Effective billing and coding practices are essential for optimizing reimbursements in behavioral and mental health services. Proper documentation, accurate coding, and adherence to specific coding guidelines, including those for prolonged services, are key factors for success.

Understanding California, Payer, and Behavioral health-specific nuances and diligent focus on enrollment, timely filing, and payments reconciliations reduced denial rates and increased collections by 52%.

While the application of prolonged service codes may be fairly simple, very few codes cause more confusion than prolonged service codes. It may be noted that prolonged service codes can be used for outpatient procedures as well as for inpatient care. These codes are typically used to bill for services that significantly exceed the standard time a physician takes while providing care. These may include face-to-face services as well as non-face-to-face services.

While prolonged service coding issues are highlighted in this case study, the principles of educating physicians and clinical staff is applicable for all cases where coding denials are high.

Recovering claim dues from payers for physician assistance claims requires intricate knowledge of payer-specific guidelines. Medical Billing Wholesalers’ denials research team helped the client identify and resolve out-of-network claims.

With a focus on recovering denials of PA claims from UHC and Oxford, we rebilled the claims after adhering to the payer-specific guidelines and were able to recover over $80K of A/R, while reducing the monthly denials from 73 to 11.