Behavioral health covers numerous treatment services for people who suffer from mental health conditions or addiction. Psychiatrists, psychologists, and other mental health specialists undergo extensive training to assess and diagnose complex conditions and implement plans of care. The distinct nuances of billing for behavioral health create variabilities that do not occur in the medical billing process. Maximizing revenue with behavioral health requires a clear understanding of this specialized billing process.
What Is Revenue Cycle Management (RCM) for Behavioral Health Organizations?
Behavioral health facilities, like other healthcare facilities, depend on a steady stream of revenue to function. Behavioral health revenue cycle management is similar to the typical revenue cycle management for medical billing, but it does require a foundational understanding of the intricacies of the specialized billing process.
From verifying eligibility to collecting payments, or coding and electronic claims processing to rejection appeals management, managing the revenue cycle is critical to ensure that physicians and other clinicians are reimbursed accurately and in a timely manner.
Behavioral billing has some significant differences and can be more complex than medical billing, including:
- Visit duration – Behavioral health visits are limited to a certain number of minutes, such as 30 minutes or 60 minutes. The coding for visit duration varies, which does not occur in medical billing.
- Visit limits – Insurance payers limit the number of visits in a month or year, so verifying eligibility is critical to ensure that limits are not exceeded.
- Multiple components – Behavioral health billing can incorporate two components – psychotherapy and psychiatric evaluation.
Experienced coders and billers have a firm grasp of these unique aspects of behavioral health billing by the payor and understand how each facet ties in with the complete revenue cycle. Managing the big picture of this special process requires a team of experts who can connect one workflow action to the next. Establishing a cohesive protocol from beginning to end sets the tone for the facility’s ability to maximize the essence of the behavioral health revenue cycle.
Challenges and Considerations When It Comes to Behavioral Health Revenue Cycle Management
Revenue cycle management for behavioral health does not need to burden a facility. The focus of any behavioral health organization is to provide effective and safe patient care, not stress about the process of revenue cycle management. There are, however, challenges that must be considered when engaging the workflow of coding and billing, understanding that they can be overcome.
- Verifying eligibility – This is a common error in many facilities. Best practices demand eligibility checks prior to a patient arriving for an appointment, or at least when they check in. Failure to capture a complete eligibility check may result in services rendered without coverage, inaccurate coding, or a denied claim. Often self-funded plans available from an employer carve out behavioral health coverage. You must call the benefits department to ask this specific question.
- Prior authorizations or referrals – Many insurance payers require authorization for services, or a referral from a primary care physician, prior to rendering treatment. Without a valid authorization or referral, claims may be rejected.
- Delayed payments – This could relate to multiple factors, from errors with coding or billing, or lack of adequate coverage or authorization at the time of service. There can be issues with credentialing if the facility profile is inaccurate or a provider is not linked to a contract. A facility’s revenue is negatively impacted if payments are unnecessarily delayed.
- Dynamic regulations – Change is constant in healthcare. This does not exclude behavioral health in terms of the regulatory requirements in place for coding and billing. Regulations are in a constant state of flux, so coders and billers must stay up to date on the latest changes to remain compliant.
- Claim denial management – All healthcare and behavioral health facilities have to manage denied claims, whether the denial relates to eligibility or coding errors. Regardless of the reason, a process for managing denials is essential. Many organizations have a small team of experts who are solely responsible for managing denied claims.
- Non-covered services – Behavioral health is a unique subspecialty in healthcare. Some services are not covered by insurance, requiring the patient to pay out of pocket. Claims can also be rejected, for instance, if psychotherapy services are delivered by an unlicensed provider.
These are challenges that may appear to be insurmountable to the novice coder or biller. An experienced team can analyze these challenges and develop a plan to tackle any of these challenges with reasonable resolutions.
How We Can Help With RCM Services
You have enough on your plate with the demands of delivering effective and safe patient care; your patients demand the best, and you strive to give your best. Take the worry of revenue cycle management off your shoulders and allow a team of experts to manage the flow. Revenue cycle management for behavioral health is about maximizing your efforts with a dedicated team, not taxing your existing team with extra tasks or the burden of complex responsibilities. Coronis Health offers a comprehensive suite of services, from credentialing to benefits verification, collection services to account management, and financial analysis to utilization review.
When you look at the full picture of how Coronis Health can guide your behavioral health facility to a higher level of revenue cycle management, the decision to outsource is easy.
Outsourcing Behavioral Health RCM
Outsourcing your behavioral health revenue cycle management does not mean you are relinquishing control – you just recognize that you can function better with a team that is dedicated to the success of your revenue cycle. Consider the following to determine if you should outsource your behavioral health coding, billing, and overall revenue cycle management:
- Coding, billing, and collections are overly burdensome to your administrative team.
- A higher rate of turnover creates more work and additional responsibilities for the coding and billing team.
- Challenges with retaining talented Utilization Review staff that have relationships with the care managers.
- Lack of knowledge related to behavioral health coding and billing, resulting in lower reimbursement.
- Decrease in resources for patients if providers are focused on revenue cycle management instead of patient care.
- Errors with, or incomplete insurance payer credentialing or enrollment.
- Consistent errors with eligibility verification, or complete lack of verification prior to rendering services.
- Not adhering to coding and billing standards, such as using inaccurate or outdated codes.
- Timely billing
Coronis Health can solve your problems and calm your worries. Outsourcing your behavioral health revenue cycle management is the next step in creating success for your facility. The first step is contacting Coronis Health for a free financial check-up.
Why Partner with Coronis Health for Behavioral Health Revenue Cycle Management?
The picture is quite clear – revenue cycle management for behavioral health organizations is a complex process, just as behavioral health is a unique and specialized service. Your patients deserve 100% of your time and expertise, so you should partner with a company that can offer you the same peace of mind with your facility’s financial health.
Coronis Health can kickstart your journey to revenue cycle management success by offering a one-on-one consultation with customized recommendations. We cater our services to meet your needs, but most of all, we cater to the success of your facility so you can focus on your patients.
Contact Coronis Health today and take action with your revenue cycle management. Schedule a free financial check-up, and learn how we can partner with you to improve your financial future.