Revenue Cycle Management (RCM) is an important pillar of healthcare as it is the “gas that makes the engine run”. It wasn’t always a significant operational requirement for behavioral health and specifically addiction recovery centers.
Previously, few insurance companies covered these services and patients paid the providers directly, but in recent years, that’s changed. Data shows that 60% of Americans can have their mental health services fully covered by insurance and 58% of nonelderly adults are covered by insurance for mental illness or substance use disorder.
Now that insurance has started to cover these services differently, it’s become important for providers to find a solution. The problem? The process isn’t as straightforward as other healthcare services for a variety of reasons.
- Every diagnosis and treatment coverage can be unique. Because of this, any mistake can hurt reimbursement rates, which tend to be lower for behavioral health services.
- Navigating insurance is tricky at best. Many patients in need of these services are uninsured or underinsured, with one in five nonelderly adults with substance use disorder or mental illness uninsured. This means more work on RCM staff and higher rates of self-pay.
- There’s an immense focus on care. This is a good thing, but if it overshadows the bottom line, it’s hard to keep operations running smoothly. Patients need the best care while also making sure providers have their business needs met.
- Regulations and coverage frequently change. If providers don’t stay up to date on either, it can lead to costly errors.
There are hundreds of RCM providers out there that all claim to be the best option for providers, but for specific services under behavioral health like addiction treatment, opioid and substance abuse medication-assisted treatment (MAT), and mental health treatment, it’s best to find a partner that can develop the best RCM strategies.
Choosing an RCM Partner Specialized in Behavioral Health and Addiction Treatment Services
If an organization has used an RCM company before, but didn’t find the results they were looking for, it might be because they weren’t specialized in behavioral health, mental health, and addiction treatment services. That may not seem important, but here are a few reasons why it’s beneficial for the longevity of a business.
They have experience.
An RCM partner who has worked in behavioral health for some time knows that processes, legislation, insurers, and needs change constantly. They know what to expect and can keep an eye out for changes other companies may overlook because they cover so many types of care. This can help a business adapt to changes quickly and efficiently, saving time, headaches, and money.
They foresee problems.
An experienced RCM partner will troubleshoot problems before they arise and set up better processes so that there are fewer billing and collections errors in the future, paving a route to success.
They work with specific needs.
An RCM partner who specializes in behavioral health understands that services can change and will work with a provider to scale business needs. Whether it’s supplementing existing staff or behavioral health capabilities, they will make sure that the provider has the tools their business needs to thrive.
A behavioral health provider could go with any RCM service, but the best ones tend to meet and exceed their business needs. With 10 years of addiction treatment RCM experience, Strivant Health has learned how to navigate the complexities of getting paid quickly and correctly.
Some of our addiction treatment client results include:
- Increased MA gross collection ratio by 40%
- Reduced eligibility-related denials by 85%
- Decreased authorization denials by 90%
- Overturned 90% of first-pass claim denials
- Reenrolled 85% of patients with continuous coverage
Learn more about our capabilities to optimize people, processes, and technology and contact Mike Schiller, VP of Business Development.