Outsource CCBHC billing at just 2.49% of your monthly collections
CCBHC Medical Billing Services, built for Certified Community Behavioral Health Clinics in the USA
Billing mistakes for Certified Community Behavioral Health Clinics (CCBHCs) can be expensive. This is especially true if payment is not being sought by the CCBHC for reimbursable patient encounters or claims are not being prepared in accordance with the CCBHC’s Prospective Payment System (PPS) methodology, specific payer requirements, or required documentation standards set by Medicaid programs and other applicable payers. Such mistakes may lead to delays in PPS payments under Medicaid, denials of behavioral health claims, missed prior authorization deadlines, and decreased reimbursement for services already rendered by the CCBHC to its patients.
The risk is even greater if a CCBHC relies on its own internal billing and revenue cycle staff to perform these functions without specialized training in CCBHC Billing. These include submission of claims under PPS-1 or PPS-2, submission of valid behavioral health service codes, compliance with requirements for multiple services provided on the same day, compliance with Medicaid’s billing rules, and maintaining complete case notes of the treatment.
CCBHC RCM Services Company (like BellMedEx) provides medical billing services tailored to the needs of each CCBHC and CMHC. Trained billing experts help licensed regional mental wellness centers convert fully documented patient encounters into claims that meet all the requisite requirements of Medicaid, Medicare, and applicable private payers. These specialists also handle prior authorizations and denied claims. They also help collect past due payments from federal healthcare programs, state-funded health plans, and private insurance carriers for CCBHC services that went unpaid.
Through these services, BellMedEx enables CCBHC organizations to protect their revenue, speed payment cycles, and stabilize cash flow.
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Where Revenue Gets Lost
CCBHCs Are Wasting Time and Revenue in Billing, Why?
The different payment methods associated with PPS-1 and PPS-2 can make it difficult for a Certified Community Behavioral Health Clinic (CCBHC) to accurately calculate and submit reimbursable services through Medicaid’s billing and claim submission process.
Another challenge is that detailed information must be recorded by the CCBHC’s front desk staff for every psychiatric care encounter.
All the three main types of insurance carriers (government, federal, and independent) also apply separate rules to claims submitted by CCBHCs. These rules include payment calculations, service codes, patient recordkeeping standards, and preauthorization conditions.
The high volume of Psychiatric Treatment Reimbursement Requests also increases the likelihood of calculation errors, claim rejections, or payment delays for the CCBHC. Sometimes the reimbursement is not received in full or on time by the CCBHC from government or private-based insurance payors.
State PPS Methodology Alignment
In states participating in the Medicaid Demonstration for Certified Community Behavioral Health Clinics, services are reimbursed to CCBHCs using the Prospective Payment System (PPS) method selected by each state. The state may adopt PPS-1, PPS-2, PPS-3, or PPS-4. That is why each method has its own rules and guidelines for calculating payments and filing billing claims.
For a CCBHC to receive valid reimbursement for services under one of these methods, its payment process must operate according to the specific PPS method selected by the state for that particular clinic.
If CCBHC billing staff use the wrong PPS method when preparing claims, errors may occur in the submitted applications. Similarly, if the payment requirements established by the state are misunderstood or incorrectly applied, this can also affect the reimbursement amount received by the CCBHC.
As a result, claims submitted by the CCBHC through the state Medicaid program may be denied by the state Medicaid agency. Payment to the CCBHC may be delayed by the state Medicaid program if Medicaid does not receive all the information required for accurate processing. In addition, the CCBHC may receive an incorrect payment amount from Medicaid.
Daily vs. Monthly Encounter Rules & Stacking
Certified Community Behavioral Health Clinics (CCBHCs) that use either the PPS-1 or PPS-3 payment methodology under their state’s Medicaid system are reimbursed on a daily basis through the state Medicaid program. In contrast, CCBHC organizations operating under PPS-2 and PPS-4 receive payments on a monthly basis.
Further, under the daily PPS method, most eligible services provided by CCBHC clinicians or other qualified CCBHC practitioners to a single Medicaid beneficiary on the same day are generally counted as one eligible daily encounter.
For example, if one clinician provides psychiatric counseling or therapy to an individual while another clinician provides a psychiatric medical service to the same individual on the same day, both are considered a single eligible daily encounter rather than separate daily encounters.
Under PPS, the specific clinician providing the services does not alter this classification. Therefore, CCBHC Billing Staff should combine all services provided on the same day into one reimbursable eligible daily encounter, but the specific code for each service provided must still be documented.
