Healthcare in a digital environment is complicated, particularly with the numerous regulations that seem to be constantly rolling out additional layers. Healthcare providers are spending more time and resources as they organize patient care, and this time could be put to better use. Using a qualified, outsourced behavioral health billing company can provide better service as your workload reduces, you experience fewer disruptions and your profitability increases.

10 Advantages of Outsourcing Your Behavioral Health Billing

Decreased Employee Expenses. You will not be liable for employee healthcare, acquisition costs, PTO, and other employee load expenses when you are outsourcing your behavioral health billing. The amount of resources expected to manage the behavioral health insurance process is high. Another point of using an outsourced behavioral billing solution is the cost-share model. This enables billing expenses to be based on your volume and earnings. This is an advantage if you have a low-income month; you will not have a fixed cost associated with your billing.
Improvement of Revenue Cycle. As the legal and administrative terms for behavioral health providers constantly keeps growing in complexity, and as claims process grows more challenging, working with a skilled, qualified billing company trained in behavioral health can provide big relief. RCM software or Behavioral Health Revenue Cycle Management is a specific application specially designed for practices that treat patients with behavioral concerns. It helps practices process payments, handles claims, and creates revenue better than using a generic billing application. This will drastically improve the management of your revenue cycle.
Keep Patient Data Secure. One of the major concerns that prevent physicians from outsourcing their medical billing is internet security. Protecting patient and practice data is critical. All professional outsource medical billing company has the responsibility to protect all patient information (HIPAA compliant).
Reduce Staff Errors. Even the smallest blunder can cause an insurance company to deny a medical billing claim, with someone on your staff to correct the mistake, resubmitting the request and waiting for the revised application to be accepted and processed. Working with a specialty provider reduces staff blunders, since they have more experience working with billing and have undergone a lengthy training process, much greater than your in-house team.
Greater Consistency. Due to unplanned staff changes or employee absence, billing in-house puts your practice at higher risk for revenue interruption. An outsourced medical billing service provides an entire team of experienced people ensuring that your claims get prepared efficiently, leaving your practice less exposed to interruptions in cash-flow.
Better Claim Processing. Every insurance claim must be paid promptly and accurately in order to optimize a medical office’s cash flow. Time is valuable, generally healthcare staff do not have the luxury of reviewing and following-up on each claim. Let’s face it, healthcare professionals and their support staff are often pulled in various directions. But these claims should be presented as soon as possible and accurately the first time. Otherwise, unpaid claims can quickly rob an office of resources that could be applied elsewhere. Being forced to make tons of phone calls to insurance providers only wastes more time and adds frustrations. Healthcare providers should greatly consider outsourcing this function to reduce the administrative load placed on their support staff. Good medical billing companies are quick, consistent, and accurate with the submission and processing of any insurance claim.
Transparency. Others believe that outsourcing your billing means giving up control and the power of your practice, but this is entirely incorrect. When you outsource your billing, you obtain greater control and transparency. You can review compiled data or monitor the process at any time, according to your discretion. This gives you up-to-the-minute evaluations of how your practice’s billing is being processed and whenever you decide.
Profitability Increase. Due to incompetent, inadequate, or inaccurate claims, medical providers lose revenue. However, that’s not the case if you outsource billing to a qualified behavioral health billing group. Why? Simple! These outsourced behavioral health billing specialists are just that, experts, much more skilled than your in-house staff. They’re skilled at handling appeals and reversing denials. They hold the insight and expertise to pinpoint specific areas of vulnerability, limiting repetitive errors in claims, and assuring more claims are met (paid out) on the first attempt.
Knowledgebase. Outsourced billing solutions for behavioral health come with a wealth of knowledge. They understand the various complexities of billing insurance and hold the knowledge to examine trends and recognize industry transitions on the spot. Longevity in this niche area is not common; however, necessary. The results that stems from longevity and experience is priceless. Being able to understand each insurance carriers’ historical trends, paid amount(s), fine print of policies, etc., can have a massive impact on your behavioral health organization’s capacity to collect on insurance.
Faster Procedure. Automating routine administrative duties makes your work more productive and valuable. Automating same-day claim submissions will increase your cash flow. A standard paper-based claim may take at least two months to move through all the channels before you receive payment. Advancing a clean claim, appropriately coded for maximum benefit, supported with the assistance of the EHR can result in full compensation in a short period of time.
Conclusion

These are plenty of great reasons to outsource your behavioral health billing to a professional group. It makes sense to outsource revenue cycle management services to a third party, putting less strain on your internal resources.

