Behavioral Health Authorization Management

Treatment Over Time

Mental health treatment is usually most successful in a series of sessions. Like many other types of therapy (such as PT, OT, Speech Therapy, etc), behavioral health sessions can be minimally useful if only utilized once or sporadically and often require the repetition of multiple treatments, over time, to be most effective.

While there are acute situations that require a one-time intervention, mental health treatment is usually applied more than once. This length of time might be a few weeks, months, year – or a lifetime, depending on the client’s diagnosis and behavioral health needs.

The Importance of Behavioral Health Authorization Management

For this reason, psychotherapy and psychiatry is endorsed and reimbursed by payers in a series: for example, an insurance company will agree to pay – or “authorize” – 20 sessions of a particular CPT code (the treatment administered) for a certain ICD code (the client diagnosis that supports the treatment).

This means that most providers have to track the approved auths for each clients (aka, “authorization management”). If they bill for a session that isn’t covered by an authorization – whether it’s expired or all of the approved auths have been used up – they won’t be reimbursed! This puts a lot of pressure on agencies to manage their auths.

Paper Vs Software

Tracking auths on paper is one reason that organizations often seek out electronic software. While it may not be a big deal for small practices or providers who see a small number of clients, larger agencies can be crippled by ineffective behavioral health authorization management.

That being said, just because a system is electronic, doesn’t mean it’s got a good handle on the auth process. If you’re looking for an EHR, be sure to ask each program you consider to demonstrate how their authorization tracking works and how it can help eliminate this common headache for you.

Any mental health program you’re considering for your agency should ensure that you cannot bill for expired and/or used up auths – and also alert you when you’re getting close to those parameters.

Do Your Research!

For more tips about functionality to look for when shopping for a system, check out our Free Guide to Mental Health EHR – and our EHR Resource Center.

How Does PIMSY Handle Behavioral Health Authorization Management?

PIMSY’s authorization management capabilities are a perfect example of how using an integrated, streamlined EHR can save time & money. In PIMSY, if a provider starts to write a session note for an expired or used up auth, the CPT bill code won’t even show up as an option for them to use!

Each time a valid auth is used, PIMSY automatically decrements the master list, sending you an alert when it’s time to re-up authorizations. You have control over when and how to be alerted: when you’re down to a certain amount of unused units left; within two weeks of the expiration date, etc.

With PIMSY, your clinicians will literally not be able to process an invalid authorization, helping you to never again bill for an ineligible session. With authorization management, electronic eligibility verification, note scrubbing, easy electronic billing, and comprehensive reporting, PIMSY empowers you to make sure that every session is fully billable.

Contact us to see how PIMSY is your flexible, customizable, and affordable EHR solution: 877.334.8512, ext 1 – hello@pimsyehr.com

Leigh-Ann Renz

Leigh-Ann Renz is the Marketing & Business Development Director of PIMSY EHR. For more information about electronic solutions for your practice, check out Mental Health EHR.