The pressure and frustration of navigating complicated insurance rules, constantly changing regulations, and claims requirements can make your revenue cycle tough to manage. Even when you sink plenty of time and labor into billing, errors happen. And, when they do, they can impact your facility’s bottom line, patient care, and compliance. Revenue cycle management software designed for behavioral health providers can give you all the tools you need in one place, keeping you more efficient and compliant.
3 of the most common billing errors
Incorrect coding
There are all kinds of coding mistakes your team can make. Nearly every action in behavioral health treatment needs to be coded and evaluated, though, so it’s not surprising. For example, you might run into issues with:
- E/M vs. psychotherapy codes
- Rounding up session time
- Crisis codes
- Medical necessity documentation
- Prolonged service codes
Incorrect codes result in rejections, which keep you from getting reimbursed. They can also cause your payment cycles to extend and even put you at risk of penalties and audits.
Missed authorizations
Some of your patients may have pre-authorization requirements on all or some parts of their treatment. Failing to acquire pre-authorization before you render treatment could mean you don’t get reimbursed. Missed reimbursements can lead to extended pay cycles and revenue loss.
Every insurance plan will have its own unique pre-authorization requirements. Trying to review them all manually as your patients enter and move through the treatment process will mean inevitably missing some.
Improper claim formatting
Even simple formatting issues can stand in the way of reimbursements. Missing patient information, incorrect dates, and improperly formatted claims can trigger automatic rejections. Not only do rejections affect your bottom line, they also cause more work for your billing and reimbursement teams, making the effect on your bottom line even more pronounced.
Consequences of billing errors
Cashflow is directly reliant on clean claims. Billing errors cause delayed reimbursements and even outright denials, making your revenue cycle unpredictable and billing forecasting cloudy in its own right. When you’re unable to get a clear picture of your finances, you can’t invest in resources or improvements that directly impact patient care.
But inaccuracies can also be compliance risks. Regulatory audits require billing accuracy and adherence to standards. Errors, especially when persistent, can trigger audits, which can turn up substantial fined, corrective actions (that cost you time and labor), and increased oversight.
On top of cashflow and compliance issues, billing errors can tank your reputation. Making the billing process complicated and/or unreliable for your patients, referring partners, and payors quickly ruins their trust in your ability to operate and put your sustainability as a business on the line.
Sunwave helps prevent errors
So much of the potential for billing errors comes down to manual input. There’s no need for your team to be pulling data from one system to another and trying to match everything up. Sunwave automates what needs to be, allowing your team to shine in the more demanding areas of revenue cycle management.
- Seamless automation: The Sunwave platform brings CRM, EMR, and RCM all together allowing for seamless automation. No more manually transcribing notes and codes from one module to another, giving your team to space to do the things they’re great at.
- Real-time checks: Instant insurance eligibility verification is easy with Sunwave. When you verify coverage before treatment, you can get accurate pre-authorizations, so you get more clean claims from the start.
- Claim scrubbing: Our robust validation engine scrutinizes claims before they’re submitted, identifying and correcting coding and formatting issues. Clean, compliant claims with less work from your team means better satisfaction, faster payments, tight revenue cycles, and better predictability.
- Reporting: Detailed reporting gives you oversight over everything you need. You choose the variables you need to track, Sunwave will give you smart data that translates into quick fixes if needed.
It’s time to make the switch to a better platform. Call 561.576.6037 or schedule a demo online to see how Sunwave Health can transform your operation.
