This past month, Kipu Health invited industry revenue and billing experts to our “Rev Up Your Revenue Cycle” thought leadership event in Los Angeles, California. Kipu Health, along with Avea Solutions (who Kipu acquired last fall), hosted the event to share knowledge on how treatment facilities can fine tune their behavioral health revenue cycles and prepare for future changes that lie ahead in the industry, including value-based care reimbursement models.
The Behavioral Health Industry is Changing Fast
Paul Joiner, who joined Kipu Health last July as CEO of Kipu, kicked off the event with opening remarks stressing that the Behavioral Health industry is currently in a state of rapid transformation, requiring organizations to be able to adapt quickly. “Kipu is committed to investing heavily in our technology solutions to create agility for our customers. Now more than ever, facilities need to be able to respond quickly to payer requirements, regulations and other upcoming changes” he emphasized. “We’re focused on making sure that data and information can be shared and moved quickly to support the patient’s continuum of care. Kipu is building the ecosystem to do this, beyond providing an EHR system.”
Key Takeaways from the Panel Discussion
The event panel featured Ben Dittman, Founder of Avea Solutions, Co-Founders of Centerline Billing & Consulting, Patrick Mahoney (CEO) and Gabe Hynes (COO), Greg Keilin, Founder and COO, Prosperity Behavioral Health, and Rodney Zimmers, Co-Founder of Transparent Billing. Here are their key takeaways:
It all Starts with Verification of Benefits
- When verifying benefits, if something doesn’t sound right, question it. Errors can happen on the payer’s end, and it’s important to fix them while the patient is still in treatment.
- Have staff make notes about anomalies, and set up processes to communicate and discuss them.
- Ask about coordination of benefits. It’s a critical step that is often overlooked and can be the difference in a claim getting paid or denied.
- While doing verifications, check the quick eligibility – it will give you information on the patient’s policy while you are waiting for the full verification.
- Any errors made during the VOB process during intake are nearly impossible to correct once the patient is discharged, so take time to educate and train admissions and business development teams on how to correctly understand a VOB and what to watch out for.
Authorizations & Documentation
- Good documentation directly correlates to an increase in authorizations.
- Spend time on treatment plans so that they don’t appear “cookie-cutter” to a case manager. Include specifics about the patient’s situation, such as what is going on in their family life, what prompted treatment for them at this time, what level the family is involved in treatment.
- Adoption of your EMR and entering notes the right way by your clinical staff is critical, and will directly impact your revenue. Make sure you give your clinicians a system that works for them.
- It’s important to tell the patient’s story in the documentation. Clinicians are inclined to focus on reporting progress, so a good rule of thumb to have them follow is that if they were told their patient had to leave treatment tomorrow, what would they say to advocate keeping them in treatment? Be sure to include these points in their notes in addition to progress.
- Auditing your charts on a regular basis is good practice. Making improvements to documentation practices will have a direct and positive impact on reimbursements.
- Payers watch for documentation that is routinely copied and pasted, especially with group notes. Go the extra mile to include specifics such as the patient’s triggers, labs, nursing assessments, observations taken from nightly rounds, etc.
- Make sure to add your clinician’s credentials to their profile in the EMR, and follow a specific format. Payers want to see that appropriately credentialed people are providing services, and making this simple fix will eliminate unnecessary delays in getting your claims paid.
KPIs and Best Practices for Claim Submissions and Payments
- Ideally, claims should be billed the same day every week.
- Report and track the number of days between Date of Service and Date of Submission. Best practices are for this metric to always be below 7.
- Tracking and reporting on the number of units for each service delivered, by payer, will directly correlate to your revenue 3 to 4 weeks out.
- Monitor the number of days between Date of Claim Submission and Date of Payment. Any claim not getting paid in 60 days needs to be analyzed, with the issues for delay identified and categorized.
- Look for root causes and trends in your data, and take time to discuss with staff. Identifying the amount of revenue stuck due to key issues why claims are being paid, such as “no documentation”, helps motivate teams to prioritize, develop new processes and follow-through.
- Now more than ever is the time to operationalize your data. Create dashboards that bring visibility to your KPIs across the patient care continuum, from pre-admission to discharge.
And last, remember the revenue cycle doesn’t just exist at the end of the process, the revenue cycle surrounds the whole patient experience.
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It’s time to Rev Up YOUR Revenue Cycle!
For more information on how Kipu can help you manage your revenue cycle and improve your billing, click here. If you are ready to optimize your workflows, streamline processes, and get rid of the guesswork, book your consultation now.