Behavioral health professionals need to take care of several psychiatric issues like mental health and addiction disorders, pretty much all the time.
But because of the complexity of each issue, billing for it can be pretty hard.
So how can these professionals handle the billing process?
Well, many of them use a Revenue cycle management system for this.
What is Revenue Cycle Management?
It is the financial process that many healthcare providers use to manage the administrative and clinical functions related to claim processing, payment, and revenue generation.
It covers pretty much everything, from patient registration and insurance verification to coding, billing, and payment collection.
The main goal of RCM is to take care of all the financial outcomes and make sure that healthcare professionals get paid for all the services that they provide.
Understanding Behavioral Health Revenue Cycle Management
Many mental health institutions are more than likely to rely heavily on a steady income.
But, the way psychiatry works, billing needs one to have a clear understanding of the revenue cycle.
From checking eligibility to processing electronic claims, managing the revenue cycle is necessary for accurate and timely repayment. Here are the key distinctions:
- Visit Duration Challenges: If you’ve visited a psychiatrist, then you know that any visit is usually at intervals of 30 or 60 minutes. This can be pretty hard to code because each visit is for a different duration.
- Visit Limits Complexity: Many insurance providers will limit a patient’s visit to a mental health care professional on a per-month or per-year basis. There is a need for some pretty thorough eligibility verification to avoid these limits and ensure accurate reimbursement for the healthcare provider.
- Dual Components Dynamics: Behavioral health billing involves two components – psychotherapy and psychiatric evaluation. Each demands specific coding expertise and this adds to the complexity of the billing process.
We must understand these differences. Experienced coders can steer through these complexities, making sure of a seamless workflow and comprehensive revenue cycle management.
DID YOU KNOW?
According to a Black Book Market Research report, 93% of healthcare providers in the United States reported a direct positive impact on their revenue cycle performance after implementing RCM solutions.
Addressing Challenges in Behavioral Health RCM
While effective patient care is the primary focus of behavioral health organizations, psychiatrist medical billing challenges are pretty much unavoidable.
Getting over these challenges is necessary if one wants to succeed in the field of RCM.
These things can include the following:
- Eligibility Verification: By checking the patient’s eligibility, professionals can pretty much avoid giving services to anyone without proper coverage. Besides, any errors in eligibility verification can result in wrong coding or denied claims and impact the revenue cycle.
- Authorization and Referral Precision: Many insurance providers need some patients to get authorization or referrals before they allow for the services. Some claims can even be rejected if the authorization fails.
- Timely Billing Imperative: Delayed or late payments can sometimes happen because of some coding errors or no coverage at the time of service. These can have a huge impact on revenue
- Dynamic Regulatory Landscape: Regular and constant changes in regulatory requirements mandate continuous updates for coders and billers. Keeping up with compliance and avoiding regulatory problems requires the coders to be up to date on the most recent changes.
- Effective Claim Denial Management: Some rejected claims need the RCM coders to have strong procedures in place..
- Managing Non-Covered Services: You might just have to pay out of pocket for some behavioral health treatments that your insurance does not cover. Claims by unregistered providers can be rejected, which shows just how important open and honest communication is about the services that are covered.
Professional teams can analyze these challenges and develop effective plans to improve billing processes, making sure that there is continuous improvement in revenue cycle management.
Strategies to Streamline Behavioral Health RCM
To simplify behavioral health RCM, consider the following strategies:
- Comprehensive Assessments: Make in-depth assessments to find possible problems before they become more serious. Allow for a more proactive approach to revenue cycle management by putting preventive measures in place to avoid billing issues.
- Operational Efficiency: Simplify processes and minimize operational breakdowns to make sure that good care services are given while optimizing billing procedures.
- Clinical Integration: Align medical and business aspects to maximize clinical efficiency. Improve the connection between patient care and revenue cycle goals, creating synergy in healthcare operations.
- Financial Performance Optimization: Get some detailed financial reviews done to find new revenue opportunities. And fix any underlying financial issues for continued financial well-being.
The global revenue cycle management market in terms of revenue was estimated to be worth $49.6 billion in 2023 and is poised to reach $148.6 billion by 2030, growing at a CAGR of 11.1% from 2023 to 2030.
Sum-up
You need some strategic methods to address the complexities in the behavioral health RCM.
Outsourcing is a pretty great way to allow healthcare facilities to focus more on patient care.
It’s all about knowing the true value of having a team of dedicated professionals who can take care of the revenue cycle management.
In this landscape, Medcare MSO offers a wide range of services, from credentialing to benefits verification and financial analysis, allowing facilities to optimize efforts and focus on delivering exceptional patient care.
Contact Medicare MSO today for a free financial analysis and take the first step toward elevating your behavioral health facility’s financial health.
