Medical billing in any specialization can be complex and cumbersome, but psychiatry billing is more prone to frustrating mistakes because of the field’s unique nature. To help make sure you get paid on time, avoid the hassle of rejections, and maximize your earnings, we’ve compiled the most common mental health billing mistakes made by psychiatrists in Ontario, British Columbia, and Alberta.
Billing using the wrong code
It sounds simple: if you don’t submit the correct code, your claim won’t be approved. However, using the right code is often more complicated in practice–– particularly when providing multiple services to a patient.
For example, OHIP doesn’t allow psychiatrists to bill multiple codes for a single patient in one day. If a patient comes into the hospital and you bill for a consultation (A190), then see the same patients again for the same issue and attempt to bill a partial assessment (A194), the higher code in the claim will be rejected (A190). This is particularly problematic in this case, because A190 has a higher dollar value than A194.
There are also limits on how often you can bill certain services, like consultations. In Ontario, consultations are only billable once every 12 months. If the same patient returns to the ER six months later, you either need to bill for a repeat consultation (unless it’s an entirely separate issue) or use a regular time-based billing code.
If you see a patient more frequently than once a day, ensure you’re billing correctly for your time and not exceeding allowable limits.
Double billing by multiple physicians
One of the common issues that makes psychiatric billing so complex is that, in many cases, your patients are under the care of several different doctors. There are restrictions on multiple physicians using the exact same code for a specific patient. If this occurs, your claim will be rejected. If you are part of a medical team caring for a patient, it’s important to make sure your claims aren’t identical, otherwise one of you won’t receive payment.
Using the wrong diagnostic code
It’s crucial that psychiatrists use a diagnostic code that’s specific and relevant to the issue you’re treating. If you’re not specific enough, your claim can be rejected. For example, if you’re treating a patient with depression caused by substance use and you bill for generalized depression, your claim could be refused. Similarly, billing too many generic codes, such as “anxiety disorder,” could raise a red flag and result in extra scrutiny or rejections.
The best way to avoid this common mental health billing mistake is to document your patient interactions thoroughly and make sure the billing code you choose is as relevant as possible to the visit based on what you’ve written down in the patient’s chat. Spending an extra few minutes on this step can help avoid billing headaches down the road.
Not using premiums or incentives when you bill
Another common mental health billing mistake is overlooking or misusing premiums and incentives. Special visit premiums or billing incentives pay you an additional amount over your normal billing for coming into the hospital at certain times, in certain situations, or for coming in to assess a patient from another hospital or clinic. They can’t typically be used for pre-booked appointments. Common scenarios where you can use specialized codes are urgent and emergency medical situations, for high-risk community care, and if you have to travel to another hospital. Note: the premium would only apply to the first patient you traveled to see, not any subsequent patients.
Remembering to use these premiums can help maximize your income, but they can also result in your claims being refused if you use them improperly.
Incorrect patient information
Details aren’t just important when it comes to choosing the right code, they’re also important when submitting patient information. Common reasons psychiatrists’ claims are refused include incorrect or incomplete patient information, such as omitting their health card number or misspelling a last name. Other frequent oversights are forgetting to add details like their hospital admission date or the name of the referring physician. Double-checking these minor details will help make sure you get paid quickly.
What to do when your psychiatry billing is rejected
Even the most diligent and detail-oriented physicians will occasionally make medical billing mistakes. Here’s what to do when they happen and your billing is rejected.
OHIP
If your billing is rejected in Ontario, you can typically resubmit your claim. When you encounter an error, it will be accompanied by a code and explanation, which you can then look up in our searchable database. You can then fix the billing mistake yourself, or you can leave handling rejections and resubmissions to us with our Comprehensive Plan.
For more information about OHIP rejection codes, please check out our OHIP Rejection Library.
For more mental health billing tips, please check out our OHIP Billing Tip Library and our Psychiatrists’ Guide to Billing in Ontario.
MSP
Many MSP rejections can be resubmitted, but some exceptions include claims paid to another psychiatrist, claims made for the wrong diagnostic family, second rejections, and exceeding the limit for each type of claim. It’s especially important to avoid these types of common mental health billing errors. Rejections from MSP will include an error code, along with an explanation of what the code means so you can address the mistake.
For more information about MSP rejection codes, please check our searchable database of MSP Explanatory Codes.
For more MSP billing tips and troubleshooting, check out our MSP Rejection Examples and Tips to Fix Them.
AHCIP
If you receive a rejection, make sure to address it quickly so you don’t experience a lengthy delay in getting paid. This is particularly important because changes to the Alberta Government Schedule of Medical Benefits have reduced the window in which physicians can resubmit claims.
If your claim is rejected, you will receive a statement that includes error codes, which you can then look up to determine where you went wrong.
For more AHCIP billing tips, please check out our Ultimate AHCIP Billing eBook.
Whether you’re in private practice or working in a hospital setting, taking charge of your billing, investing in good billing software, and being aware of common psychiatry billing mistakes now can save you a lot of time and stress in the future.
