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The Top 5 Ways to Maximize Revenue Cycle Management in Behavioral Health (2021)

4 Minute Read

Many behavioral health clinics are looking to tighten their revenue management cycles as a way to bolster cash flow while at the same time creating cleaner accountability.

Streamlining billing and accounts receivable will make your practice more competitive, free up resources, and support your growth plans.

Many practices are surprised to learn just how frequently common errors cause revenue losses due to slow or stagnant reimbursements.

The complexities, inherent in billing and reimbursement, for behavioral health agencies often mean that collecting receivables quickly and efficiently requires a fully staffed operation.

If you feel that the pace of demand in this area is too fast for your practice to keep up with, it may be time to look into a third-party billing platform. Don’t be intimidated by that prospect. It has never been easier to streamline revenue management using systems that benefit both practice and patients. Why? Because the software helps you manage all the information seamlessly and automatically.

Take a look at the following emerging trends for practices looking to get faster payment turnaround while creating smoother, clearer communication regarding reimbursements with patients.

A Full Picture for Revenue Cycle Management

The best revenue-management program is an integrated one. That means marrying the clinical side with the billing side to reduce miscommunications, errors, and oversights. However, practice managers and owners often operate on the misconception when revenue-cycle management is all about billing.

Better Overall Practice Management

A strong strategy builds up your future patient’s billing profile before a patient ever visits a facility. Following the first contact with a patient, it’s time to discover and document all of the benefits for mental health, substance and abuse and applicable services that can be referenced during billing. This will then usher the patient profile into a path of pristine records and notes regarding care plans. It’s also important to keep all records synchronized with billing history, claims submission, payment tracing and overpaid/underpaid claims management.

Efficient Revenue Cycle Management

Many practices are stuck in a cycle of allowing claim rejections to push outstanding payments far past the industry standard of 45 days. In some cases, rejections are left to be “battled out” in perpetuity because simple errors are not identified. Needless to say, this isn’t the easiest or most efficient way of doing things.

Here are your essentials for creating smooth billing blueprints that reduce rejections:

  • Procedures that ensure claims are being routed to the right payers. As you may know, health services and mental health services are often sent to different payers. Incorrectly submitting a claim to the wrong payer means that claim will remain outstanding until your office discovers the error.
  • Preventing the scheduling of appointments with providers who aren’t credentialed to bill the patient’s insurance.
  • Knowing the payer-specific rules for data requirements like policy number, authorization number, diagnosis, and patient date of birth.
  • Integration of clinical workflows and billing workflows to eliminate double entries and redundancies that could trigger claim rejections.
  • Designations for place-of-service billing for telehealth, school, community and in-office visits.
  • Designations for services to ensure that clinicians are billing properly for services under their own NPI or supervising NPI.
  • Modifier rules with or without fee adjustment.
  • Designations for routing claims to the right payers.
  • Designations for fee schedules.

Using a system designed to identify and rectify errors with little disruption to the complete billing cycle should be the goal. The easiest and most cost-effective way for most offices to achieve this is through a third-party vendor. However, there is always the worry that you will lose the ability to peek in on the status of rejected or “anomalistic” bills. This is why it’s essential to select a vendor that provides you with on-demand reporting features for viewing billing statuses, such as ClinicTracker. Additionally, ClinicTracker handles most of the above tasks automatically, which reduces the likelihood of denied claims.

At the heart of managing an automated workflow with a faster turnaround are claims generations and submissions. It is crucial that your billing structure is also capable of handling waterfall billing, statement processing and resubmission of rejected claims. All of these elements working in tandem create a failsafe approach that prevents unpaid bills from slipping through the cracks due to bad data management. Yes, there is beauty in automated functions for billing. However, the picture is not complete without an accompanying accounting strategy that is equally as focused on catching and correcting errors, bottlenecks and redundancies.

Automated Insurance Eligibility Verification

Integrating coverage authentication and eligibility checks with your intake form, cut significant time from your billing workflow. Using an automated procedure, staff can confirm insurance validity instantly. In addition, an integrated system should allow you to verify eligibility for all appointments that are booked during specific chunks of time. This makes following up with patients a very easy process if there are questions on coverage. Within this same portal exists a record of plan information that allows staff to access information regarding coverage, deductibles and more. Ultimately, staff are more prepared to help clients work out payment solutions before charges are incurred. It is also an important tool that can also be expanded to help your service to walk-in patients or last-minute bookings.

There are a few ways that ClinicTracker goes beyond most EHR systems in automating insurance eligibility and thus reducing denied claims. ClinicTracker:

  • Allows for multiple active authorizations.
  • Auto-links claims.
  • Keeps track of used/remaining sessions.
  • Configures master packages to prefill authorization information when payers send back standard authorization units.
  • Tracks how many initial sessions remain before an authorization is needed.
  • Sending helpful reminders to the clinician to remind them to obtain authorization before the initial sessions run out.

Better Accounting Strategies

When updating billing practices, it is important to see where the numbers fall in terms of the bigger picture. That is why it is recommended that behavioral health practices take measures to identify revenue streams, examine allocations, create project budgets, track funds and manage payables using an integrated accounting platform. This is especially important for practices that are trying to move into growth spaces by attracting new clients and expanding client-retention initiatives. Our accounting system uses your own data to help you define and reach objectives using a cloud-base system that pulls from your newly integrated revenue management platform. This means you can base projections on the actual numbers coming through your practice instead of guesses based on nothing other than annual revenue and expenditures. This approach moves your revenue management plan from being reactionary to being predictive and reactive.

Smart Revenue Management Cycle Procedures

For practice owners and clinicians, the time of office staff is valuable.

One of the perks of good revenue management is that staff members can focus on the human side of running a practice instead of being bogged down by antiquated, piecemeal billing systems.

A streamlined revenue management cycle births a better client experience because staff can easily review transactions to provide over-the-phone and in-person billing support to clients. They will also have time to go over benefits and billing with clients throughout the care process with a better understanding of the overall reimbursement picture. On the reporting end, practice owners can easily drill down on transactions contained within balance sheets and records to verify accuracy.

If you’re ready to upgrade to an automated revenue management platform, ClinicTracker can help your practice reduce overhead costs while increasing reimbursements. Using seamless data transfers between our BillingTracker system and your practice’s general ledger, you can reduce your current billing cycle by days while reducing time spent managing claim reimbursements and billing.

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