Effective revenue cycle management is vital for behavioral health and substance use recovery providers to ensure sustainability and the delivery of quality care. Common billing challenges include insurance denials, high patient costs, and limited resources for effective billing and collections. However, there are strategies you can implement to improve your revenue cycle management and ensure financial sustainability, which we’ll explore in this blog post.

How To Improve Revenue Cycle Management

Take Advantage of Your EHR

You’re using your EHR all day, and if you’re using it right, that means you have access to a treasure trove of useful data about your revenue cycle’s health. You should optimize your EHRs to match your specific needs, automating workflows and creating dashboards that monitor your financial goals effectively. You can make a lot of revenue cycle improvements simply by reacting to data provided by your EHR. Configurable dashboards and analytics can visualize trends or changes for faster decision-making.

Regular Audits and Reviews Help Improve Revenue Cycle Management

Conducting routine audits and reviews enables providers to identify any gaps or inconsistencies in their revenue cycle management processes. By analyzing coding, billing, and documentation practices, providers can identify areas for improvement and implement corrective measures promptly. Regular audits also enhance compliance with industry regulations, reducing the risk of errors that could lead to revenue loss. Your EHR should provide reports on current billing issues, past billing, and audit history.

To conduct regular audits and reviews, you need to set up a task list that includes establishing audit criteria, determining the frequency of an audit, identifying a responsible staff member to lead the audit, and identifying resources needed for the audits.

Streamlined Insurance Verification and Authorization Processes

Ensuring swift insurance verification and authorization is essential to prevent delays in reimbursement. Behavioral health and substance use recovery providers should implement streamlined processes to minimize administrative burdens. Use your EHR’s eligibility verification systems, establish clear communication channels with payers, and incorporate automated authorization tools. Efficient insurance verification and authorization processes lead to faster reimbursements and improved cash flow.

Make sure your EHR includes insurance eligibility and verification systems, allowing real-time verification of patients’ insurance coverage. This helps reduce the administrative burden of manual verification and ensures that accurate insurance information is obtained.

It can also generate alerts and notifications to inform staff about missing or expired authorizations. This helps proactively manage authorizations to avoid treatment delays and potential claim denials.

Simplify Client Billing and Collections

Simplifying client billing and collections processes has a direct impact on the revenue cycle. Providers should provide clear and transparent information about payment options and expectations to clients at the outset of treatment. Using your EHR to automate billing, offer online payment portals, and enable recurring payment plans can simplify the process for clients and increase collection rates. Regularly reviewing and optimizing fee schedules can contribute to accurate and fair billing practices.

EHRs can automate the generation and submission of claims, reducing manual entry and paperwork; for example, you could submit batch claims. This streamlines the billing process and reduces the likelihood of errors or delays in claim submission.

Additionally, EHRs can facilitate accurate coding and documentation, which is crucial for appropriate billing. EHRs often include built-in coding guidance, ensuring compliance with coding rules and reducing the risk of claim denials. The documentation captured within the EHR can also support the billing process by providing a comprehensive and complete record of the services provided, thereby increasing the chances of accurate reimbursement.

EHRs can also assist in client collections by providing tools for managing client financial accounts. These tools can include features such as tracking outstanding balances, setting up payment plans, and generating patient statements. By having this information easily accessible, agencies can proactively manage patient collections and reduce the days in accounts receivable.

Lastly, EHRs offer reporting capabilities that provide insights into revenue cycles, claim statuses, and outstanding balances. These reports help agencies identify trends, monitor performance, and take appropriate action to optimize billing and collections.

Maximizing Reimbursement through Accurate Documentation and Coding

Proper coding and billing practices are crucial to effective revenue cycle management. Agencies must invest in training to do billing and coding accurately and efficiently. Using automation technology and setting up a process that tracks denied claims can help to identify areas that need improvement.

Adhering to accurate and detailed documentation and coding practices is crucial for maximizing reimbursement. Providers must ensure that medical records accurately reflect the level of care provided and properly document any comorbidities or complications. Regular training and education for coding and billing staff are essential to keep up with evolving coding guidelines and payer requirements. Regular audits of documentation can help identify areas for improvement and enhance revenue integrity.

Outsource Billing to Improve Revenue Cycle Management

If you lack the resources to handle your own billing properly and you find yourself falling behind on collections or constantly having to re-submit claims, it’s time to get help. Some providers balk at the cost, but here’s the thing: even if you’re amazing at billing, doing your own billing IS costing you money. That’s especially true if providers spend their billing hours on billing tasks instead of seeing clients. Therapy Brands offers managed billing services for agencies tired of falling behind.

To sustain their operations and continue delivering high-quality care, behavioral health, and substance use recovery providers must optimize their revenue cycle management strategies. By adopting and continuously refining these strategies, you can enhance their financial stability while efficiently supporting the well-being of your clients.

Therapy Brands supports thousands of substance use recovery and behavioral health professionals. We often hear about the billing challenges you face daily, so we created software designed to simplify billing and maximize reimbursement. Schedule a discovery call, and let us show you how to improve your revenue cycle.