However, under PPS-3, a separate rate is established for an eligible daily crisis service. This allows the CCBHC to receive Medicaid reimbursement for eligible mobile crisis intervention and/or on-site crisis stabilization services in accordance with the state’s approved payment rules.
Missed CCBHC Encounters
Organizations formally certified as CCBHCs can provide a wide range of behavioral health services to their patients that are reimbursable through independent insurance carriers as well as Medicaid and Medicare. These services may include mental health treatment, substance abuse treatment, emergency assistance, integrated patient case management, and peer support.
To secure reimbursement for these CCBHC-provided services from insurers, patient encounter data recorded in the organization’s Electronic Health Record (EHR) must be accurately transferred to the Healthcare Invoicing & Insurance Claim Filing process.
If these documents are incorrect or cannot be successfully transmitted to the CCBHC’s EHR billing system, patient encounters that were eligible for payment may never be submitted to insurance companies. This means that the CCBHC may not be reimbursed for services already provided to patients that could have been paid for by the medical insurers.
Service-Level Data & Shadow Billing Gaps
For CCBHC Payment Claims, the basic PPS encounter code and the initial information submitted to Medicaid for reimbursement are not enough. An authorized community mental wellness facility must also maintain detailed records of the individual mental healthcare services provided to each Medicaid patient. This detailed service-level entry is often referred to as “shadow billing.”
In CCBHC Demonstration payment claims, CMS uses T1040 for encounters counted on a daily basis and T1041 for encounters counted on a monthly basis. In addition, the Q2 modifier identifies information about individual services associated with the CCBHC encounter. However, the exact form of the payment claim and the coding requirements may vary according to each state’s Medicaid program.
Therefore, the CCBHC Billing System must accurately link the services listed in the documentation to the codes and identifiers required by the state Medicaid program. If service-level information is missing or combined with incorrect coding, the payment claim may be incomplete, and errors may occur in the submitted information.
As a result, the CCBHC may experience delays in claim processing and inaccurate information reaching Medicaid agencies and CMS.
DCO Billing Gaps
If a CCBHC arranges for a Designated Collaborating Organization (DCO) to provide required services—such as primary medical care screenings and/or crisis services—instead of providing them directly, the CCBHC remains responsible for submitting payment claims to Medicaid.
If there is not a regular and coordinated exchange of information between the DCO’s electronic health record (EHR) and the CCBHC’s billing system, this can result in lost revenue for the CCBHC, delayed payments from Medicaid, and compliance problems related to the distribution of Medicaid funds between the CCBHC and the DCO.
Crisis Service Billing Complexity
A CCBHC must provide access to crisis services 24 hours a day, 7 days a week, to individuals who are in a behavioral health crisis.
Individuals eligible for crisis services under PPS-3 or PPS-4 may receive specific PPS rates for certain eligible services, such as mobile crisis intervention or crisis stabilization services.
Thus, the payment calculation method must be able to correctly identify the crisis encounters to which the different crisis payment rules apply. This allows the CCBHC to know what payment claim to submit and when the corresponding Medicaid Payment is due.
Cumulative Monthly Outlier Tracking
Both monthly payment methods, PPS-2 and PPS-4, may include a mechanism for additional payment when the total cost of eligible CCBHC services provided to a patient during a single month exceeds the state-established threshold.
For example, if one Medicaid patient receives an unusually high volume of CCBHC services within a month and the total eligible cost of those services exceeds the state-set limit, the provider could lose potential additional reimbursement from the state Medicaid program. It’s because the situation is not correctly identified and the corresponding payment request is not submitted.
Quality Bonus Payment (QBP) Data Alignment
Quality Bonus Payments (QBPs), also known as “quality performance rewards,” are incentive payments made by states to certified community behavioral health facilities under Medicaid when a CCBHC achieves established performance goals based on specific quality metrics. For example, if a CCBHC shows a certain percentage improvement over its previous performance on a given quality measure, the state may issue an incentive payment in recognition of that improvement.
CCBHCs submit quality performance information from two primary sources: administrative data derived from submitted payment claims and records of patient clinical encounters contained within EHR systems.
CCBHCs therefore need to ensure that their clinical documentation, quality performance reporting, and payment calculation systems are properly aligned.
