Over the past two decades, utilization of behavioral health services has exponentially increased, due to the expansion of insurance coverage for mental health care starting in 2008 and a shrinking stigma against those seeking help for mental illness.1 With one in five U.S. adults suffering from a mental health disorder, and over 47% of those adults seeking treatment, behavioral health providers can expect to see a year-over-year increase in their caseload.2 However, new opportunities bring new challenges — especially in the billing office.
Behavioral Health Insurance Coverage: A Double-Edged Sword
Historically, behavioral health billing was relatively simple, with cash-only practices as the norm. Now, health plans are required to provide behavioral health coverage to make these services more affordable and accessible to their members. Despite the new stream of patients made available by insurance coverage, working within the confines of health plans can quickly dampen the financial benefits for large behavioral health practices and medical service organizations (MSOs). For many billing teams, managing the behavioral health revenue cycle is a new terrain, rife with opportunities for billing errors and claims processing bottlenecks as the industry transitions to an insurance-based payment framework.
Three Keys to Unlocking an Efficient and Profitable Revenue Cycle
Behavioral health revenue cycle management (RCM) encompasses every step from gathering patient information during the scheduling process to collecting payment for services rendered. However, moving just one claim through the revenue cycle is easier said than done, especially for large, multi-provider practices and MSOs. To set your revenue cycle up for success, follow these three steps:
- Take a proactive approach to billing. From shifts in coding guidelines to variable payer requirements, the behavioral health billing landscape will continue to evolve to accommodate the unique needs of the specialty. Getting ahead in each step of the revenue cycle is vital to avoiding the potential cash flow disruptions from these changes. To ensure a smooth billing and payment process, stay ahead of:
- Verifying insurance eligibility
- Estimating patient financial responsibility
- Coding updates and billing guidelines
- Claim review and submission
- Denial management and resubmission
- AR follow-ups with patients and payers
- Leverage business intelligence. Even with the right staff and workflows in place, every large practice or MSO will inevitably have gaps in their billing processes without revenue cycle analytics. Business intelligence provides the level of insight that a practice needs to accurately and comprehensively evaluate financial performance to determine which step in the revenue cycle is falling behind. Before revenue leakage touches the bottom line, business intelligence tools automatically identify gaps and outline targeted strategies to correct the underlying problems. By combing through past trends and forecasting future growth and practice needs, business intelligence analytics can help practices and MSOs optimize their resources to capitalize on revenue-driving opportunities and build a more resilient revenue cycle.
- Partner with behavioral health RCM experts. Specialized RCM workflows — especially for behavioral health — can be incredibly complex. Most billing teams struggle to capture all revenue and drive maximum reimbursements due to inevitable errors and inefficiencies throughout their revenue cycles. Working with a partner with extensive experience in behavioral health billing is the most important decision a practice or MSO can make. An experienced partner like Accurio ensures that every possible dollar is captured and collected, and, more importantly, reduces the burden on in-house staff and allows practices to dedicate more time, attention, and resources to providing the best possible patient care.
Accurio specializes in behavioral health billing, verification, and AR follow-up for multi-provider behavioral health practices and MSOs in need of a more efficient revenue cycle that can rapidly scale to new growth. Our business intelligence-powered approach provides the tools and insights necessary to eliminate errors and create end-to-end efficiencies, achieving an average 98% collection rate with less than a 6% cost to collect.. With Accurio on your side, your practice or MSO can overcome even the most complex billing hurdles to drive consistent, long-term business growth.
Sources
- The Mental Health Parity and Addiction Equity Act (MHPAEA). (2023, September 6). U.S. Centers for Medicare & Medicaid Services.
https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity - Mental Illness (March 2023). National Institute of Mental Health.
https://www.nimh.nih.gov/health/statistics/mental-illness
