TDNet Discover

The purpose of this case study is to describe the reasoning behind claim errors for mental health providers at a mental health billing company, focusing on telehealth services. For the utility of this study, the claim errors are generally defined as lost revenue due to documentation or billing errors. Using Andersen’s Behavioral Model, billing inaccuracies can be analyzed and identified based on the model's components: Environmental, Population Characteristics, Provider, and Healthcare System. An extensive literature review reveals the relationship between the claim errors caused by the feasibility of telehealth growth, inconsistent reimbursement policies, and misapplication of Current Procedural Terminology (CPT) codes, all of which lead to administrative burdens, payment delays leading to carryover balance, and loss of service capacity. This project employs an ethnographic case study method to examine actual billing procedures, coding methodologies, provider documentation, and various workflows. It aims to discover systemic elements that lead to repeatable mistakes. Addressing billing inconsistencies allows better revenue cycle management for mental health organizations, which reduces provider burnout and maintains equitable patient access to telehealth services. This study informs the practical and theoretical impact of billing accuracy as a major building block for an organization's sustainability and the successful delivery of mental health outcomes.