If a CCBHC fails to collect the necessary clinical information or cannot accurately transmit that data to its quality reporting and payment systems, important clinical information may be missing from its performance report. Such a report may be incomplete.
Consequently, if the CCBHC does not meet the threshold established by the state and does not receive the Quality Bonus Payment, it may later be difficult for the CCBHC clinic to demonstrate that they had actually achieved the required level of quality performance to get bonus reimbursements from Medicaid.
CCBHC Cost and PPS Reconciliation
The Medicaid payment rates for CCBHCs, which determine how much will be paid for eligible mental treatments, are not the same for every clinic. These rates depend on the clinic’s own characteristics, including the projected cost of providing CCBHC services to Medicaid beneficiaries, as well as the services actually delivered to those beneficiaries.
That is why it is important for the CCBHC Revenue Cycle Management Staff to understand the relationship between the care provided to patients, the use of those services, the cost to the organization, and the amount Medicaid reimburses for those services.
See, it is not enough to know only whether Medicaid paid or denied a submitted claim. It is also important to determine whether the amount received from Medicaid is reasonable in relation to the volume of services provided and the actual costs incurred in delivering those services.
Billing Across a Broad Service Model
CCBHCs provide a variety of services. This includes everything from mental health services to addiction treatment to psychosocial programs.
If the medical facility’s EHR system is not configured according to CCBHC procedures, it may be difficult for the CCBHC’s Finance Team to accurately link all of these services to the process of preparing and submitting claims for payment to applicable insurers.
Full Revenue Cycle Support
How CCBHC Revenue Cycle Management and Billing Services Help
Certified Community Mental Health Clinics provide a wide range of services including behavioral health treatment, substance use disorder treatment, and crisis intervention. Multiple services can also be provided to a patient in one visit. The broad spectrum of services provided by CCBHCs makes it more complicated to determine payments and file claims than outpatient behavioral health treatment.
CCBHC Medical Billing Firm helps organizations meet all these requirements accurately and get correct reimbursement from insurers for the billable behavioral health services provided to patients.
Patient Registration & Eligibility Verification
Errors in a patient’s name, failure to verify a Medicaid insurance plan, or failure to determine payment responsibility among multiple insurers are common reasons why health plans deny claims sent for reimbursement several weeks after submission by the CCBHC’s in-house billing staff.
Before a patient receives reimbursable behavioral health services, such as individual or group psychotherapy, the Expert CCBHC Biller verifies the patient’s eligibility, available insurance benefits, and which payer—Medicare, or a private insurer—is responsible for reimbursing the CCBHC for the covered services provided to the patient.
Credentialing, Payer Enrollment & Authorization
If a behavioral health provider at a CCBHC is not correctly registered with the relevant payer, the insurance company may reject the claim for services. Additionally, prior authorization requirements vary depending on the treatment provided by CCBHCs. If the authorization expires during a patient’s treatment, the claim may also be denied, although timely action can prevent this.
CCBHC Billing Management Entities keep provider enrollment records up to date. They proactively monitor payer authorizations and their expiration dates for reimbursable mental health wellness treatment to reduce claim disallowances caused by enrollment errors or expired approvals.
Behavioral Health Coding & Charge Capture
There are some risks to coding for therapeutic care that community behavioral care facilities don’t usually see in standard medical billing. For example, applying incorrect modifiers to crisis service claims, reporting discrepancies in the number of service units, or recording diagnoses that do not substantiate the medical necessity of treatment can lead to errors. These errors may cause private and government insurers to deny payment claims submitted by the CCBHC for covered behavioral health services provided to its patients. In addition, the CCBHC may face compliance audits by state Medicaid agencies, and Medicare reviewers.
CCBHC Reimbursement Specialist compares information recorded in the health center’s billing software on a daily basis. This process helps identify uncoded procedures, incorrect modifiers, or discrepancies in documentation before claims land with the payers. This enables CCBHC to avert claim rejections caused by these errors and keep accurate records for payer inspection.
Specialized CCBHC PPS Billing & Claims Management
CCBHC Revenue Operations Team uses a system capable of generating payment claims according to each health center’s specific PPS rate. This includes daily or monthly payment rates, additional payments for costs exceeding established limits, and performance-based payment requirements.
Before submitting claims to private carriers or federal healthcare coverage, the revenue managers review all claims processed through the intermediary and verifies their accuracy.
In addition, the billing operations manager monitors the current status of all claims handled by the intermediary. In case the claim is rejected or hold for review, the manager follows up with the intermediary and the respective insurance provider.
