The Ohio Department of Medicaid (ODM) and the Ohio Department of Mental Health and Addiction Services (OMHAS) have created resources to assist mental health professionals with the billing process.
However, when some mental health providers look through Ohio Medicaid’s Behavioral Health Coding Workbook, they are not always sure how to successfully submit their practice’s medical billing claims.
Randomly submitting claims and hoping things will be alright is not considered best practice. Many questions can start to appear as one looks through the various codes and descriptions. The Ohio Medicaid behavioral health codes and descriptions are as follows:
- Unit of Measure
- CPT/HCPCS (Procedure Codes)
- Modifier(s) (1 or 2)
- Billing Agency (MH, SUD or Both)
- Description (Service)
- Per Diem Rate
- Licensed BH Practitioners
Individually, these terms may make sense. But when used in combination with patient visits and claim submissions, the billing process can become daunting and raise questions. Especially, when mistakes can disrupt cash flow and cause aging accounts to balloon in size.
Some of these questions may include:
- Can I use the same procedure code for an Independent BH Professional that I would use for a BH Professional Under supervision?
- How are the various licensed BH (behavioral health) Professionals different from a Medical Behavioral Health (BH) Practitioners?
- Can a BH Paraprofessionals Under Supervision submit claims that meet ASAM criteria?
- What are the differences between a “SUD clinically managed low-intensity residential treatment” and a “SUD clinically managed population-specific high intensity residential treatment (adults)”?
Procedure Codes, Parity Laws and Insurance Options:
At first glance, one will notice that these treatments have different per diem rates. For example, the population-specific high intensity treatment has a higher rate. However, all of the data needs to be entered properly, or the insurance claim is likely to be rejected or denied.
Other areas of confusion often arise from not knowing the particulars of billing and submitting claims in Ohio for behavioral health services.
Confusion often occurs when behavioral health practitioners do not understand the most frequent CPT codes used by Ohio addiction treatment facilities and insurance providers. This is quickly remedied by having administrative back-office staff who are experienced, knowledgeable and professional.
The second area of confusion occurs over issues of Ohio insurance parity laws. In these cases, a practice’s billing agents may not be fully up-to-speed on the parity regulations that insurance companies and addiction treatment facilities in Ohio must follow.
Not being aware of Ohio’s best insurance options for addiction treatment centers. As of February 2023, these options include private insurance (PPO and HMO plans) and public insurance. (Medicare and Medicaid). Of course, the exact amount of coverage a person can receive depends on the details of their specific insurance plan.
- Unaware of the most common procedure codes (CPT or HCPCS).
- Not aware of the insurance company parity laws that exist in Ohio.
- Lack of knowledge about the specific available Ohio insurance options.
It is for the above reasons that we strongly recommend that practices and clinics outsource their billing requirements. In doing this, practitioners can focus on the clinical side of their practice. Finding partners who can successfully and consistently take care of a practice’s billing and credentialing needs is well worth it.
The best way to create a successful billing process is to choose an integrated system that enables you to consistently file clean claims, managed aged accounts and monitor credentialing/enrollment issues.
We provide these capabilities to our medical billing clients. We use intuitive and powerful practice management systems that allow practices to gain access to their data and billing analytics. We scrub claims and work to prevent payment delays. Our reporting tools allow practices and clinics to monitor billing patterns and identify areas for potential improvement.
ABCS RCM – Advanced Billing & Consulting Services provides knowledge and experienced medical billing services. One of our specializations is behavioral health billing and credentialing services.
We also offer staff management software, electronic visit verification (EVV) and billing services for agencies that provide supports for the Ohio I-DD community.
To learn more, email or call them at 614-890-9822 or 866-460-2455.
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