Behavioral Health Authorization Management

PUBLISHED ON: 03.03.2016

Go Back To EHR (Electronic Health Records)

Treatment Over Time

Mental health treatment is usually most successful in a series of sessions. Like other types of therapy, behavioral health sessions can be minimally functional if utilized only once or sporadically. 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 time varies depending on the client’s diagnosis and behavioral health needs.

The Importance of Behavioral Health Authorization Management

Psychotherapy and psychiatry are 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 specific ICD code (the client’s diagnosis that supports the treatment).

This means that most providers have to track the approved authorizations for each client (aka, “authorization management”). They won’t be reimbursed if they bill for a session not covered by approval! This puts a lot of pressure on agencies to manage their auths.

Paper Vs Software

Tracking auths on paper is one reason organizations often seek out electronic software. This might not be a big deal for small practices or providers. Larger agencies can be hampered 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. Be sure to ask each vendor you consider to demonstrate how their authorization tracking works. You will want to know how it can help eliminate this common headache.

Any mental health program should ensure that you cannot bill for expired and/or used-up auths. It should 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.