Denial Management, A/R & Underpayment Recovery
If a payment for CCBHC services is rejected due to an error regarding patient eligibility, it indicates that the billing process needs to be corrected before claims are submitted again.
CCBHC Healthcare Claims Management Specialists categorize all rejected claims according to the reasons for their rejection. It also assists in appealing claims denied by insurers and monitors the status of these appeals.
In addition, the support entity maintains records of the medical center’s outstanding receivables according to each payer, the aging period, and the amount owed. This enables billing staff to prioritize high-value payments that have passed their due dates.
The support entity also compares each payment received by the CCBHC from health insurance organizations against the applicable PPS rate or the payment rate established in the contract. In this way, underpayments by insurers can be identified, and necessary action can be taken to recover the remaining amounts owed to the CCBHC.
Payment Posting & Revenue Reconciliation
If the amount received by a CCBHC is recorded incorrectly, it may cause a denied claim to go unnoticed, an underpayment to remain undetected, or an overpayment to appear in the medical center’s account. The in-house staff may remain unaware of these errors for months.
CCBHC Payment Accounting Specialists record all received Electronic Remittance Advice (ERA) details and insurer-issued Explanations of Benefits (EOBs) in the relevant accounting system. These records are linked to each patient’s original payment claim. The specialists also compare payments received under PPS with each medical center’s specific rates, such as daily payments under PPS-1 or monthly payments under PPS-2. It also checks that the amounts received correspond to the payment rates previously set.
Reporting, Compliance, Audits & EHR Support
An outsourcing billing partner specializing in medical billing for CCBHC clinics conducts ongoing reviews to identify potential errors in service codes or documentation before claims are submitted to commercial insurers or CMS for reimbursement.
This RCM partner integrates the CCBHC’s health records system with information received from the intermediary that transmits payment claims to insurers. It also ensures that all medical information is accurately and completely transferred from the facility’s electronic health records to its billing system.
This process is to avoid unnecessary denials of claims, to find errors in billing as they happen and to have complete documentation for review by the insurer. Thus, the CCBHC is eligible for immediate reimbursement from health insurance companies for Billable Behavioral Health Services provided to patients.
Payer-Specific Billing, DCO Support & Revenue Optimization
Rules for public and private insurance companies are different as well as the requirements for provider enrollment, patient eligibility and the contractually agreed payment rates. For example, Medicaid requires providers to be properly enrolled and patients to be eligible for treatment. Similarly, private insurers have their own conditions for including medical centers in their approved provider networks and reimbursing services at mutually agreed rates.
If a CCBHC provides services in conjunction with a Designated Collaborating Organization (DCO), accurate payment calculations depend on the correct transfer of all necessary information from the DCO’s Electronic Health Record (EHR) to the CCBHC’s Billing System.
Experienced CCBHC Billers review the reasons for repeated claim denials, provider performance, and the stages of the payment process where errors occur. They then make necessary changes to the underlying billing procedures rather than correcting each rejected claim separately, helping prevent similar errors in the future.
Benefits of Outsourcing
Why Outsourcing CCBHC Medical Billing is beneficial?
Because Medicaid PPS payment calculations for psychiatric treatment services at CCBHCs are more complex than standard medical billing, a specially trained team is required to handle the clinic-specific billing procedures. These include combining multiple services provided on the same day into a single billable encounter, preparing payment claims for crisis services, and tracking the validity of authorizations received from insurers.
The Contracted Medical Billing Services Agency (like BellMedEx) uses its combined expertise in accurate behavioral health coding, PPS payment requirements, and proactive revenue management. The objective is to identify errors in financial submissions lodged with healthcare carriers, address denied claim submissions, and monitor outstanding balances so that amounts owed to the psychiatrist can be recovered in a timely manner.
With the help of these services, CCBHCs can increase their collections from Medicaid, Medicare coverage programs, and commercial insurance providers.
PPS-to-Claim Accuracy
Experienced CCBHC billing staff reviews Medicaid claims prepared by the medical center and ensures they meet the appropriate Prospective Payment System (PPS) requirements. One of the following four payment methods applies to each facility:
Daily payment: PPS-1 or PPS-3
Monthly payment: PPS-2 or PPS-4
In addition, the billing team reviews applicable rates for crisis services and determines whether the services provided qualify for additional reimbursement when eligible costs exceed the state-established threshold.
