How to Improve Collections and Reduce A/R in Behavioral Healthcare
Just like in any business, ensuring a smooth accounts receivable process with minimal late collections can improve the financial health of your behavioral healthcare facility.
To ensure that your center stays on top of your billing and revenue management, you’ll need to have either a dedicated team of medical billers or an outsourced third-party billing service that you can trust. Whether your team is in-house or contracted, you’ll want to have mechanisms in place that ensure streamlined collections.
The key to setting up strategic collections processes is understanding your center’s revenue and billing procedures. You will also need to ensure that your billing team is familiar with the insurance providers that you accept as well as their reimbursement policies.
Ensure that Your Intake Processes Are Standardized
Whenever you accept a new patient, it’s important to make sure you collect all of the relevant data needed from them to ensure accurate billing. This data includes personal information, such as their name, address, and phone number, as well as their insurance details.
If the treatment that your patient is seeking will be lengthy, it’s important to get pre-authorization for their stay prior to admitting them for care. In some cases, insurance providers will require pre-authorization for any behavioral health services, whether they are inpatient or outpatient.
Following a standardized intake process helps ensure that your medical billing team has the correct information that they need before submitting a claim.
Collect Deductibles Upfront
Most health insurance policies require their subscribers to meet certain deductibles or make copayments before they reimburse further claims. If possible, at the beginning of the intake process or prior to admission, attempt to collect any copayments upfront.
You can contact the insurance company to determine how much of the deductible has been met so far. This is especially important for high-deductible plans.
In some cases, the deductible to be paid by the patient can be several thousand dollars before an insurer begins to pay for treatment. Depending on your facility’s policies, collecting a portion of the deductible upfront can be helpful in reducing the risk of nonpayment.
Make Sure Physicians and Caregivers Take Accurate Notes
Any time a service is provided to a patient, accurate notes must be taken by the care providers. These notes should indicate the treatment provided, the length of time taken, and the results of any lab tests.
They should also indicate the date and time that services were given. Anything of relevance to the patient’s condition should be included within all client records. This information will help the medical billing team determine the appropriate billing codes to use to avoid the potential for mistakes.
All patient records should be stored electronically and on paper for future use when submitting claims.
Since physicians commonly have hundreds of patients, it can be difficult to remember the patient’s conditions and services performed, especially as time goes by. Having records available ensures that they can be referenced when submitting a claim.
Use Software Designed for Behavioral Health to Manage the Revenue Cycle
Revenue cycle management software specifically designed for behavioral health, such as that offered by Sunwave Health, can help ensure all aspects of the client management and billing cycle processes are handled properly.
The system offered by Sunwave Health has a built-in medical billing feature that is designed to ensure clean claims, reducing the level of manual effort required to correct mistakes.
This software can save a lot of time for your billing team and help your facility collect payments through quicker processes. Sunwave offers a free demo for behavioral health providers who are interested in improving their revenue management procedures.
Utilize Online Patient Portals for Payment
These days, most payments are made online or in person. There are fewer individuals who are likely to send a check in the mail for treatment services.
Having an online portal that patients can review after they have received treatment can expedite the payment process. They will be able to make any payments on outstanding balances due directly through their portal, rather than needing to write out a check or send an outstanding balance via snail mail.
Online portals can also be used for records management. This management is important when a patient needs to provide their primary care physician with details of their visit or needs a new prescription for their pharmacy. Portals can also be helpful for scheduling future appointments or services.
Know the Claim Rules for All Insurance Providers that Your Facility Accepts
Claim rules vary across insurance providers. Some providers may allow claims to be submitted for long periods of time after the initial treatment, while others may accept submissions for several months. You’ll want to make sure that your staff is aware of the billing protocols for all of the insurance companies that you collaborate with.
Your team should also know what documentation is required to substantiate a claim. If an insurance provider has a history of regularly denying claims, try to get to the root of the issue. If denials are a result of missing or incomplete information that the provider requires, ensure all billing team members are aware of what is needed.
Follow CMS Guidelines for Billing
Submissions for behavioral health services are unique in that there are many CPT and Revenue codes that must be considered when submitting a claim. These codes can vary based on just slight differences.
For example, there are two very similar CPT codes that are used to distinguish a 15-minute therapy session from a 30-minute session. Using the wrong CPT code can lead to delays in your billing collections. This conflict is different from more straightforward medical procedures such as an MRI, which has only one CPT code.
CPT codes are regularly updated by the AMA each year. Once revisions are made, it’s important for the medical billing team to be aware of changes. Using an older or invalid CPT code can result in claim denial. Your team will then need to follow up on the cause of the denial and resubmit the claim, leading to slower revenue collections.
Keep Track of Your Billing Metrics and KPIs
There are a variety of metrics that can be used to track the efficiency of a behavioral health facility. These metrics can be the first indicators of problems with medical billing, issues with claim submission policies, or mistakes in the intake process.
Using a dedicated revenue cycle management system can provide you with the KPIs you need to make strategic adjustments to your revenue cycle before problems hinder your collections process.
Popular KPIs used specifically for behavioral health include clean claim rates, denial tracking, and bill charge lag times. Each of these measurements is quantifiable, which means they are derived from data related to the billing process.
The collections process for any behavioral health facility should be continually assessed to ensure that it is operating proficiently.
Ensuring that all employees who have a part in the patient revenue cycle abide by standardized procedures can help behavioral health facilities to collect receivables in a timely manner. If everyone operates as a team, you’ll likely encounter fewer problems with accounts receivable and bad debts.
Follow up on outstanding invoices is essential. Make sure your collections team has visibility and access to the claims they need to constantly and consistently collect outstanding balances to lower your outstanding aging and increase revenue.