Clearinghouses for Behavioral 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.
Start Free Trial
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.
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 about 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.
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.
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.
More Resources on Billing and Clearinghouses
What Is CPT Code 96127 and How Does It Affect Your Income?
Brief behavioral assessments are a great way for behavioral health professionals and…Read More
What Out-of-Network Clinicians Need to Know About Insurance
An out-of-network provider is a clinician who has not signed a contract…Read More
Recent DSM-5-TR Updates
As a behavioral health professional, it’s essential to stay up-to-date on changes…Read More
6 Reasons Why You Should Avoid Medical Transcribing Services
6 Reasons Why You Should Avoid Medical Transcribing Services Amidst record rates…Read More
CMS 1500 Claim Form Instructions
A CMS 1500 form is a claim form you will often use…Read More
Putting Together a Good Faith Estimate
Healthcare rules and regulations are constantly changing. In late 2021, Congress passed…Read More
Complete Guide to Mental Health Billing
Mental health services are essential for the well-being and emotional healing of…Read More
How to Read Mental Health Eligibility Verification Data
Working with insurance can often be one of the most frustrating aspects…Read More
How to Get on an Insurance Panel: Tips for Mental Health Professionals
Insurance has made behavioral health affordable for many people, but getting your…Read More
Mental Health Billing Tips for 2022
When you provide mental health care to your clients, your goal is…Read More
How to Choose a Clearinghouse
As a mental and behavioral healthcare provider, you want to give your…Read More
What to Know About the New E/M Coding Changes for 2022
The Centers for Medicare and Medicaid Services (CMS) and the American Medical…Read More
Automatic Coding Impact on EHR
Computer-assisted coding (CAC) is a time-saving tool that accelerates the coding and…Read More
Billing Pitfalls for Mental Health Clinicians
As a mental health clinician, you may have faced billing issues that…Read More
What Is a BillFlash Statement?
Is the billing process of your mental or behavioral health practice tedious…Read More
What Is the Difference Between a Clearinghouse Rejection and a Payer Denial?
If you are a therapist or another type of behavioral health professional,…Read More
All About Superbills: A Guide for Mental and Behavioral Health Providers
As a behavioral health professional, you’ll likely have a client ask for…Read More
How to Bill for Longer Couples & Family Therapy Sessions
It’s no secret that therapists across the globe aim to help people…Read More
Mental & Behavioral Healthcare Billing: How to Maximize Your Reimbursement Rate
As someone who works in behavioral health care, you entered the profession…Read More
How to Prepare for an Insurance Treatment Review
As a behavioral health professional, you want to provide the best care…Read More
Intuitive, Accessible, Time-Saving
ICANotes - the only EHR software that actually thinks like a clinician.