5 Common Challenges in Behavioural Health Revenue Cycle Management and How to Solve Them
Billing can be a lot to handle at a behavioural health facility. There are insurance details to check, claims to prepare and payments to keep track of. And that’s just part of it.
Some days everything goes fine. On other days, the billing team might spend hours fixing an issue that could have been avoided.
Behavioural health revenue cycle management involves all the work that goes into getting paid for the care provided. It starts when a patient enters treatment and continues until the payment is received.
There are a few problems that come up quite often. Let’s look at five of them and what facilities can do to make things easier.
- Claim Denials
When an insurance company denies a claim, someone from billing has to look at it again. They need to find out why it was denied and what needs fixing.
Sometimes it’s just the wrong billing code. Other times, there’s a mistake in the patient’s information. In some cases, the payer asks for more information from the treatment records.
The team then has to go back and check what went wrong. If the same mistake appears in several claims, they’re stuck fixing it over and over again.
What can help?
Take a look at the claims that were denied recently. Check the reasons given by the insurance companies. Take the denied claims from the last few weeks and read through the reasons given by the payers. Say four or five claims came back with coding issues. Was the wrong code chosen for the service or did someone enter it incorrectly? There’s a difference.
Before the next set of claims goes out, check those same details against the patient records. The team has already spent time correcting these mistakes once. There’s no point letting the same ones go through again.
That way, the team won’t have to keep going back to correct the same errors.
- Insurance Verification Problems
Insurance verification can be tricky. Every payer has its own requirements and those requirements aren’t always easy to keep track of.
Some plans need authorization before certain services begin. Others have limits on treatment days. A patient’s coverage may also change during treatment.
Imagine finding out that an authorization expired after several more days of care were provided.
Now the billing team has another issue to deal with and payment for those services may be at risk.
What can help?
Start with the insurance check at admission. Staff need to know what the patient’s plan covers and whether treatment needs approval from the payer.
Authorization dates need attention too. Check when approvals expire and who’s handling renewals. If a patient moves from detox to residential care, ask the payer if another approval is needed. Better to check now than have billing issues later.
- Missing or Incomplete Documentation
This is another problem that can hold up billing. A clinician may have completed a session but forgotten to sign the progress note. An assessment might still be incomplete. Or a treatment plan hasn’t been updated when it should have been.
The care was provided but the records may not have everything needed to support the claim. The billing team then has to contact the person responsible and wait for the missing information.
Sometimes it gets sorted out the same day. Sometimes it takes longer, especially when staff are busy.
What can help?
Staff should know which records they need to complete and the deadlines for each. Charts need to be checked regularly. Checking hundreds of charts by hand takes a lot of time. Ai Chart auditing tools can help find missing signatures, unfinished notes and records that are overdue.
Staff can then look at what’s missing and complete it. Finding these issues soon after treatment is usually easier than going back to them weeks later.
- Late Payments
Some claims take longer to get paid than others. A payer might need more information. A claim may be under review. Sometimes the payment is delayed and the billing team doesn’t know why.
The bigger problem is when nobody follows up. Staff are often busy submitting new claims. Older claims may go unchecked for weeks. That can leave the facility waiting for money it needs to pay staff and cover other expenses.
What can help?
Check unpaid claims regularly. See which ones are still pending and how long they’ve been there. If a payment is taking too long, contact the payer to find out why.
Also look at whether certain payers regularly take longer to pay. There may be a reason that needs attention. It’s worth finding out.
- Too Much Manual Work
Billing teams often have to do quite a few things by hand. They enter patient information, check records, update spreadsheets and follow up with different departments.
Sometimes the same information gets entered into two systems because they aren’t connected. It may not seem like much when you’re dealing with one patient. But when there are hundreds of records, even small tasks can take up a large part of the day.
Manual work also makes it easier for things to be missed. A claim doesn’t get updated or someone forgets to follow up. Then the team has to go back and fix it.
What can help?
See which tasks are taking up the most time. Maybe staff are checking the same records more than once. Maybe they’re entering information that already exists in another system. Start there.
Billing software can help keep track of claims. Chart auditing tools can check records for missing notes, signatures and other details.
But there’s no need to automate everything. Sometimes the problem is simply that two departments aren’t sharing information properly. Fixing that process might be enough.
Final Thoughts
Billing issues are part of running a behavioural health facility. That doesn’t mean the same problems have to keep happening.
A missing signature, an expired authorization or a claim that hasn’t been followed up can all lead to delays. The best place to start is by looking at what goes wrong most often.
Improving behavioural health revenue cycle management doesn’t always require a major change. Checking insurance details on time, reviewing documentation and keeping track of unpaid claims can already make the work easier.
And when staff aren’t spending so much time fixing the same issues, they can get on with everything else that needs attention.
