Services offered by mental health providers in Georgia include evaluations, therapy, behavioral health evaluations and counseling, as well as continued treatment. Though patient care is the top priority, generating a patient-centric, sustainable practice also demands an efficient revenue cycle.
Revenue cycle management (RCM) encompasses the revenue generation lifecycle from patient registration and insurance verification to claim submission, reimbursement and patient collections. Failure to properly make the smallest of changes at any point can result in lost revenue, payment delay or claim denials. Implementing consistent billing practices, tracking claims and implementing consistent administrative processes can add to a mental health practice’s bottom line.
Understand the Mental Health Revenue Cycle
The first step in revenue cycle management improvement is to understand each step of the revenue cycle. Staff should take accurate demographic and insurance information prior to an appointment. Check eligibility and benefits, find out if behavioral health services are covered, if authorization and/or referral is required.
Following the visit, providers are required to make an accurate record of services. This documentation is then used by the billing staff to choose a diagnosis and procedure code to submit claims to the insurance companies.
Claim coding isn’t the end of the process. Practices need to be aware of the status of claims, paying them accurately, chasing up unpaid claims, dealing with claim denials, and collecting the patient’s responsibility. Standardized procedures for such activities can help ensure that claims are not overlooked, and can help ensure a consistent revenue stream.
Consider Specialized Mental Health Billing Support
There are some billing requirements that can vary from other health care specialties with behavioral health. Collaborating with a Mental Health Billing Company in Georgia can enable practices to set up more organized methods for verifying eligibility, claim submission, claim denials, payment posting and follow up on accounts receivable.
Billing support can be helpful for mental health claims, which may include restrictions on services, authorization, telehealth policies, and/or payer-specific documentation policies. With a bit of knowledge, you can avoid unnecessary mistakes when claiming.
All practices that will be using external billing support should stay on top of their financial reports and billing performance in their practice regularly. Administrative tasks handed over to third parties do not mean that there is no need for supervision. Rather, practices should ensure that they have access to their collections, denials, outstanding claims and reimbursement trends.
Verify Insurance Before Every Appointment
One of the best methods to avoid revenue cycle issues is to verify insurance. Coverage can vary from appointment to appointment, even in the case of a patient receiving care from the same doctor for months.
Staff to verify active coverage, behavioral health benefits, deductibles, copayments, coinsurance and authorization requirements. If possible, this information should be looked at prior to the appointment.
Verification also increases patient communications. By letting patients know upfront what their out-of-pocket costs might be, they will be less likely to be surprised by bills later in the day. This can help to lessen payment disagreements and enhance collections.
Improve Clinical Documentation and Coding
Good documentation is essential to a successful mental health bill. Medical record must clearly substantiate the service rendered, Service Time (if applicable), Patient Condition, and other information needed to properly code the service.
Providers should ensure that notes are not left to build up and are completed in a timely fashion. Failing to complete the documentation or it being delayed may delay claims and result in claims becoming inaccurate.
Programming should also be in accordance with services offered. Practices should follow the most up-to-date CPT and ICD-10-CM guidelines and ensure the proper use of modifiers as they are needed. Education regarding coding requirements can be provided to the clinical and billing team regularly to ensure they are aware of changing requirements.
Submit Clean Claims Promptly
A clean claim has all information needed for a claim to be paid without further inquiries or corrections being made. The higher the percentage of clean claims the faster the reimbursement.
Claims submitted should be reviewed prior to submission for erroneous patient data, insurance information, missing modifiers, codes, authorization issues, and missing provider data.
It’s also crucial to submit the application on time. Insurance companies set deadlines for insurance claims to be filed and claims that come in after the deadlines are passed can be rejected. Having a set time frame for claim submission will help prevent practices from incurring unnecessary delays and lost reimbursement.
Develop an Effective Denial Management Process
Claim denials make it to the news in even well-managed practices. The critical distinction is in their response to the denials and how fast and effective the response is.
