5 Proven Strategies to Strengthen Your Behavioral Health RCM to Avoid Challenges

In Behavioral Healthcare, managing financial operations is equally important to providing client care. Because it is the one that ensures stability in behavioral healthcare practice financially. Revenue Cycle Management empowers behavioral health practices to thrive and ensure financial stability to make providers peacefully handle clients. 

So, RCM requires more efficiency and needs to be strengthened. However, Behavioral Health RCM is associated with many challenges. Strengthening the RCM ensures smooth navigation of the challenges. 

In this blog post, we have shared the challenges of behavioral health RCM and 6 proven strategies to strengthen the Revenue Cycle Management to navigate the challenges.

Behavioral Health Revenue Cycle Management

Behavioral Health RCM is a process that behavioral health providers use to manage the entire financial aspect, from the start of client registration to final payment collection from the patient or insurance company. The process includes:

• Appointment scheduling
• Patient insurance verification
• Claims preparation and submission
• Payment posting 
• Payment Collection

More micro and macro processes are included as well. Each of the processes requires more efficiency to make the entire Behavioral Health RCM more strong.

Related: How to Master Operations and Revenue Cycle Management in Behavioral Health Urgent Care

Challenges in Behavioral Health RCM Providers Should Know About

Behavioral health providers often face many challenges during the RCM process. Challenges include complex billing procedures, medical coding, documentation requirements, and compliance often create burnout and stress. Moreover, making mistakes and errors in the process ultimately leads to claim rejection and payment delays. 

So, to navigate these challenges, providers need to understand these challenges thoroughly and the reason for these errors.

1. Complex and Varied Billing Codes

• The Medical Billing Codes is not a one-time thing, it continuously evolves.
• Behavioral healthcare providers have to deal with a diverse range of codes which includes CPT, ICD-10, and HCPCS codes. 
• Managing these codes while billing for services like therapy sessions or group counseling will make providers overwhelmed.
• Behavioral healthcare providers might make mistakes in accurate code selection for services rendered.
• This leads to claim rejection, delayed reimbursements, and loss of revenue.

2. High Claim Denial Rates

• Coding errors, missing information, or failure to meet the requirements of the payers are common reasons for claims being denied in behavioral health practices. 
• Denials are huge administrative burdens that require much follow-up and resubmissions.
• A high denial rate will disrupt cash flow, delay payments, and stress the financial health of behavioral health organizations.

3. Difficulty in Managing Prior Authorizations

• It is also time-consuming and labor-intensive to get prior authorizations for behavioral health services.
• Approval varies between payers, and much paperwork is required. 
• Any delay or denial in the authorization process may disrupt or stand in the way of patient care, delay treatment plans, and affect provider revenue, frustrating the providers and patients alike.

4. Inadequate Documentation and Coding Errors

• Behavioral health providers often errors in coding because of poor or wrong documentation.
• Inadequate documentation cannot justify services billed and leads to rejections or audits of claims. 
• Therefore, detailed compliant documentation is crucial for proper reimbursement and prevention of revenue loss for behavioral health practices.

5. Compliance with Evolving Regulatory Requirements

• The regulations such as HIPPA, Medicaid, and insurance policies constantly change.
• So, behavioral health providers must stay updated with these changes. 
• Staying updated with these evolving changes can be challenging but it is important.
• Non-compliance might lead to hefty penalties and practice reputational damage.

6. Inefficient Patient Payment Collection

• Collecting payments from patients has been cited as one of the biggest challenges within behavioral health.
• The presence of high patient deductibles, unclear billing practices, and no plans for payment delay the revenue collection process. 
• Implementing patient-friendly billing strategies along with other flexible payment options would improve collections and strengthen the financial stability of the providers.

7. Data Accuracy and Reporting Issues

• Accurate and timely reporting of information is very crucial for a smooth revenue cycle.
• Behavioral health providers commonly face problems with incorrect data, incoherent reporting, and unavailability of analytics tools. 
• Providers cannot identify revenue leaks when the financial performance insights are not accurate; thus they are not able to make informed data-driven decisions.

6 Strategies to Strengthen the Behavioral Health RCM

Though challenges in behavioral health RCM are many, implementing the right strategies will strengthen the RCM and help to navigate the process. Here are the 6 strategies:

1. Implement Integrated EHR and RCM Solutions

One of the best strategies to strengthen the Behavioral Health RCM is leveraging technology solutions. Invest in EHR integrated with Revenue cycle management tools. 

Leveraging this powerful integrated solution is more important as it helps to automate the charge capture, claims scrubbing, and submission processes to ensure efficiency in the workflow. Make sure the EHR is specialized for behavioral health so that the system will be more suitable for the workflow.

Related: The Top Features a Behavioral Health EHR Must Have

2. Enhance Documentation and Coding Practices

Medical Documentation and coding are the most crucial components in Behavioral Health RCM. It is the one that ensures precision and compliance with CPT, ICD-10, and HCPCS. 

Practices need to ensure that providers are properly documenting the services rendered for clients and billed with appropriate codes. This will minimize the denial rate and optimize reimbursement outcomes for behavioral health providers.

3. Develop an Effective Denial Management Strategy

Claim denials do happen in medical billing, but the rates of claims getting denied can be significantly reduced. Behavioral health practices need to develop a strong denial management strategy to appeal the claims to recover the lost revenue.

To do that, practices need to analyze the denial patterns and identify the cause of the denial. Then, develop a systematic approach to resolve the issues and re-appeal the claims to the insurance companies. Use the data to improve the process and prevent any future denials.

4. Streamline Prior Authorization Processes

Automated prior authorizations, integrated with payer systems, reduced turn time and allowed electronic submissions and status tracking. 

This reduces manual intervention, increases the accuracy of approvals, and accelerates speed in the delivery of treatment, ensuring revenue continuity and reduced administrative overhead.

5. Leverage Advanced Analytics and Reporting Tools

Advanced analytics platforms, which combine machine learning algorithms, deliver predictive insight into claim denials, payment delays, and all other revenue leakage points. 

Advanced dashboards and automatic reports enable KPI tracking and analysis of payer performance in terms of workflow optimization.

6. Adopt Patient-Centric Billing and Payment Solutions

This will ensure the safe, real-time processing of payments and statement generation through the integration of automated billing platforms with patient portals. 

Electronic payment reminders, management of payment plans, and digital wallets improve collections. It improves patient trust by making transparent, itemized billing, reduces aging accounts receivable, and ensures constant revenue generation.

CapMinds Revenue Cycle Management Solution

Effective revenue cycle management is essential to improve healthcare practices’ financial health. 

To avoid the drawbacks, minimize claim denials, and improve your revenue cycle management, an expert must be put into use in your practice.

At CapMinds, we are bringing a comprehensive solution to make your billing and coding experience better. Our medical billing team expedites your entire billing process. Utilizing our Revenue Cycle Management Solution, your healthcare practice benefits from:

• 24/7 Support: Always available for your queries.
• Dedicated Client Manager: Personalized service for your practice.
• Efficiency and Accuracy: Streamlined billing, fewer claim denials.
• Financial Optimization: Maximize revenue, and correct underpayments efficiently.
• Enhanced Cash Flow: Timely collections, and improved financial management.
• Compliance and Security: Adhere to industry standards always.

We optimize your charges, submit your claims, on-time collection, reduce accounts receivables, identify underpayments, and increase your practice’s net collections, thereby better clinical and service expansion.

We also have a dedicated client manager who will be exclusively assigned to you. And the team will be available around the clock to assist with your queries. 

“Reach out to CapMinds to make your medical billing process easier and more effective”