June 5, 2024

The Continued Importance of Mental Health Credentialing: A Focus Beyond Mental Health Awareness Month

As we move forward from an impactful Mental Health Awareness Month this past May, it becomes an appropriate opportunity to discuss a crucial subject: the landscape of mental health credentialing, particularly mental health credentialing with insurance companies.

The Mental Health Awareness Month, since its inception in 1949, has carried the torch for discourse on mental health awareness, making laudable strides towards eradicating the ill-placed taboo associated with mental health. A noteworthy development that emerged from the 2019 Public Health Emergency (PHE) was the much-celebrated transition towards an outspoken acceptance of professional services for mental and emotional health. Still, despite significant progress in equating mental health with physical health, the journey has only just begun.

With over a million mental health professionals currently practicing in the U.S, the demand for mental health services shows an upward trajectory. This urgent need is starkly evident in rural areas, where an estimated 160 million Americans are facing a shortage of mental health care providers. A critical factor contributing to this shortage is the low reimbursement rates from payer networks, a problem faced when handling mental health insurance credentialing services that include Medicare, Medicaid, and private commercial plans.

Continuing Struggles & Achievements
in Mental Health Support

Attempts to ameliorate access to mental health have included the 2008 Mental Health Parity & Addiction Equity Act, which mandates the equitable treatment and reimbursement of mental health services akin to other medical coverages. The Affordable Care Act, expanding coverage to an estimated 30 million in 2016 and subsequent permission to providers to offer medical and mental health services via telehealth during the 2019 crisis, are considerable strides forward. Starting on January 1, 2024, the Center for Medicare and Medicaid Services (CMS) has allowed licensed mental health counselors and marriage and family therapists to enroll as Medicare Part B providers. The Commonwealth Fund reported in May 2020 that the number of U.S adults receiving mental health diagnoses was higher than in other high-income countries, with a predicted rise in the need for psychiatry by 25% from 2018 to 2025, as per a study by the University of Michigan.

Credentialing and Mental Health:
A Required Focus

With these evolving changes aimed at improving access, credentialing and enrollment professionals need a focused strategy, and the role of mental health insurance credentialing services has become more critical.

Firstly, it is essential to understand licensing requirements and practice guidelines for all mental health specialties in the prospective regions of service. This understanding determines the necessary amendments to the relevant policies & procedures (P&P) and ByLaws for compliance.

Secondly, the requirement of a credentialing or a human resource (HR) process for the onboarding of these providers within the organization must be established – varying levels of practice within the mental health sphere will dictate this need. Credentialing professionals need to work in tandem with payer enrollment specialists to ensure insights on government and private health care coverage network requirements for provider participation are effectively addressed during the mental health credentialing process.

Moreover, the successful and efficient onboarding and in-network enrollment of mental health practitioners relies on comprehensive data points and documentation, ranging from professional demographic information, license, academic records, National Provider Identifier (NPI), references, insurance details, to personal demographic information.

Post-Credentialing and Reimbursement

Finally, it is onus on the network to ensure that the Current Procedural Terminology (CPT) codes or Healthcare Common Procedure Coding System (HCPCS) are included in the confirmed participation agreement. This inclusion ensures successful reimbursement for services rendered by mental health providers, contributing to a healthy revenue cycle.

As mental health figures continue to rise, it is clear that the ongoing importance of mental health credentialing will be centered stage in the healthcare industry’s agenda in ensuring the correct steps are made to provide mental health services effectively and efficiently.

Onus on the network— inclusion that ensures successful reimbursement for services rendered by mental health providers.

Sources