The objective of this review is to determine whether the Medicaid PPS claims submitted by the CCBHC for eligible behavioral health encounters meet the payment requirements of its state Medicaid program and are using the PPS methodology approved by the state Medicaid agency for the facility.
Complete Encounter Capture
The CCBHC’s dedicated billing team reviews all scheduled patient appointments that are captured in the Electronic Health Record (EHR). Then it confirms that all applicable data for behavioral health services was properly transferred to the medical center’s billing system.
For example, if a patient has two different services on a single day (e.g., individual therapy and medication management), the billing team ensures that both services are documented properly and in full.The respective claim is worked out according to the applicable PPS rules.
In this process, the CCBHC is able to find billable encounters that previously were not included in payment calculations due to missing clinical documentation, incorrect service coding, or incomplete data transfer from the clinic’s EHR to its billing system. It also helps the clinic recoup Medicaid reimbursement for services already rendered to patients.
Service-to-Documentation Checks
CCBHC billing staff also review the medical documentation that accompanies each claim for behavioral health services. The goal is to make sure all records meet the requirements of CMS or the appropriate private insurer.
For example, when reviewing a claim for time-based psychiatric treatment, the team verifies that the patient’s clinical record shows documentation of the actual time spent in treatment to support the billed service code and to confirm that the claim meets the insurer’s reimbursement requirements. Likewise, for crisis service claims, it verifies that the correct service codes are used.
This review reduces the possibility of insurers rejecting claims because of improper recordkeeping. It can also help the CCBHC avoid documentation-related objections in compliance reviews by state Medicaid offices or Medicare inspectors.
Payer-Specific Billing Controls
CCBHC billing team evaluates every claim according to the specific rules of the responsible payer and the conditions applicable to the billable service.
For example, CCBHC claims submitted under the Medicaid Demonstration use HCPCS code T1040 for daily encounters and T1041 for monthly encounters. In contrast, where the relevant requirements apply, Medicare uses CPT code 90834 for a 45-minute psychotherapy session.
Billing team applies the right rules on each claim.
PPS Reconciliation & Payment Review
CCBHC Healthcare Billing Agency calculates expected Medicaid reimbursement for services provided to patients based on the medical center’s current state-approved PPS rates. The calculation also incorporates the factors that determine eligibility for supplemental payments, such as outlier payments under PPS-2 or PPS-4 when the monthly cost of care of an eligible patient exceeds the threshold established by the state Medicaid program, where applicable.
That estimated amount is then compared to the amount the CCBHC actually receives from the state Medicaid agency or its Medicaid managed care plan.
For example, the revenue management team tries to see if the facility received additional reimbursement under PPS-2 and PPS-4 when the eligible cost of services exceeds the threshold set. The team also compares approved PPS rates with payments received through Medicaid managed care.
If there is a discrepancy between the expected and received amounts, the billing agency investigates the cause of the underpayment and contact the relevant payer or state Medicaid agency to recover the outstanding balance.
Revenue Leakage Identification
Billing specialists review the medical center’s entire revenue and collections process. Their goal is to identify payments that have not been collected or have been delayed because of unrecorded billable encounters, unpaid Medicaid claims, unresolved denials, or underpayments by Medicare and private insurers.
In addition, the billing team compares medical records with submitted claims to identify services that were documented in the EHR but never included in payment calculations or the required submission of detailed service information.
Real Impact
Results CCBHCs See when they Outsource Billing to BellMedEx
Typical outcomes for CCBHC clients within the first two to three billing cycles after onboarding.
30–40%
Reduction in denial rate within 90 days
25%
Average drop in days in A/R
96%
Clean-claim rate on first submission
2–4 wks
Typical onboarding to full billing handoff
BellMedex Medical Billing @ 2.99%
Licensed Professional Counselor
I would like to send out a heartfelt appreciation for all of your hard work in helping my Health Counselling clinic take care of our billing and credentialing needs. You have made my job as a practice owner much easier.
Plastic Surgeon
We are more than satisfied with BellMedEx and would highly recommend them to anyone searching for an efficient billing company. Working with BellMedEx has felt effortless and we are vastly thankful for their services.
Internal Specialist Medicine
BellMedEx has been a phenomenal asset to our company. Assisting with billing, credentialing and enrollment, BellMedex has been consistently reliable from the first day of our relationship.
Psychiatrist
Catonsville, Maryland
Our medical facility has been working with BellMedEx for about 2 years now and we are very pleased with their services. BellMedEx Medical Billing is a great company for billing needs. The customer support is great.
