Behavioral Health Revenue Cycle Management
Behavioral health encompasses more than just psychiatric visits or time spent with a counselor. From substance abuse and addiction treatment to eating disorders, a dedicated team of experts is required to maintain robust revenue cycle management (RCM) for a behavioral health facility. Poor revenue cycle management is not uncommon in behavioral health, but creating efficient processes with a dedicated team of RCM experts can move a facility in the right direction.
What Is Revenue Cycle Management (RCM) for Behavioral Health Organizations?
Behavioral health revenue cycle management begins with the same process that medical facilities engage in – registration and verifying benefits and eligibility. The rest of the process is essentially the same as medical RCM, but some of the steps may be repeated if coding, billing, and claim submission result in denied claims.
Behavioral health traditionally relied on patients paying out of pocket for services, as third-party insurance companies offered little, if any, coverage, but that has changed over a period of decades of parity between medical and behavioral health services. Private and larger behavioral health facilities accepting third-party insurance plans now have the ability to develop a heartier foundation of revenue.
The following are the essential components of RCM for behavioral health organizations:
- Pre-registration (when scheduling an appointment) and registration (checking in) – must be complete to ensure all patient information is obtained
- Verification of benefits and eligibility at time of service – determine if coverage is active and what each plan covers
- Review collection and financial policies for the patient
- Accurate charge capture – requires a full understanding of all behavioral health services CPT and diagnosis codes
- Claims submission – creating the piece that generates the reimbursement for the facility
- Resubmission of any denied claims
- Utilization review – claims assessment to ensure codes are applied accurately
- Remittance – receipt of reimbursement for services rendered
Revenue cycle management for behavioral health relies on a strong focus on the typical process followed for medical billing and coding. But to maximize reimbursement and a fully robust RCM, a foundational knowledge of behavioral health codes is critical, as the guidelines for coding are significantly more complex.
Challenges and Considerations When It Comes to Behavioral Health Revenue Cycle Management
Revenue cycle management for behavioral health organizations can be tricky. The challenges experienced by in-house billing teams range from time demands to inaccurate coding:
- Complex patients requiring additional specialty services
- Manual claims processing and RCM
- Increased days in accounts receivable
- Demands of billing staff to address other administrative tasks, causing stress and lack of efficiency and time management
- Inaccurate coding for specialized services, such as inpatient rehabilitation, eating disorders, or substance abuse
- Insufficient financial policies resulting in lower collection rates and compliance
- Lower patient satisfaction due to higher rates of billing or coding errors
Reimbursement for behavioral health and substance abuse treatment is not as black and white as it is for traditional medical concerns, such as an appendectomy or infection treatment. Insurance companies may not deem mental health concerns medically necessary.
These challenges can present significant roadblocks to creating a fully-functioning RCM, but you don’t have to be a magician to accomplish what may seem daunting. Considering the challenges behavioral health specialists face with the vast range of conditions and complex cases, facilities should consider outsourcing not only billing and coding services but complete RCM to ensure that reimbursement is maximized.
How We Can Help With RCM Services
RCM services for behavioral health must stretch beyond simple coding and billing. By outsourcing your revenue cycle management, you can adopt a new lease on your facility’s revenue health. In addition to taking over your organization’s RCM, you can see a significant improvement in your overall profit. RCM for behavioral health is not unlike that of medical facilities. However, the complexities of behavioral health billing processes demand a high level of understanding of its complicated nuances. Outsourcing could be the answer to your RCM challenges.
Outsourcing Behavioral Health RCM
When your team is focused on patient care, you will understand why outsourcing could be the answer to the challenges you face with behavioral health RCM.
An outsourced team can focus on key performance indicators (KPIs), such as:
- Aging accounts receivable
- Denial rate tracking
- Lag times between services and billed charges
These KPIs measure how each challenge affects the outcomes of your RCM. Outsourcing your RCM not only focuses on billing, coding, and reimbursement. Measuring your facility’s success falls into the hands of your own team of experts so you can create success with your patients. Additionally, outsourcing can provide you with the data you need with comprehensive reports to analyze where you can make improvements in your documentation processes, which increases accuracy with coding and billing.
Why Partner with Coronis Health for Behavioral Health Revenue Cycle Management?
Coronis Health has a reputation for providing world-class services for medical billing and revenue cycle management. If your behavioral health organization faces challenges that prevent it from reaching optimum levels of reimbursement and overall RCM health, contact us today to schedule a free financial checkup. Revenue cycle management for behavioral health deserves the attention of our experts so you can give your attention to what matters the most – your patients.