however, a single practicing professional is often overwhelmed by the need to keep up to date on billing codes, unique requirements of insurance companies, and changing regulations. This, in turn, leads to missed billing opportunities, paperwork mistakes, and lost work hours. When you add in need to check up on unpaid claims and refiling needs, it is near impossible for a single person to operate at full efficiency. In the end, it’s usually much more cost effective to outsource this process from the beginning.


The unique rules and financial demands make billing for mental health providers a much different beast than general medical billing systems.

Acute Billing Concerns for Mental Health Providers

Mental and behavioral healthcare claims are only approved; roughly 85% of the time. This is caused for a myriad for reasons, but the majority fall into only a few groups.


While we have been able to maintain a 97% claim approval rate for the practices we are managing billing for.


As stated before, mishandling these issues can cost a practice considerable amounts in reimbursements.

●    Constantly Changing Rules and Billing Methods

Insurance policies are always changing, and they all eventually lapse. If a practice doesn’t make an effort to be proactive on checking up on these issues, they can quickly find themselves trying to handle an overload of paperwork -plus, medical and mental health practitioners are often notified last of insurance changes or problems.

To add to the confusion, the rules dictating how all of this must operate are often shifting. Compliance regulations, coding systems, and more need to be followed to the letter. Not keeping up with these changes quickly adds up when problems arise.

You need to ensure you double and perhaps triple check all of your patient’s insurance info before a visit. Also make sure you stay up to date on preferred filing methods and rules.

●    Staff concerns

Costs are more of an issue for mental and behavioral health offices. This can lead to understaffing, usually in the administrative department (for obvious reasons). Cutting costs in regulatory efforts can overload your other staff and decrease morale. This in turn also increases turnover rates. Behavioral health billing and psychiatry billing services are often used these days in lieu of hiring full-time staff. Outsourcing billing to a specialist dramatically reduces the chances of late payments, rejected claims, and improper coding issues.

Victoria YoungHow Is Mental Health Billing Different From Medical Billing?
read more

Exclusive Partnership with TherapyNotes

GreenpointMed is excited to announce an exclusive partnership with TherapyNotes, a leading EHR for mental health providers. As part of this partnership, GreenpointMed is one of a select group of medical billing companies which TherapyNotes customers have access to. The combined partnership of the leading technology platform for notes, billing, scheduling and other important features, with the service excellence of the GreenpointMed billing team makes this a win-win for providers.

Justin GainesExclusive Partnership with TherapyNotes
read more

Beware of the “Unspecified” Diagnosis Code

ICD-10 was introduced to the medical billing world in October, 2015. ICD-10 codes became key to the success of any medical billing platform, whether you bill yourself or outsource your billing almost immediately. The key difference when billing ICD-10 codes vs ICD-9 is that the ICD-10 codes begin with a letter, such as F or G. ICD-9 codes did not follow this format.

Justin GainesBeware of the “Unspecified” Diagnosis Code
read more

GreenpointMed’s Drive To Be More Efficient

I’m obsessed with efficiency. In my daily life, either personally or for GreenpointMed, it is a never ending quest. Our business’ #1 goal is to make the billing process simple & efficient, and we accomplish that better than nearly all private billing companies on the market. It’s an easy formula for us: pay attention to the details, always communicate and be precise. Almost sounds like a winning strategy for a football team, though never for my Miami Dolphins!

Justin GainesGreenpointMed’s Drive To Be More Efficient
read more

Medicare ID Numbers Are Changing: 5 Things to Know

The long awaited change to Medicare ID numbers is here so now is a good time to take a moment to make sure you are prepared. New ID cards will start shipping and be distributed to Medicare beneficiaries in April 2018 and, fortunately, you have time to prepare. This doesn’t mean you should wait until the very last few weeks before the old ID numbers are no longer active to have a plan in place; no, no. Create a plan now so that way when your patients came to you with their new ID cards you will be able to confidently tell them how seamless the transition will be. Why? Because you have a plan, and because you read this blog.

Justin GainesMedicare ID Numbers Are Changing: 5 Things to Know
read more

Happy 2018! New year; new benefits

Happy New Years to all! Let’s all have a happy & prosperous year. Part of making sure that the year starts off in the right direction is to make sure you know your patients’ benefits. Remember, benefits reset at the beginning of each calendar year, so everyone starts at square one with a deductible to meet. It’s important to know the details so you can A) make sure you are collecting the maximum allowable amount, and B) communicate with your patients about their responsibility until their insurance kicks in.

Justin GainesHappy 2018! New year; new benefits
read more

Why I started GreenpointMed

Often times when I begin a conversation about why GreenpointMed’s services are the right fit for a healthcare provider, I inevitably veer into the story of why I started GreenpointMed. It is not that I am eager to tell the story; I am not. By nature, I am a private person and shy at the opportunity to talk about myself. However, I find it instructive to detail the “why” because it ultimately is what the mission of GreenpointMed is built on – to make the business of healthcare simple & efficient for healthcare providers.

Justin GainesWhy I started GreenpointMed
read more

5 Solid Practice Management Tips

Starting a practice is hard, but keeping a successful practice going is even harder. Much like any business, your “edge” is the key to success. I always like the reference to, “what’s your edge”? If you read any of Mark Cuban’s books or blogs, he always stresses that the differentiator between you and everybody else is your “edge”. Finding it, keeping it and building it is the key to maintaining a successful business.

Justin Gaines5 Solid Practice Management Tips
read more

Telehealth and Insurance – It’s Not Complicated!

Telehealth, telemedicine, e-health, online therapy is a major force in healthcare. As healthcare continues to evolve, one of the primary drivers of healthcare change is technology. Technology has helped cure diseases, increased life expectancy and countless other things. Today, one of the newest and up-coming ways in which technology is changing healthcare is through Telehealth.

According to the AMA, “telehealth has the power to transform health care…” for both providers and patients. In the comfort of one’s own home, a patient can speak to a doctor, receive a diagnosis and treatment at a fraction of the cost of a doctor visit. The cost does not include money; it also includes time, effort, sacrifice. Organizations such as the American Telehealth Association have grown in tremendous size to promote the use of and advance telehealth. From both a cost and efficiency standpoint, telehealth is a “win-win” for both providers and patients.

Justin GainesTelehealth and Insurance – It’s Not Complicated!
read more

The Business of Healthcare is Unavoidable

No matter what field you are in, there will always be a business element to it that is unavoidable. Some fields are simpler than others. For example, if you owned a store selling bolts, the business of running your store would be quite simple. Likewise in many other businesses; it’s just simple & easy. Unfortunately, healthcare is not simple and easy.

Justin GainesThe Business of Healthcare is Unavoidable
read more