Addressing Challenging RCM Scenarios in Behavioral Health Services
July 10, 2023
Revenue cycle management (RCM) is a complex process that involves numerous steps, from pre-service to post-service. In behavioral health services, the process can be especially challenging due to the unique characteristics of the patient population, such as a greater likelihood of mental illness and higher rates of substance abuse. Furthermore, the specific types of services provided, such as inpatient and outpatient care, create additional complexities for RCM.
In an effort to maximize revenue and combat high denials, behavioral health services must address the specific complexities of their patient population and care services.
- First, it is important to build a comprehensive understanding of the patient population in order to accurately report data. This includes identifying and capturing patient information such as diagnoses, medical history, and any other relevant information. By doing so, the claims processing system can be configured to ensure that all necessary data is taken into account when submitting claims to payers.
- Second, a thorough review of the services being provided must be conducted in order to accurately report claims. This includes double-checking that all services rendered are accurately documented and that all billing codes are correctly entered in the system. Additionally, behavioral health services must ensure that all services provided are within the scope of the service contract, and that all prior authorizations are obtained.
- Finally, a rigorous appeals process must be in place to address any denials or underpayments. Appealing denied claims can be a complex process, and it is important to understand the payer’s policies and requirements in order to successfully navigate the appeals process. This may include identifying any errors in the claim that occurred when it was initially submitted, as well as providing additional evidence or documentation to support the appeal.
By taking the necessary steps to address the complexities of RCM in behavioral health services, providers can ensure that they are maximizing their revenue and avoiding denials and underpayments. By keeping track of patient data and services provided, properly documenting claims, and successfully navigating the appeals process, behavioral health services can improve their RCM processes and ensure their financial health.