How a Dedicated Billing Specialist Will Add Value to Your Organization

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As the owner or operator of a behavioral health organization, your livelihood hinges on your ability to maximize efficiency for patients and your staff. But achieving this goal is often easier said than done, especially when your collections and claims processing seem to be stuck in quicksand. The good news is you can jump start your revenue cycle management by seeking the services of an experienced billing expert to oversee your billing and collections. Below are eleven ways a dedicated billing specialist will add value to your organization.

1) Serve as a trusted point-of-contact

The path to a smoother revenue cycle begins with an experienced billing specialist who can be trusted to provide a clear explanation of a patient’s eligibility, charges and claims, as well as your agency’s overall financial status. By serving as a single point-of-contact, a knowledgeable billing specialist can help prevent frustration and promote faster bill payment.

2) Evaluate coverage prior to treatment

Many behavioral health providers are surprised to learn the top reasons why claims are denied. The American Association of Professional Coders points to incorrect or incomplete patient information, expired insurance coverage and a lack of prior authorization as three of the top four reasons why claims are denied.

Given this information, it is wise to evaluate a patient's insurance coverage before every appointment. This measure takes time but can help prevent wasted time and rejected claims. A dedicated billing specialist can handle this step by checking eligibility to confirm a patient's coverage is still in effect. By providing real-time eligibility verification, a billing specialist can put your practice on the fast track to claims payment.

3) Verify claim accuracy prior to submission

Another way billing specialists can help prevent clogs in the revenue cycle is to make sure expected charges contain the necessary information for each payer and that claims are formatted properly to ensure successful delivery to the payer. Some of the most prevalent types of mental and behavioral health billing errors include the following:

  • Documentation errors, such as failure to note the place and time of service
  • Errors with billing units, such as the use of one-hour codes to bill treatment that lasted only 30 minutes
  • Policy violations, such as the failure to record charges in a timely fashion

By capturing these errors and other mistakes on the front end, your number of denied claims will decrease. This will help ensure you get paid the expected amount the first time the charge is sent out. Additionally, a specialist can help take steps to avoid making the same mistakes in the future.

4) Uncover cost-effective practice solutions

Behavioral health services are billed differently than other types of healthcare services. Insurance companies often impose time restrictions on counseling sessions and may have strict pre-approval guidelines for patients with complex treatment needs. A billing specialist will know how to navigate the murky waters of insurance service coverage and can uncover legitimate solutions to ensure successful claim submission and payment.

5) Maximize your revenue

A good billing specialist should ensure an agency is maximizing their revenue. This means an agency knows it is billing for every service that was conducted – without exception. The specialist will also ensure same-day services are documented and completed to ensure any payer bundling rules are met – this will aid in getting paid what you expect the first time, out the door. This also means all remits are posted promptly and all partial payments or denials are reviewed and acted on.

In the services world, progress notes are often what drives a charge from being created. If a billing specialist is on point to ensure notes are created promptly, a charge can then be created more quickly. The sooner a charge is created, the quicker you can create a billing file. Once the a billing file is out the door, the sooner you can get paid.

6) Aid in the switch to electronic billing

Switching to electronic billing can help a practice increase efficiency and reduce administrative costs. Additionally, the majority of payers prefer to be billed electronically. Despite these facts, the majority of healthcare practices still use paper-based medical billing.

An experienced billing professional can help your organization make a smooth transition to electronic billing. As a result, your practice will spend less money on postage, paper, envelopes and printing costs. Most importantly, an invoice can be sent with a few clicks of a mouse, enabling you to receive payment faster.

7) Identify billing inefficiencies

Making the switch to electronic billing is a great way to improve efficiency at your practice. But there are often other billing inefficiencies that can slip through the cracks as you and your team tend to patients, scheduling and operational issues. A focused billing expert will be able to spot these inefficiencies and bring them to your attention for correction. Here are some examples of things that can cause bottlenecks in your revenue cycle:

  • Incorrect coding
  • Illegible medical records
  • Incomplete documentation
  • Missing test results or diagnoses
  • Incomplete care plans

8) Provide claims rejection support

Your total write-offs will be dramatically reduced with the help of a dedicated billing expert who can assist with claims rejection resolution. There are many ways a specialist can provide support in this area, including the following:

  • First, they can make sure the rejection was not the result of a billing error. If it was, the specialist can often clear up the issue with an update to the billing fields or through an update to the patient record.
  • Next, they can carefully read through the insurance policy in question to ensure that all sections are clear to the patient and provider.

9) Remain abreast of the latest industry changes

Healthcare laws and mental health billing regulations are constantly evolving. Failure to stay on top of changes to healthcare laws can land your practice in hot water. Skilled billing professionals often attend continuing education conferences to gain insight into these changes. They can also make sure you and your team are educated about how the changes impact day-to-day operations. As a result, they can help boost your medical billing compliance.

10) Financial reports

Without the help of a dedicated billing specialist, it can be difficult to track your Accounts Receivable (AR) or know what financial reports should be run to provide the necessary results you are seeking. Do you want to report on charges, payments or AR? How do you want the data broken down? By Payer? By Date of Service? A committed specialist can prepare the necessary reports to summarize co-pays, receivables, claims and outstanding balances. Through timely and accurate reporting, you can identify weaknesses and continually improve the health of your revenue cycle.

11) Allows you to focus on top priorities

If you are like many providers and executives, you likely wear many hats. In fact, you may find yourself attempting to resolve billing issues, which are often not within your realm of expertise.

With a dedicated billing specialist to handle your claims, collections and reporting, you can turn your attention to key performance indicators (KPIs) such as sessions booked, revenue generation, patient outcomes and patient satisfaction. Your staff can also devote time to expanding your referral network, updating your website and enhancing your digital marketing strategy. The end result is a highly functional, well-organized behavioral health organization.

As outlined above, there are many ways a dedicated billing specialist can enhance your organization's functionality. Learn more about our wide array of billing solutions here.

Topics: Business Process, Billing