All claims that are denied should be classified by the reason they are denied. Issues can range from eligibility issues, to missing authorization, coding problems, duplicate submissions, documentation problems, or a late filing.
Practices to look for are not just to correct individual claims, but also to find the common patterns. If the same reason for denial occurs often there could be a potential workflow issue that needs to be addressed.
A well-designed denial management process would involve the following: setting up responsibility, setting up follow up deadlines, documenting the actions and tracking the process of appeal outcomes.
Monitor Accounts Receivable
Accounts Receivable (A/R) is the amount of money that the practice is owed for services rendered. If claims and/or patient balances are not paid for a longer period of time, it may be harder to collect.
A/R ageing practices ought to regularly review A/R ageing reports and divide the balances into categories like 0–30, 31–60, 61–90, 91–120, and in excess of 120 days.
The ones that are older should be given special attention. Staff should identify if the payment is delayed due to a problem with payer processing, information missing, payment was denied, incorrect posting, and/or lack of follow-up.
Practices can better uncover revenue that may not be collected if they have regular A/R monitoring.
Strengthen Patient Payment Processes
Many mental health practices have a significant part of their revenue from patient responsibility. Patients may end up paying a higher out-of-pocket expenses with a high deductible insurance plan.
Practices should have clear and open financial policies and make these policies known. Patients should be aware of copayments, deductibles, how they will be paying for their treatment, cancellation procedures, and payment options.
Holding known copays when they are rendered can help to decrease delinquent copayments. Statements will also be timely, easily understood and accurate.
Good communication can lead to a better financial experience and eliminate confusion for patient and administrators alike.
Track Revenue Cycle Performance
You can’t improve anything that you don’t measure. By monitoring the key performance indicators, it will be possible to gauge the effectiveness of billing processes.
Examples of metrics that can be useful are days in A/R, clean claim rate, claim submission time, collection rate, percentage of balances over 90 days, reimbursement trends and denial rate.
It is important to be checking these numbers on a regular basis – not just when cash flow is an issue. For instance, if there are more denials than ever before, this could be due to a payer policy change or coding issue within the payer’s system.
Performance data helps to inform practice leaders in making decisions and prioritizing improvement efforts to where they will have the most impact.
Frequently Asked Questions
What are the benefits of revenue cycle management (RCM) for mental health clinics?
Effective RCM leads to timely payment of practices for the services they provide, minimizes claim delays, controls outstanding balances and ensures practices a predictable cash flow.
Which of the following is a common cause of denials of mental health claims?
Common issues include errors in patient information, coverage status, claims not covered because of missing authorization, coding problems, lack of documentation, duplicate claims, missed deadlines for filing claims, etc.
What are some ways that mental health practices can avoid billing mistakes?
Practices can check insurance coverage prior to visits, enhance documentation by providers, audit claims prior to submission, offer provider coding education, and track denial trends.
So which revenue cycle metrics should practices track?
Denial rates, clean claim rates, days in accounts receivable, collection rates, outstanding balances and reimbursement trends are all important metrics to track.
Is better patient communication a key to collections?
Yes. Providing those benefits and clarifying the estimate of monetary liability, insurance policies and outstanding balance in an easy-to-understand manner may help eliminate confusion and motivate prompt payments.
Conclusion
The goal of optimizing revenue cycle management is to look at all of the revenue cycles surrounding patient care. Georgia mental health practices can bolster their finances by confirming insurance, keeping records up-to-date, ensuring timely claims are submitted, resolving claims quickly, and managing accounts receivable.
Performance data also should be utilized to uncover issues that are occurring over and over rather than taken on an individual basis. When these are paired with clear patient financial communication and the seamless administration process, they can produce a more robust, and more predictable revenue cycle.
A well-designed RCM program in the end will help maintain financial stability and enable mental health providers to focus more of their time and resources on delivering quality behavioral healthcare.