It’s approximated that $3 trillion worth of medical claims are submitted every year to insurance companies, etc., with $262 billion worth of these claims denied. Approximately 65% of the denied medical claims are not resubmitted to the organization which denied the claim. Statistical data indicates that commercial payers are denying 58% of those claims.

Appealing against denials can eat up a lot of time and money, hence a good bit of health providers find it impractical to appeal against denied medical claims. Additionally, it can be a real burden to create a denied claim reduction program (within their medical billing process). This is due mostly to the extra manual processes, work and pressure stacked on internal resources.

However, handling denied claims shouldn’t be so difficult. Here are some denial management tips, which will make the handling of denied claims easier for healthcare provider teams. Review these tips carefully and implement them.

Claim Review Guidelines — Check These Before Submitting

Medical billing and coding professionals should use a checklist (QA process) before submitting every claim. This will create a much higher rate and probability of acceptance by insurance groups. Within the checklist, the following should be taken into consideration:

Get Proper Signatures
Claim Proofreading
Ensure that the Coding is Accurate under ICD-10-CM
Patient Information Confirmation
Authorized Information Release or Signature on File
Calculate Fees Properly
Physician Credentials Attached
Make Sure All Attachments are Included
Original Claim Forwarded
Know Your Numbers and other Denial Statistics

Health care provider resources handling medical claims should be aware of the dollar rate, the number, value of claims and the denial rate, before trying to resolve the problem of high number of denials. This helps discover the root cause of the denials and how systems can be improved and also assesses how many claims will be accepted in the future. The provider should understand the type of claims for which it can recover the maximum amount of money. It’s important to determine the trends in denied claims and take measures to prevent such trends.

For example, if a medical provider is making appeals for denied claims to a particular payer, and winning almost all the appeals, it is possible that they’ll will be able to work with the payer to make relevant process improvements, so that claims are not denied in future. On the other hand, if the healthcare provider is losing appeals, there are errors in the upstream process, so it is necessary to make improvements in the overall protocol to eliminate future problems.

The resources handling denied claims should not exclusively focus on getting denied claims for larger amounts resolved. Denial management additionally involves handling smaller problems which recur frequently, which collectively amount to larger figures.

Check Upstream Processes

A denial management team should try to determine at what stage the problem is occurring in the revenue cycle and how it can be resolved. If the problems are identified and resolved early, the efficiency of the program to prevent denials, as well as the revenue cycle, will increase. It’s advisable to analyze the processes in the revenue cycle. Often, a problem in an upstream process adversely affects downstream activities. After problems are detected (accountability application); solutions can be applied.

Leverage Data and Analytics / Attribution

In denial management, it’s crucial to have complete data on claims made, denied claims, reason(s) for denial, so that it can be analyzed to spot trends. Analytics tools should be used to find data set patterns more easily. Denial management often becomes easier after analytics is used, since it’s a lot easier to predict data. Reporting delays can take place for organizations who do not have real time analytics. Claims Analytics / Attribution tools are extremely useful resources for hospitals and medical providers, since they assist in determining denied medical claim trends, which ultimately cause revenue loss. The key is to attribute what works and why.

Team Up with All Departments

A denial management team should be formed within a medical provider. It’s a lot easier to handle denials if a group of internal resources are involved. Those resources that’ll consistently monitor issues and implement improvements. The team should meet regularly to discuss the root cause of denied claims. Suggestions to ensure that the claims are not denied should be considered. Get all departments involved on this team.

The State of Digestive Health in America
The digestive system is a marvel of biological engineering, tirelessly working to break down food and absorb nutrients. However, the prevalence of fast food, preservatives, and a high-speed lifestyle has led to a significant increase in digestive disorders. According to the National Institute of Diabetes and Digestive and Kidney Diseases, 60 to 70 million Americans are affected by digestive diseases. Conditions such as gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), and various forms of indigestion are becoming increasingly common.

The Impact of Diet on Digestion
The typical Western diet, characterized by high levels of processed and canned foods, poses a challenge for our digestive enzymes. These enzymes are crucial for breaking down food, but they are often insufficient due to the diet’s lack of naturally occurring enzymes found in raw or minimally cooked foods. Overcooking further depletes these enzymes, placing additional burdens on the body’s digestive capabilities.

