Like any healthcare provider, behavioral health services depend on a steady flow of income to operate. Like medical billing, behavioral health revenue cycle management (RCM) involves distinct complexities. Understanding these distinctions is crucial for maximizing reimbursement.
Behavioral health billing: Different from medical billing
Behavioral health billing differs from medical billing in a few key ways:
- Visit duration: Behavioural health visits are timed (e.g., 30 or 60 minutes) and coded differently based on duration.
- Visit limits: Insurance plans often limit behavioral health visits per month or year. Eligibility verification is critical to avoid exceeding these limits.
- Multiple components: Each session may involve psychotherapy and a psychiatric evaluation, requiring specific billing codes.
Optimizing revenue in behavioural health requires a team with a strong knowledge of these unique aspects and how they connect to the entire revenue cycle. An organized protocol, from start to finish, ensures efficient management.
Challenges in behavioural health RCM and how to address them
Revenue cycle management in behavioural health should not overpower facilities. Patient care remains the priority, with coding and billing challenges manageable through effective workflow strategies and problem-solving approaches.
- Verification of eligibility: Eligibility should be checked before or during a patient’s appointment to prevent uncovered services, inaccurate coding, or denied claims. Employer-sponsored plans often exclude behavioural health coverage, requiring verification with the employer.
- Prior authorizations and referrals: Insurers often mandate pre-authorization or referrals from primary care physicians for treatment. Claims may face rejection without these prerequisites.
- Delayed payments: Delays can be caused by coding errors, lack of coverage, authorization issues, or inaccurate provider credentials.
- Dynamic regulations: Coding and billing regulations constantly change. Coders and billers must stay updated to ensure compliance.
- Claim denials: All healthcare facilities face claim denials due to eligibility or coding errors. A denial management process is essential.
- Non-covered services: Some behavioural health services are not covered by insurance and require out-of-pocket payment.
These challenges may seem intimidating, but an experienced team can develop solutions.
Outsourcing Behavioral Health RCM
Behavioral health professionals should focus on delivering the best possible care to their patients. Outsourcing RCM is not about surrendering control; it’s about partnering with a team dedicated to optimizing your revenue cycle. Outsourcing RCM to a team of experts allows them to do just that. expEDIum provides a complete suite of RCM services, from credentialing and benefits verification to collections and financial analysis. For Behavioral Heath we have over 600 plus providers, 40 plus clinics, more than 1.3 million claims. expEDIum can address the issues and streamline your RCM process. Outsourcing is a step towards achieving success for your behavioral health facility. Contact expEDIum today for more information
