Specialty
Behavioral Health Billing
Behavioral health has the tightest authorisation regime in outpatient care, and the most common denials arrive long after the sessions they relate to.
What makes it different
The things that decide whether these claims get paid.
- Authorisation is granted in units that run out
- Approvals cover a number of sessions within a window. Care continues; the authorisation quietly expires. Denials then arrive for sessions already delivered, which is the hardest money to recover.
- Time-based codes need documented time
- Session codes are defined by duration. A note that records what was discussed but not how long the session ran cannot support the code billed.
- Parity does not mean uniformity
- Mental health parity requires comparable coverage, not identical administration. Payers still apply their own authorisation processes, visit limits and documentation standards.
- Telehealth rules remain in flux
- Modifiers, place-of-service codes and coverage differ by payer and continue to change. Rules correct last year are not reliably correct now.
Where the money goes
Four leaks specific to Behavioral Health.
A healthy practice in this specialty collects around 94% of billed charges. Most of the gap below that is made up of these.
- Sessions delivered after an authorisation quietly expired
- Time-based codes unsupported by documented duration
- Telehealth billed with a modifier a payer no longer accepts
- Group and individual sessions coded interchangeably
| Measure | Result | Reference |
|---|---|---|
| Collection rate | 94.0%OK | > 93% |
| Days in A/R | 28OK | < 30 |
| Denial rate | 4.0%OK | < 5% |
| A/R over 90 days | 8.0%OK | < 10% |
Illustrative figures — not a client result.
Questions
Asked most often.
Why does authorisation cause so many denials here?
Because the limit is reached during care rather than before it. Nothing flags at the point of service, so the practice finds out weeks later via a denial for sessions already given.
Can expired-authorisation denials be appealed?
Sometimes, where the clinical need is documented and the lapse was administrative. Tracking authorisations against the schedule is considerably cheaper than appealing them.