Mental Health Billing vs. Medical Billing: Understanding the Differences - AZZLY® (2024)

FAQs

Mental Health Billing vs. Medical Billing: Understanding the Differences - AZZLY®? ›

Mental health billing is the process of submitting claims for services related to behavioral health and addiction treatment. Unlike medical billing, mental health billing is more complex and requires a deeper understanding of mental health diagnoses, treatment plans, and coding.

The primary difference between mental health billing and medical billing are the limits and restrictions insurance companies have for behavioral health claims. Behavioral health care also involves more nuanced treatment plans.

The byzantine rules and regulations of the insurance industry make successfully submitting claims a difficult and frustrating process. As a result, mental health practices often only collect 85 percent of the money owed to them.

Differences between medical coding and medical billing

While medical coding is focused on translating medical procedures into codes, medical billing is focused on receiving payment for those services. Another difference between medical coding and medical billing is the training required for each profession.

The two types of medical billing are professional and institutional. First, let's look at professional billing. Individual medical practices use professional billing, and when someone specializes in professional billing, they often need to understand coding and billing systems.

Both 90834 and 90837 are intended to bill for the same service – psychotherapy. The primary distinguishing factor between the two codes is time / duration of visit; 90834 is defined as 45 minutes of psychotherapy, while 90837 is defined as 60 minutes.

CPT Codes 90832-90838 represent psychotherapy. Psychotherapy without medical evaluation and management services are reported as 90832, 90834 and 90837.

A career as a medical biller and coder can be stressful. Sometimes, the stress can be too much to handle. Having to bear so much pressure can make even the strongest people crack. If you do not deal with your stress properly, it can take a toll on you mentally and physically.

The certification exam for medical coding and billing can be challenging, but certainly not impossible—over 70% of examinees passed in 2022. However, preparation and practice are vital for passing the exam, which is why MedCerts offers the Medical Coder & Biller Certification Course to help you succeed.

How Long Does It Take To Become a Medical Biller and Coder? In most cases, it takes between one and three years to become a medical biller and coder. Earning a medical billing and coding certification can take up to one year, while earning an associate degree can take up to three years.

What is the hardest part of medical billing and coding? ›

One of the trickiest aspects of the job is applying a binary mindset to complex scenarios. Rarely is a patient's condition as simple as it looks on paper. The coder's job is to take a vague collection of symptoms, medical history and past treatments.

Medical billers use the codes assigned by medical coders to prepare and submit claims to health insurance companies. Sometimes, billers may be responsible for reviewing codes for accuracy before sending medical claims. While some billers might perform medical coding responsibilities, this is not always the case.

You may be more comfortable in medical coding. Coders more often do their day-to-day work on their own in occasional collaboration with other healthcare staff. This is typically a better option for analytical, detail-oriented students uneasy with the idea of talking to people all day.

The 837I (Institutional) is the standard format used by institutional providers to transmit health care claims electronically. The Form CMS-1450, also known as the UB-04, is the standard claim form to bill Medicare Administrative Contractors (MACs) when a paper claim is allowed.

There are three types of CPT codes: Category I, Category II and Category III. All codes are five digits and can be either numeric or alphanumeric.

There are three types of billing methods: time-based, usage-based, and feature-based. Time-based billing is the most common type, where the customer is billed based on the duration of the service. Usage-based billing charges the customer based on the amount of resources or bandwidth they use.

Pharmacy billing occurs when a prescription is sent to the pharmacy to bill a patient's drug insurance, while medical billing occurs when the provider submits the claim to the patient's medical insurance. Sometimes, insurance requires a specific type of billing, but, at other times, the provider can choose.

Why is Billing Complicated? Basic business billing involves a buyer and seller or service provider and client. Medical billing is more complex because there is the healthcare provider, patient, and their insurance company.

Mental health benefits legislation involves changing regulations for mental health insurance coverage to improve financial protection (i.e., decreased financial burden) and to increase access to, and use of, mental health services including substance abuse services.

When a provider bills you for the difference between the provider's charge and the allowed amount. For example, if the provider's charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30.