Herbal Remedies and Dietary Adjustments
To counteract the effects of a challenging diet, many Americans turn to herbal dietary supplements. These natural remedies are favored for their ability to support the body’s systems without the severe side effects associated with some pharmaceuticals. Herbs like fennel, ginger, and peppermint have been shown to aid digestion and alleviate symptoms of common gastrointestinal issues.

Tips for Improved Digestive Health
Establish Regular Eating Patterns: Consistency in meal timing can significantly benefit digestive regularity.
Incorporate Probiotics: Foods like yogurt and fermented products such as kombucha and miso introduce beneficial bacteria to the gut.
Choose High-Fiber Foods: Apples, whole grains, and green vegetables can help prevent constipation and maintain a healthy digestive tract.
Opt for Enzyme-Rich Fruits: Papaya, with its digestive enzyme papain, can assist in protein breakdown and soothe the stomach.
The Role of Probiotics and Fiber in Digestive Wellness
Probiotics are live microorganisms that, when consumed in adequate amounts, provide health benefits, particularly for the digestive system. They can be found in fermented foods like tempeh, kimchi, and sauerkraut. These foods not only supply probiotics but also break down antinutrients, making it easier for the body to absorb essential nutrients.

Fiber is another key component of a digestive-friendly diet. It adds bulk to stool, which can alleviate constipation, and acts as a food source for beneficial gut bacteria. Whole grains, such as oats and quinoa, are excellent sources of fiber that support a healthy digestive system.

Conclusion: Embracing a Holistic Approach to Digestive Health
Digestive problems can be daunting, but they are manageable with mindful dietary choices and the support of herbal supplements. By prioritizing fiber-rich foods, probiotics, and natural digestive aids, individuals can foster a healthier digestive system. For those seeking additional support, a range of herbal dietary supplements is available in the U.S. market, offering a safe and effective way to enhance digestive health without adverse side effects.

Data suggests that many hospitals find it increasingly difficult to scale and guarantee high revenue cycle performance. As we all know, hospitals have a large number of expenses. It’s crucial that they receive prompt patient payments from insurance companies, etc. It’s vital for all hospital departments to work together to meet revenue goals. If a hospital has become financially successful, there’s a reason for it. It’s extremely important to attribute which protocol(s) works and why, to ensure the optimal execution of a revenue cycle.

One of the many reasons hospitals face financial crisis, revenue cycle success is unattainable due to roadblocks. Hospitals have to focus on the movable roadblocks, clearing the path for prosperity and gain. It’s paramount for hospitals to focus on the various components within their revenue cycle such as scheduling, patient registration and eligibility checks, upfront patient collection, claims management and medical billing and patient collections.

Below, some of the major revenue cycle challenges faced by hospitals:

The Cost of Collecting

At present, many patients are expected to pay directly for large parts of their health care costs. It’s best practice for hospitals, or any other medical provider, to collect payment from a patient at the point where service was rendered. Although this helps the hospital economically, many patients are unable to fit the total cost of a medical bill. Especially where insurance coverage has either lapsed or doesn’t cover the majority of a bill, the hospital is left to collect on the bill. The spend on resources for such collections can be large and put a dent into the over success of a revenue cycle.

Hospitals can try to reduce patients medical bills by offering discounts for prompt payment. This helps increase the percentage of payment at the point of service.

Claim Denials

At present, medical claims data suggests that hospitals and other health care providers are writing off a larger number of claim denials, compared to five years earlier. The evidence available indicates that this trend is likely to continue, because the success rate of health care provider appeals against claim denials has declined in the last few years.

For many years, hospital medical claims were denied mainly due to technical errors. Now, the reimbursement is increasingly based on the value of the treatment to the patient, and the number of denials related to technical errors has increased. Hence, if a hospital wishes to recover large amounts, they should ensure that the clinical documentation used for making claims has improved. Hospitals should show insurance companies how they offer increasingly better health care. After all, they need to justify their claims.

Cash Flow Problems

Cash flow is important for any medical organization, due to the plethora of expenses that exist. However, in the last few years (according to data) there has been some positive news. Cash flow has greatly improved for health care providers. Medical revenue cycle experts claim that there are many reasons for improvement in cash flow. It’s widely regarded that writing off claim denials has been particularly effective in recouping losses.