The most compelling reason to recoup more revenue from insurance payers is that by doing so, patients pay less and stick with treatment longer.
Reducing claim denial rates are good for your agency’s bottom line. Higher revenues mean behavioral health, mental health, and substance use treatment agencies can continue to stay in business and help people heal. However, the most compelling reason to take steps to recoup more revenue from insurance payers is because by doing so, patients pay less.
When patients pay less out-of-pocket, they stick with their mental health treatment plans longer and have a less stressful experience. Paying less for mental health literally saves lives but people are often unable to find a provider who accepts their insurance.
These barriers to care have resulted in suicides and drug overdoses skyrocketing. In Minnesota alone, suicide rates have risen by 79% over the last two decades. The Mental Health Parity and Addiction Equity Act of 2008 was a great step forward to ensure that insurance companies cover mental health services. Unfortunately, a decade later, there continues to be a growing gap between mental health and medical coverage with out-of-pocket expenses for behavioral health growing 13 times faster than all inpatient care.
Before you can reduce your claim denial rate, you have to know what it is. We built a calculator to help you. All it takes is 5 easy steps!
Now you have your claim denial rate!
If it’s more than 10%, something isn’t quite right. While you should never expect to get your rate down to 0%, it should be close if your agency is financially healthy.
Behavioral health agencies, like hospitals, struggle with the same root causes behind denial write-offs. Here are seven of the most common. Use this list as a checklist to see which might be causing issues for you. Once you pin down what reason, or multiple reasons, your rate is what it is, you can begin implementing process and system changes to address it.
Between 2011 and 2019, denial write-offs increased by 79%. However, of claims rejected by insurance payers, only 35% are reworked and resubmitted. Paying attention to your claim denials can help you increase your profit margin and help your patients heal.
Focusing on the administrative side of your business can seem like it’s taking too much time away from your mission of helping people heal. Yet when you are able to reduce claim denials, you’re looking out for your patients’ financial wellbeing which often plays into their mental health. Partnering with an external billing service, like BillCare, can reduce how much time you spend chasing down payments while also boosting your agency’s finances.