Behavioral health revenue cycle management (RCM) can be a major headache without the right processes and tools in place. From verifying coverage before a patient’s appointment to submitting claims and appealing claim rejections, there are many moving pieces to manage throughout the behavioral health RCM process.

Working in behavioral health and human services (BHHS) means your organization relies on insurance reimbursements to maintain profitability and stay afloat with already strapped resources. As such, you can’t afford to miss out on potential cash flow due to poor revenue cycle management practices. 

That’s why it’s important to choose a tailored solution that can streamline and automate these processes. Explore the basic tasks and challenges that come with behavioral health RCM as well as the key considerations to keep in mind when looking for a billing tool.

What Is Behavioral Health Revenue Cycle Management?

Behavioral health revenue cycle management is the process of tracking and collecting revenue from patients and health insurance companies for services rendered. It’s a multi-step process that begins before the patient’s appointment and ends once full payment has been received, including any insurance reimbursements owed. 

Here’s a closer look at the steps generally involved in RCM:

• Patient pre-registration and registration: When a patient calls to schedule their appointment, the receptionist or intake coordinator collects key information, such as the patient’s full legal name and insurance details. This step is also where the practice will typically create the patient’s profile in its electronic health record (EHR) system, which may be separate from the organization’s billing system or integrated with it.
• Benefits verification: If the patient indicates they have insurance, staff should verify their coverage and eligibility before the appointment and again at the time of service. If a prior authorization is required by insurance and has not been submitted by a referring provider (such as the patient’s primary care doctor), this will also need to be initiated and processed before services are rendered.
• Charge capture and coding: Providers must document and code the services provided during the patient’s appointment or treatment for accurate billing. 
• Claims processing: This is when the billing department submits the claim to the insurance company or clearinghouse for reimbursement. 
• Denial management: If the claim is denied, the billing team will need to correct any errors or provide any additional information requested and resubmit the claim.
• Payment posting: Once one remittance for the claims is received, the payments must be recorded and posted to the correct patient’s account.
• Receivables follow-up: If any outstanding balances are due, the organization will need to either follow up with insurance or initiate patient collections (depending on whether the patient or insurance portion is owed) to obtain the remaining balance.
• Reporting: This step involves detailed reporting and analyzing key metrics to review RCM trends and identify opportunities for process improvement. 

Specific workflows can vary based on each behavioral health provider’s specific practices and procedures, and some steps like denial management or patient collections follow-ups may not be necessary for every claim. All of these steps may seem time-consuming and cumbersome, but thankfully they can be automated and simplified with the right RCM and EHR programs.

The Unique Challenge of Behavioral Health Revenue Cycle Management

Behavioral health can be more challenging than other medical specialties when it comes to healthcare revenue cycle management. Keep the following factors in mind when navigating behavioral health RCM.

Complex and Ongoing Patient Care

Behavioral health care is often more complex and ongoing compared to other medical fields that tend to deal with more acute illnesses or injuries. Mental health treatment can require ongoing collaboration between multiple care providers and trial and error to find the medications or treatment models that best suit each client. 

Oftentimes, behavioral health organizations offer a variety of treatment options under one roof — for example, group and individual therapy, outpatient programs, and intensive inpatient programs. Patients often use different services simultaneously or transition between programs and providers within the same organization. 

This can make billing and record keeping more complex as there may be specialized coding and added hoops to jump through to justify treatment choices to insurance companies. The billing process can be especially challenging when dealing with payers like Medicare and Medicaid that have their own specific requirements for behavioral health billing and claims reimbursement. To handle this complicated process, BHHS organizations need a tailored RCM software solution that can address the nuances of behavioral health medical billing.

Frequent Claim Denials

The rate of claim denials tends to be higher for behavioral health services while the reimbursement rates for services are generally lower when compared to other healthcare specialties. This means that BHHS organizations must work harder to maintain financial sustainability and more carefully track their claims to avoid missing out on revenue due to claims denials.

Limited Staffing Resources to Devote to Revenue Cycle Management

The behavioral health industry is chronically understaffed while demand for services is increasing. This can create a strain on clinicians and support staff who may struggle to stay on top of billing duties while trying to serve as many patients as possible. 

When resources are limited and staff are overextended, it’s easy to make a billing error or forget a crucial step like collecting updated insurance information. Using a digital RCM service that can automate data collection and claims processing can streamline behavioral health revenue cycle management and reduce the administrative burden of medical billing.

Addressing Financial Barriers for Patients

Making care accessible for those who need it while keeping the organization afloat financially can be quite the balancing act for BHHS providers. In the United States, a recent study identified affordability as the greatest barrier for health care and noted that the prevalence of financial barriers to treatment was higher for those experiencing mental health concerns. 

Cost can be a major concern for patients across all income levels and treatment needs, especially when considering more expensive treatments like inpatient care.

That’s why the early steps of the revenue cycle management process — such as verifying insurance coverage and patient co-pays ahead of appointments and discussing treatment costs with patients — are so important. You never want patients to be surprised by their bill or be unable to pay after services have been rendered. That will significantly harm patient engagement and satisfaction and can cause interruptions in their care or lengthy collections processes to obtain payment. 

How to Choose the Right Behavioral Health Revenue Cycle Management Solution

Finding the right RCM solution to address the aforementioned challenges can be tricky. Fortunately, there are solutions to tackle the specific needs of behavioral health organizations. It’s best to go with an integrated EHR and billing solution that combines EHR tools such as patient scheduling, communications, and documents with RCM functionality for a more seamless experience. 

When you choose a system with EHR interoperability, your team will be able to access a comprehensive view of the patient's demographics, billing and insurance information, and medical records all in one place for efficient, coordinated care. Patients will also enjoy being able to access self-service tools such as scheduling, provider messaging, and payments in a centralized location.

When evaluating EHR and RCM solutions, look for a highly configurable solution that can be tailored to your organization’s specific needs. You’ll want a comprehensive and programmable system like ContinuumCloud’s EHR that can accommodate custom workflows and complicated billing scenarios to automate even the most complex care plans and coding.

It’s Time to Simplify Behavioral Health Revenue Cycle Management 

Many electronic health record solutions lack the configurability and RCM capabilities that BHHS organizations need. In these fields, you need highly configurable EHR solutions that can be tailored to best suit your unique workflows.

ContinuumCloud offers a comprehensive EHR-integrated revenue cycle management solution built specifically for the behavioral health and human services industry. Our EHR software combines revenue cycle services like coding, collections, claims submissions, and denial management with advanced reporting and compliance tools.

ContinuumCloud’s EHR software includes an integrated end-to-end RCM solution with pre-scheduling tools, real-time eligibility checks, HIPAA-compliant communication features, patient payment processing and more.

Get in touch to learn more about how your organization can boost your behavioral health revenue cycle management and improve outcomes for providers and patients alike.