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- đź’° Five reimbursement tips (from an RCM expert)
đź’° Five reimbursement tips (from an RCM expert)
More money per patient? Here's how.
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Welcome to The Census, your weekly roundup of what matters in behavioral healthcare.
This week, we’re bringing you an Operator’s Guide special edition, where we interview experts and distill their best tips to help your business grow.
So, without further ado, let’s get to it.
- Shân
P.S. First time reading? Welcome! Sign up here.
Reading time: ~3 minutes.
đź’ˇ Five reimbursement tips from an RCM expert
We’re all driven by the ultimate goal of helping people thrive. But to help your patients thrive, your business has to, too.
To this end, every behavioral healthcare provider wants two things: More patients, and more money from insurance per patient.
So we sat down with Bridgette Vail, chief clinical officer at RevWerx — a behavioral healthcare revenue cycle management (RCM) firm.
Bridgette is also a Licensed Professional Counselor with 20+ years of industry experience. Patient-first care is at the center of everything she does.
Here are her five key takeaways to help you crush your RCM goals.
1. Focus on simple ways to increase collections from claims
… And the first one isn’t surprising: Improve the accuracy and completeness of your clinical documentation and coding, the first time.
You should also:
Practice timely follow-up on unpaid claims
Establish healthy relationships and clear communication channels with insurance companies
Continually train staff on the best ways to document medical necessity and the latest billing + coding guidelines
Not investing enough in training staff on proper documentation and billing and coding practices is one of the biggest mistakes providers make when it comes to their revenue management.”
Yes, we know this isn’t new news. But if you were already doing it all, you probably wouldn’t be reading this…
2. Anticipate future hurdles as the space evolves
The reimbursement landscape is constantly changing. So, ongoing training and adaptation are key to navigating regulatory complexities and evolving models.
But obviously, you can’t anticipate everything.
Two areas where Bridgette foresees potential future challenges for providers:
The growing prevalence of high-deductible health plans. These push providers to focus more on patient collections — which can be nuanced, time-consuming, and challenging.
The shift towards value-based care. Be prepared to need more comprehensive data tracking and outcome measurement.
3. Make careful evaluations amid the slow move toward in-network models
Bridgette’s team has noticed a trend favoring in-network models, as insurers and providers seek to create more predictable and manageable cost structures.
But it’s complicated.
Although being in-network can enhance patient access to care and ensure consistent reimbursement rates, it’s not always the best option.
Especially when out-of-network models can give patients expanded choice, reduced wait times, and tailored treatment plans.
The bottom line?
“A total transition to an in-network model requires providers to navigate complex negotiations with insurance companies and potentially adjust their service offerings to meet network requirements.
“While the in-network model offers benefits, it’s crucial for providers to carefully evaluate the financial and operational implications,” says Bridgette.
This search interest doesn’t lie. US search interest, six-month rolling average. Source: Google Trends
4. Identify gaps and trends to maximize authorization
To do this, you need to track KPIs and analyze data. If you don’t, you won’t know which areas require regular attention and improvement.
This is where tech solutions can really shine.
Data capture and analysis technology can maximize authorization at clinically appropriate levels of care and lengths of stay in treatment.”
Luckily, these solutions are also fast becoming more user-friendly and affordable. This leads us to the next point…
5. Embrace AI in RCM (it’s a good thing)
AI solutions boost efficiency and accuracy. They also ultimately lower costs for providers, and can tackle some of clinicians’ biggest admin headaches.
“We’re building an inclusive clinical and compliance support program for clinical staff to effectively utilize medical necessity and clinical criteria to support the care they are providing,” Bridgette told us.
“These projects are set to transform how we secure authorizations, decrease denials, retain reimbursement, and manage and support behavioral health services, with a focus on benefiting the clients and families we serve.”
We’ll ask for a reader discount once they’re live...
As behavioral services fight for parity on the healthcare stage, focusing on patient-centric care will be key. To achieve this, we must leverage technology to improve efficiency and maximize reimbursement.
If you have any questions for Bridgette, drop us a mail here.
Thank you for reading! We’ll be back next week with our usual coverage of the latest news headlines.
- Shân
P.S. If you want more Operator Guides like this, open this link to let me know (I’ll track how many clicks it gets).
Special thanks to Bridgette Vail for her insights.
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