Behavioral health services include a wide range of services catered to the physical and mental well-being of individuals; that is why this is one of the challenging healthcare departments when it comes to billing. Behavioral health revenue cycle management services include a range of services created towards optimizing revenue generated, decreasing denials, and improving patient experience.
Why is behavioral health revenue cycle management service challenging?
The way insurance companies (primary payers, in most cases) handle behavioral health bills is slightly different from how they deal with other traditional practices. With other departments like cardiology or pulmonology, the billers and coders know exactly how patient notes must be decoded and converted into bills and the severity of treatment. In most cases, the services directly match the signs, symptoms, and patient history.
When it comes to revenue cycle management services for behavioral health, the experts always have to walk on thin ice. Billing depends on many factors, like the patient’s willingness to be treated, the length of each session, the frequency of follow-up, and the actual treatment plan. In many cases, behavioral health experts need to create custom treatment plans based on the current physical and mental state of the patient.
The treatment plans can drastically vary over time as it depends on the state of the patient and their willingness to be treated.
As a result, the payers may have many reasons to stall or deny payments, and it takes excellent revenue cycle management service providers to understand the struggle between the healthcare providers and the payers and act as a balance in between.
Until a decade ago, many insurance covers did not include behavioral health therapies and treatments, and as a result, these were out-of-pocket payments for the patients. It is only recently that behavioral health has been covered under medical insurance, and this means everyone in the industry is still learning and adapting to billing and reimbursing for this practice. This is yet another challenge.
Prior authorization is one of the common sections of any revenue cycle management service offering. With behavioral health, this becomes slightly more challenging. Let’s say a particular patient is eligible for three therapy sessions a quarter as per their insurance coverage. After the first session, the expert finds the need for more frequent sessions.
In this case, it would be the work of the revenue cycle management service expert to send a prior authorization request. The case must be compelling enough with data and proof that the patient needs more sessions to get better, so it can be approved.
Let’s say a patient is eligible for 60 minutes of therapy a day, and due to the intensity of the session, it always runs over by an extra 15 minutes. If the RCM expert decides to bill for the additional 15 minutes, assuming that would increase the revenues for their client, they would be facing denials instead.
This also requires a prior authorization request, and it is to be noted that such requests wouldn’t be approved unless completely necessary. Being an agent between the payer and the service provider, the team handling revenue cycle management services needs to identify this issue, discuss it with the client, and find a turnaround. Such denials increase the A/R time, which, in turn, reduces the cash flow to the client. Appealing such denials is also a waste of resources.
How can effective RCM services impact behavioral services?
Though very simple, these two processes lead to many avoidable denials in behavioral health practices. Effective revenue cycle management service processes will include well-defined, strategic, and proactive eligibility verification and prior authorization to help bring down denials.
Very small or budding behavioral health practices decide to do their own billing because it is cheaper to do so and reduces operational costs. This decision, however, backfires in many instances. There are health experts who get so involved and frustrated with billing discrepancies that they don’t get the time to get on to their core competencies – treating patients.
While physician burnout is already on the rise, when physicians take up challenging backend tasks, they may experience burnout much faster. Outsourcing revenue cycle management services would help physicians grow mentally and professionally.
Claims could get denied just because the biller didn’t stay updated on the latest terms and conditions of the payers.
For a department like behavioral health, where there are multiple sub-categories and different requirements for each, revenue cycle management service providers can help establish clear RCM procedures for each category, set up automation, and ensure bills are generated and sent on time.
Let’s say you have a denial rate of 10%. If this falls under the industry average, does that satisfy you? Think of how much more revenue you would make if your denial rate went down to 7%. Behavioral health practices can dramatically increase their revenues without having any new business and just by working on their denials management strategy.
Denial management is a part of revenue cycle management services. It involves streamlined processes to identify the root causes of top denials, eliminate the causes, audit the existing billing and coding processes, and create custom game plans to attack soft denials.
Do know that denial management is the core crux of a good RCM service. Only the best of experts get it right.
Did you know that Quintessence has a multi-step strategy to attack denials? From the root cause analysis to Continuous Process Improvement steps, we go step by step in identifying, understanding, and breaking down denials so they don’t eat into your revenues and efforts daily.
Not all service providers are adept at handling the RCM needs of behavioral health practices. Experience working for similar clients, understanding the fluctuations in payer requirements, and a never-ending zeal to improve client positioning and increase their revenues make the revenue cycle management service provider stand out.
Quintessence is not just any RCM service provider but an able partner to grow with as your practice progresses. Contact us to know how exactly our RCM efforts can help your business.
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