It's only half the battle to submit a clean claim! Much of the revenue generated is either taken in or lost after the claim is out. It is the area of the revenue cycle where AR Management Medical Billing plays its part and where most practices choose to underinvest.

Aging Reports and Why They Need More Than a Monthly Review

All unpaid claims are on a deadline. All unpaid claims are going towards a deadline. It isn't just that most payers have appeal and resubmission time limits, but it's also that most payers have timely filing limits on their appeals, which can often close quicker than practices realize when no one is keeping track. Medical billing, based on a monthly review of an aging report that was reliant on AR management is getting left way behind going to the claims it needs to act on. Having a daily priority list, based on the date that the claim is due to the payers, the age of claims and the amount left to collect, is vital in effective AR management to work on recovering the most valuable revenue through first.

Denial Patterns as a Revenue Recovery Tool

Each denial that is returned from a payer will have a reason code. That code is not intended simply as an explanation of the reason that the claim was denied. It is a data point. If the reason code is a same reason code (SRC) over multiple claims from the same provider or the same payer, then it is a systemic issue that will continue to lead to new denials until someone digs to uncover the root cause of the issue. Medical Billing and AR management that takes care of the denied queue will transform the denied queue into an ever-increasing improvement process, but not an ever before endless rework cycle.

Patient Balances and the Self-Pay Side of AR Management

Though patient balances receive the lion's share of publicity when it comes to AR management, the majority of practices are seeing a rise in patient balances comprising greater and greater proportions of profitability and AR. Deductible plans are fast covering most patients for insurance and what the patient is responsible for after the insurance has covered their portion has naturally risen. Without a patient balance workflow they end up with AR medical billing that loses money every time they have a patient's responsibility, and for good reason. Indications of clarity, rapid follow-up and easy repayment puts Patient AR in the driver's seat rather than trailing behind.

Why Behavioral Health Billing Produces More Denials Than Most Providers Expect

Providers of behavioral health services provide the same measurable, impactful and tangible clinical services and witness a frustrating percentage of the claims from these services being returned as denied. Rarely, it's not so much the care itself that's the issue. It is nearly always the documentation that's the culprit. Behavioral Health Billing has more scrutiny from payers than almost any other specialty and the rules are more stringent than other providers may think when they see the denials along the way.

Service Code Accuracy in Behavioral Health Billing

The behavioral health realm's landscape of CPT codes is more complex than it seems. The individual psychotherapy codes are time based, meaning that the code chosen must match the actual minutes of individual therapy. Code for a 45-minute session and a 60-minute session are not the same. If teams have default coding that is applied without considering the length of session, then there's the potential for underbilling on longer sessions and over coding on shorter sessions. Also, codes for psychotherapy services not separate from an evaluation and management (E/M) service are often missed, resulting in lost revenue on every encounter supported by such an E/M service.

What Payers Look for in Behavioral Health Billing Documentation

Claims reviewers for payers can be expected to expect 3 things when they look at some of these behavioral health billing claims. Measurable progress toward documented treatment goals, treatment plan directing the therapeutic work and documentation of the level of care that is being billed. Any unfilled or unclear moment is susceptible if any of those moments is missing or open-ended. Any session notes that provide information about what was discussed but do not relate the information to therapeutic goals and outcomes won't be enough to set the footpath for the payer’s review to make sure that treatment is medically necessary and clinically useful.

Authorization Management That Keeps Revenue Flowing

Ongoing behavioral health services often require prior authorization from commercial payers and any prior authorizations have limits on the number of sessions from which the provider must have to account individual patient by individual patient. Practices that fail to keep up with and track authorized sessions are exposed for service delivery of sessions out of scope and claims are declined. The behavioral health billing team which proactively works on authorization, monitors the number of sessions remaining, and submits requests for renewing those prior to reaching the maximum number of sessions will not have this class of denial. With specialist occupations, which have lengthy partnerships and relationship for those therapies, authorization tracking can't be a one-off installment. It is an ongoing function deployed in running a computer system.