Understanding The Process
How the CCBHC Billing process works for more efficient community behavioral health billing?
Assess Billing Gaps
Billing executives review the medical center’s current payment system to identify difficulties in collecting reimbursement from insurance companies.
The RCM executive compares patients’ medical records, submitted claims, and details of payments received. This helps identify billable encounters that were left out of payment calculations and the reasons claims are repeatedly denied.
Using this information, the executive determines where the CCBHC is losing revenue and which parts of its billing system need improvement.
Configure Billing Systems
The billing officer configures the CCBHC’s payment system according to the state-approved Medicaid Prospective Payment System (PPS) methodology. All relevant payer requirements and the facility’s existing Electronic Health Record (EHR) configuration are also taken into account.
The officer determines whether the medical center receives daily or monthly payments under PPS. The appropriate billing method is then established on that basis.
The billing team develops procedures for evaluating claim validity and supervising preauthorization activity. This verification helps reveal possible problems before reimbursement requests are routed to the relevant health plans.
Capture Billable Encounters
CCBHC billing specialists compare completed patient appointments with medical records to verify that all behavioral health encounters have been documented and determine which are eligible for reimbursement.
The team also checks whether all service information recorded in the EHR has been accurately transferred to the CCBHC’s billing system.
If a billable encounter has not been transferred correctly, it is flagged before the corresponding claim is submitted.
Validate Billing Details
Behavioral healthcare billing agency verifies that each claim is accompanied by the medical documentation required by the relevant payer to establish its validity.
The agency also checks that the healthcare provider delivering the service is properly enrolled with the responsible insurer and that the service codes meet the applicable requirements. Necessary prior authorizations are verified before claim submission.
For Medicaid PPS claims, the billing team ensures that each encounter satisfies the requirements of the medical center’s state-approved payment methodology.
This review reduces the risk of incorrect payment calculations and helps prevent unwarranted claim refusals by Medicare, state-funded Medicaid plans, and private carriers.
Submit Clean Claims
The CCBHC’s dedicated billing team prepares claims according to the relevant requirements of insurance companies.
Each prepared claim is reviewed for errors that could cause the payer to reject or deny it.
After verification, the team submits the claims through the appropriate intermediary or directly through the payer’s submission system.
Once claims have been submitted, their processing status is monitored. If a delay occurs, the billing team informs the CCBHC.
Resolve Payer Issues
If a claim submitted by the CCBHC is returned by an intermediary or denied by an insurance company, the billing team reviews the rejection details and reasons provided by the relevant organization.
Once the cause has been identified, the team makes the necessary corrections to eligible claims that can be resubmitted. Where appropriate, it also prepares appeals against denied claims.
Timely corrections help the CCBHC resolve problems that might otherwise delay the collection of reimbursement.
The billing team maintains contact with the relevant insurer until the disputed claim is resolved or the outstanding payment is recovered.
Reconcile Payment Differences
The CCBHC’s revenue and payment management team compiles details of the amounts received from each payer. These payments are compared with the amounts due under previously submitted claims, calculated according to the applicable payment method.
For Medicaid PPS claims, specialists verify that the reimbursement received matches the approved rate established for the medical center.
The team also checks whether the CCBHC has received any additional payments for eligible crisis services or expenses exceeding the established threshold.
If an underpayment is identified, the billing team investigates its cause and contacts the relevant payer to recover the remaining amount owed to the CCBHC.
Optimize Billing Performance
The CCBHC’s specialized billing team reviews previously submitted claims and payment records to identify recurring problems in collecting reimbursement.
For example, if claims are repeatedly denied because of patient eligibility issues, this may indicate weaknesses in the clinic’s insurance verification process.
In such cases, the billing service provider improves the existing verification procedures to prevent similar errors in the future.
Identifying recurring problems also helps determine where improvements are needed in transferring medical service information from the EHR to the billing system.
Sound Familiar?
Is Your CCBHC Experiencing These Billing Challenges?
CCBHC billing can become difficult to manage when multiple issues happen at the same time.
High denial rates
Growing A/R
Slow reimbursements
Missing charges
Unbilled encounters
Authorization problems
Coding errors
PPS billing challenges
Underpayments
Poor claim visibility
Manual billing processes
Lack of reporting
Staff shortages
Credentialing delays
Payer communication problems
Revenue leakage
If these challenges are affecting your revenue cycle, it may be time for a closer review. We can assess your billing process, identify where revenue is being lost, and help build a more efficient CCBHC billing workflow.
