The demand for behavioral health services is on the rise as the stigma surrounding mental health fades, mental health awareness rises, and coverage for mental healthcare expands. According to a report by Mental Health America, over 50 million adults live with a mental illness. Unfortunately, the ratio of individuals to mental health providers is 350:1. This underscores the vital role behavioral health practices play in supporting individuals through their most challenging times.
But let’s face it — running a practice isn’t just about patient care. A mountain of administrative tasks follows that can take you away from what you do best.
One of the biggest headaches is billing. Although it’s pivotal in keeping your practice afloat, it's often riddled with challenges that can slow down revenue growth.
Staying on top of ever-changing regulations and managing denials can be overwhelming. However, with a well-crafted revenue growth strategy in behavioral health billing, you can easily navigate the maze of insurance claims. Let's explore best practices to optimize your billing processes, improve cash flow, and elevate your practice revenue.
Behavioral health services cover a broad spectrum of care, from depression, anxiety, ADHD, bipolar disorder, PTSD, and schizophrenia to treatments for substance use disorders, destructive behaviors, and eating disorders. The intricate nature of these services can often make billing challenging, leading to inefficient revenue capture and revenue leaks that threaten the financial sustainability of your practice, impede the delivery of quality care, and slow your growth.
A streamlined revenue cycle can enhance cash flow, reduce claim denials, and allow you to concentrate more on patient care rather than administrative hassles. Here are 10 strategies to boost your revenue cycle performance.
Comprehensive documentation is the backbone of efficient revenue capture. Precise documentation ensures you record every service provided, assessment conducted, and intervention delivered.
Payers often require detailed evidence to back up the care you’ve provided. Detailed records leave no room for discrepancies that could lead to claim denials or delays, ensuring the billed amount accurately reflects the care you’ve provided. For instance, if an insurance company questions a claim, your detailed documentation — from initial assessments to ongoing interventions — can quickly clear up any confusion, justifying the medical necessity.
One of the leading causes of claim denials stems from inconsistencies in insurance coverage. Shockingly, over 5.5 million adults with mental illness lack insurance, and one in ten youth covered by private insurance may not have benefits for mental or emotional care. Moreover, many patients are unaware of their coverage specifics.
Implementing a robust insurance verification process during appointment scheduling and again on the day of the visit clarifies financial responsibilities upfront (deductibles, copayment, and coinsurance), reducing misunderstandings and disputes. It also streamlines administrative workflows, reducing the burden on staff tasked with billing and collections.
In addition to verifying coverage, it's crucial to confirm pre-authorization requirements to prevent surprises and revenue losses. This proactive step minimizes the risk of denied claims, ensuring smoother financial transactions for patients and healthcare professionals.
Behavioral health services have unique coding requirements. Precise and accurate coding is imperative to secure full reimbursement for services delivered. Accurate CPT and HCPCS codes comprehensively capture the scope of services rendered, leading to improved cash flow.
On the other hand, errors in coding can significantly increase resource utilization due to the time-consuming appeals process and reduce the probability of full reimbursement.
Mental health billing is cumbersome and prone to errors. Nevertheless, leveraging advanced technology solutions can streamline your billing process and optimize revenue cycle management. Advanced technology can help automate many aspects of billing and coding, from initial documentation to claim scrubbing and submission, mitigating errors, and expediting claim submission.
Here are some advanced technology solutions that can make a difference:
CMS (Centers for Medicare & Medical Services) and AMA's (American Medical Association) ongoing initiatives in the behavioral health sector aim to broaden access to mental health services. The introduction of telehealth coverage and the extension of pandemic telehealth rules underscore the organization's commitment to enhancing accessibility and convenience for patients.
Staying updated on evolving healthcare laws, payer policies, and coding standards ensures compliance and avoids denials. Non-compliance can lead to claim denials, fines, and other significant financial penalties that can impact your practice's viability and reputation.
In addition, regularly reviewing and updating practice policies and procedures ensures you mitigate compliance risks and align with the regulatory requirements, enhancing overall operational efficiency and patient satisfaction.
Patient collections and no-shows often stem from a lack of communication about your practice guidelines. Every practice is unique, and patients must understand what to expect when they visit you.
Establishing clear and consistent policies is imperative. Here are key questions to address for effective communication:
In 2023, providers wrote off $17.4 billion in bad debt, with insured patients contributing to 53% of this figure. Upfront payment collection helps minimize write-offs, and the best way to secure these payments is by offering diverse payment options.
Recent payment trends show that 75% of customers prefer digital and electronic methods, including e-statements. It's time to capitalize on this trend and enhance patient engagement digitally.
Here are ways to encourage prompt payments:
Telehealth has become an integral part of behavioral health services. In Q3 2023, telehealth utilization for mental health was highest among other specialties at 37%.
Telehealth services are an efficient strategy to improve revenue generation. It allows you to prioritize appointments, maximize productivity, and care for more patients while alleviating the burden. However, use appropriate codes and modifiers to secure reimbursements while billing for telehealth visits. Additionally, check for adherence to payer policies and regulatory rules to minimize the risk of denials.
Provide continuous education and training for your entire staff — from clinicians to billing specialists and administrative personnel. Keep them updated on the latest billing practices, coding updates, and regulatory changes. Motivate them to participate in workshops and seminars on behavioral health billing. Identify knowledge gaps and provide targeted training. Well-trained staff can significantly reduce errors, improve the efficiency of your revenue cycle, and ensure compliance with industry standards.
Denials are inevitable, but how you resolve them can make a significant difference. Claim denials can significantly impact cash flow and increase administrative burden. Implementing robust denial management procedures helps identify, address, and prevent denials, ensuring smoother operations and improved financial health.
Here are key steps for effective denial management:
Behavioral health billing practices are unique, and most generalized practice management software may lack the functionality to customize them accordingly. Glenwood offers templates tailored to behavioral health services, which are customizable to your practice needs. Our practice management software — GlaceEMR, GlaceRCM, and GlaceScribe — alleviates the administrative burden and aims for more than 99% collection. Let's partner and streamline your billing process and boost revenue growth.
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