Important Steps of Behavioral Health Revenue Cycle Management
RCM holds a particular value in any healthcare practice’s operations. And it’s of even more importance for centers providing services in behavioral health. This is because behavioral care procedures are more complex than other medical treatments. Each of its cases may vary drastically from others. Hence, their documentation, coding, and claim processing require specialized skills.
Now, there are two ways to handle behavioral health RCM. You can hire a dedicated billing staff to perform this operation in-house. Or, you can outsource it to a third-party company. Either way, you are going to need an expert team that stays committed to some predetermined steps.
In this blog, we are going to discuss the key steps of revenue cycle management in behavioral health. Let’s get started.
What is Behavioral Health RCM?
Revenue cycle management refers to a systematic process of collecting and managing revenue of a healthcare organization. Its processes are fundamentally the same for behavioral health and substance abuse centers. But they usually have an added layer of complexity due to the overall intricacy of this specialty.
It is worth mentioning here that behavioral health centers used to rely solely on patient collections a few years ago. No insurance companies would cover these services until recently. And as it happened, the RCM process for these treatments started needing specialized billing services.
Steps To Effectively Manage RCM For Behavioral Health Services
Creating Payment Policies
Setting up policies greatly streamlines the way you receive your payments. The main aspects to consider in this regard include:
- The type of payment to accept
- The amounts payable by the patient
- Situations and scenarios when there are non-payments
- Patient no-shows
Setting payment policies around these factors can help make the reimbursement processes more transparent.
Checking Benefits
It is essential to check the eligibility and insurance coverage of your patients before providing care. You can convey these findings to the patients. This will help them understand the amount they must pay themselves.
When entering patient information, be sure to check their insurance and credit card. Communicate these details along with the payment requirements to your patients.
Charge Capturing
This step involves entering the clinical service charges in a centralized system after the care has been provided. This is where you must have a complete understanding of factors that can lead to claim denials. Moreover, you must ensure that you have entered every single charge into the system to avoid underpayments.
Coding
Coding and charge capturing run simultaneously. This means that when you document the services rendered, you must match them with their ICD codes. This step is the most complex and poses a higher risk of claim rejections.
The best way to avoid coding errors is to first ensure that you use the latest codes. Then, make sure that you use the accurate codes against the services delivered.
Claim Submission
This step involves submitting a claim to the insurer. This is where you must perform an internal review of the claim. It will help you look into any errors that are left unchecked. This way, you will be able to avoid denials/rejections and their costly resubmission process.
You can perform a claim review manually, which can take significant time and effort. Alternatively, you can consider using a scrubber. It is a software application that scans a claim in a jiffy and points out all the errors and inconsistencies.
Adjudication
This process occurs at the payer’s end. They review the claim thoroughly for its adherence to the insurance policy. They also check whether the treatment provided was medically necessary.
Based on their finding, the payers accept or reject the claim. They share their review in the form of the Explanation of Benefits. It’s a document with details about whether the claim is reimbursable or not and why.
Collection
Once the claim has been accepted, you must issue a bill to the patient. This is because you will not get the payment from the insurer directly. The patient will pay you the bill once they get the reimbursement money from the insurer.
Reporting
A revenue cycle is a complex process to track. The best way to keep a check on it is to establish a reporting mechanism. This is where you must integrate electronic health records with the RCM software. This will allow you to have all the data automatically available to the system as soon as it is entered into the health record. The software will do the rest by using this data to generate interactive reports on your billing process.
Final Thoughts
Behavioral health RCM is a challenging process. The steps mentioned above can help you stay on the right course. Still, it can be hard to adhere to keeping everything in its place when you have a patient influx. This is where you can consider outsourcing this process to a third party.
At AltuMED, we offer comprehensive RCM solutions for all specialties, including behavioral health services. For details, contact us today
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