Connect with BellMedEx to discuss your current billing challenges and identify opportunities to improve your CCBH Clinic revenue cycle.
CCBHC Billing Questions, Answered
What services does CCBHC billing support provide?
CCBHC billing services help Certified Community Behavioral Health Clinics file claims to get paid for behavioral health services. These services can also assist these clinics in recovering overdue payments from Medicaid, Medicare, and private insurers.
The billing cycle includes preparing claims for the correct payer, submitting them, and reviewing the payments received after the claims are processed. The billing team follows up with the appropriate payer when a claim is denied and assists the mental health facility in managing outstanding receivables when needed.
CCBHCs may be paid under Medicaid-specific payment methodologies, and therefore their billing process may require more specialized knowledge and experience than standard outpatient behavioral health billing.
Who can utilize CCBHC revenue and payment management services?
CCBHC revenue and payment management services are primarily designed for Certified Community Behavioral Health Clinics. However, they may also be useful for behavioral health organizations planning to pursue formal CCBHC certification.
Some Community Mental Health Centers (CMHCs) may eventually become candidates for CCBHC certification, but being a CMHC does not automatically make an organization a CCBHC. First, the organization must meet certification requirements set by its state for CCBHCs.
How does CCBHC payment differ from traditional CMHC billing?
Medicaid may reimburse certified CCBHCs through a state-approved prospective payment system (PPS). Depending on the applicable PPS methodology, payment may be calculated on a daily or monthly basis.
In contrast, traditional CMHC billing generally involves billing individual services separately.
For this reason, certified CCBHCs receiving reimbursement under PPS may need to report encounters and individual services differently. The way expected reimbursement is calculated can also differ from traditional behavioral health billing.
How does the PPS method affect CCBHC claim management?
The PPS methodology is the way in which the state Medicaid program calculates payment for eligible CCBHC encounters.
Medicaid reimbursement can be calculated either on a daily or monthly basis depending on the approved methodology.
Billing staff must accurately document each qualifying encounter and submit the required information according to the payment rules of the state Medicaid program so that they can receive proper reimbursement and prepare Medicaid claims according to the medical center’s approved PPS method.
Can CCBHC billing services handle PPS-1, PPS-2, PPS-3, and PPS-4?
Yes. A CCBHC billing service provider can create the medical center billing process according to its applicable PPS methodology.
PPS-1 and PPS-3 use daily payment methods, while PPS-2 and PPS-4 use monthly payment methods.
Each methodology has its own requirements. Therefore, the medical center’s billing procedures need to reflect the PPS method selected under its state Medicaid program so that encounter and service information is submitted according to the applicable payment structure.
Can revenue and payment management support Quality Bonus Payments?
Yes. Improving the accuracy of encounter, billing, and quality-related information is one way revenue and payment management support can assist a CCBHC with Quality Bonus Payments (QBPs).
Quality Bonus Payments are extra incentives from Medicaid for Certified Community Behavioral Health Clinics (CCBHCs) that meet certain quality performance benchmarks. The extra payments are intended to reward facilities that show good performance in delivering services and delivering favorable clinical outcomes for patients. Eligible CCBHCs that meet these standards are able to expand their funding opportunities and continue to advance their overall mission of improving community health. Those thresholds are based on applicable quality measures and the requirements of the respective state Medicaid program.
The billing service provider does not determine whether a medical center qualifies for a QBP. However, the CCBHC must be able to demonstrate that it satisfied the required quality performance criteria, making accurate and complete performance information important to the process.
Why should a CCBHC use specialized revenue and payment management support from BellMedEx?
CCBHC billing involves requirements that may not apply to general outpatient behavioral health providers. Medicaid payment rules also vary by state, making the reimbursement process more complex.
Each clinic’s approved PPS methodology adds another layer of requirements.
BellMedEx’s experienced billing team understands these differences and helps CCBHCs follow the payment rules applicable to their programs.
The team also helps identify billing issues before they become larger financial problems. These may include denied claims or missed billable encounters.
Underpayments and delayed reimbursements can also affect a clinic’s revenue.
With specialized revenue cycle support from BellMedEx, CCBHCs can reduce the administrative burden on their internal staff and pursue appropriate reimbursement for the behavioral health services they provide.
