Clearinghouse Integration for Behavioral and Mental Health Practices

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Clearinghouses in Behavioral and Mental Health

Billing for behavioral and mental healthcare is a complex task, even for the most experienced of organizations. For private practice owners, the burden is even more significant. There are thousands of medical billing codes to become familiar with, and applying them correctly is essential for maximizing your reimbursement rate as well as providing the best care.

Clearinghouses can be a valuable tool for behavioral health professionals, as long as you ensure compliance and compatibility with your EHR. This brief guide to mental health billing clearinghouses will help clarify your relationship to your clearinghouse and what you need to look for when choosing one.

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What Are Healthcare Clearinghouses?

A clearinghouse helps bridge the gap between providers and insurance companies. When you work with a clearinghouse, you pay them to audit your records and make sure they are clean and correct before sending them on and billing insurance companies. They will look for errors and verify that the codes you chose and submitted are valid. These tasks lighten the burden of verification on clinicians or billing staff.

The process the clearinghouse follows is called "scrubbing." In the case of an incorrect claim, the clearinghouse will halt the process and send the claim back for you to correct the errors. Once the clearinghouse receives a correct, clean claim, they send it straight to the insurance payer for reimbursement.

Why Use a Clearinghouse for Behavioral Health and Medical Billing?

Many people are hesitant to bring a third party into the mix when it comes to healthcare, but there are many excellent reasons for behavioral and mental health providers to partner with a clearinghouse. They come with advantages like:

  • Providing an extra step in the process of verification and catching errors that may have passed you by
  • Specializing in billing and billing only, so you don't have to
  • Saving you from hiring and training a new staff member to handle billing
  • Saving you time by allowing you to submit more than one claim as a batch, rather than sending them individually
  • Allowing you to submit claims electronically, saving postage and paperwork
  • Real-time discovery of errors, rather than waiting for claim rejection by the payer
  • Central claim management in one place

The primary benefit of a medical billing clearinghouse is taking the effort of billing and code verification off clinicians' hands, leaving more time for the all-important activity of face-to-face client time.

Mental Healthcare Clearinghouses and HIPAA Compliance

Because mental healthcare clearinghouses handle immense amounts of protected health information (PHI), they are HIPAA-covered entities. Starting in 2019, the Centers for Medicare & Medicaid Services, on behalf of the Department of Health and Human Services (HHS), are launching a Compliance Review Program to ensure covered entities, including clearinghouses, comply with HIPAA regulations regarding electronic healthcare transactions.

Clearinghouses must follow all the same rules providers and insurers do, and now that there is a system in place to enforce those regulations, providers have less to worry about when looking for a HIPAA-compliant clearinghouse partner.

Consequences of Clearinghouse Non-Compliance

The penalties for HIPAA violations are severe by design. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 reinforced HIPAA and increased the financial consequences for breaches and violations. Under HITECH, there are four categories of HIPAA violations reflecting different levels of culpability and corresponding tiers of penalty.

Tier 1 The covered entity was unaware of the violation and could not have realistically avoided it with a reasonable amount of care.
Tier 2 The covered entity should have been aware of the violation, but could not have avoided it with a reasonable amount of care.
Tier 3 The violation occurred as the result of the covered entity's willful neglect of HIPAA regulations, and there has been an attempt to correct the issue.
Tier 4 The violation occurred as the result of willful neglect, but the covered entity has not tried to correct the violation.

In 2019, the maximum annual penalty for all four categories has increased to $1,754,698. If a clearinghouse you work with experiences a breach, there may be some disagreement around who is responsible for reporting the breach to the HHS and to affected patients. The responsibility may be shared or proven to lie with one party, but it is always a good idea to be proactive after the discovery of a breach to avoid the possibility of penalties related to non-disclosure of violations.

Common Challenges of Clearinghouses for Billing

While clearinghouses are of undeniable utility for behavioral and mental health providers, you may face some challenges when selecting one to work with.

Accreditation

Since a clearinghouse will be handling patient information for which you are partially responsible, you want to choose a reputable one. The Electronic Healthcare Network Accreditation Commission (EHNAC) accredits clearinghouses, providing you with some peace of mind on the entity's compliance track record. Depending on your location, payers or states may require that all business transactions go through an EHNAC-accredited clearinghouse. You can find the list of clearinghouses that have earned EHNAC accreditation here.

Location

Clearinghouses all have different payer lists, so make sure any you are considering have included the payers you work with regularly. You may find yourself looking at a regional clearinghouse for its low prices, only to find that the insurance companies you work with most aren't on the list. Choosing a national clearinghouse will eliminate this issue before it even becomes a problem.

EHR Compatibility

Your EHR is a central tool for your practice, and you can significantly improve your workflow if your EHR can integrate with your clearinghouse. When your EHR and clearinghouse can communicate seamlessly, your revenue cycle management becomes more efficient and more accurate. You can remove the step of transferring PHI from your EHR to your clearinghouse, eliminating one point where errors or breaches can occur.

ICANotes and Clearinghouse Integration

EHRs built to address the many facets of compliance don't always deliver the best experience for behavioral health professionals. Trying to use a platform designed for medical professionals requires significant adjustments to meet the needs of a mental health care setting, and can decrease the accuracy of your records and notes. ICANotes is the only EHR designed by behavioral health professionals to meet the specific needs of clinicians like you.

ICANotes knows the ins and outs of compliance in the mental health care field and strives to stay ahead of the frequent updates to regulations. Our software is ONC-certified and meets all service standards. With a lighter burden of compliance partially shouldered by your EHR, you can save time and money, create more comprehensive notes and protect yourself in the event of an insurance treatment review or other audit.

We work hard to make every aspect of our software compliant, and we're more than happy to work with you to add any additional integrations you need to use ICANotes to its full potential. Just contact our support team, and we'll see what we can do for you. If you're interested in the most robust behavioral health EHR, see its capabilities with a live demo or try it out for yourself by registering for a free trial.

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