How Behavioral Health Providers Can Efficiently Collect Medicare Advantage Reimbursements

Doctor looking over their laptop with insurance papers next to itStrivant Health has noticed a trend that’s quickly gaining steam: the difficulty of collecting from Medicare Advantage. And we aren’t the only ones.

According to a report from the Healthcare Financial Management Association (HFMA) and Eleciting Insights, an overwhelming majority of CFOs (92%) find it’s much harder to collect from Medicare Advantage than it was two years ago, and 62% of them find it significantly more difficult. But the same HFMA report shows that 45% of health systems are considering dropping Medicare Advantage and 16% won’t accept one or more MA plans in the next two years.

This is all during a time when Medicare Advantage plans are growing in popularity with over half of the 60 million Americans with Medicare are enrolled in MA plans. And in 2022, nearly one in four MA plan enrollees required referrals for mental health and substance use disorder services, including 20% that required opioid treatment program services.

More people are using Medicare Advantage to access behavioral health services, but the reimbursement is lacking. Here’s what we recommend to behavioral health providers who are having difficulty getting reimbursed by Medicare Advantage.

Accurately Code Medicare Claims with Coverage Variability

For providers to get as much as possible coverage covered by Medicare, make sure to accurately code diagnoses for mental health and behavioral health claims, including getting prior authorization for claims that require it as soon as possible. Without it, it’s immensely difficult to get reimbursed, so coordinating care with a primary care provider to get those authorizations is important.

The process can get even more daunting if patients choose a different independent provider association (IPA), which they can do monthly. If that becomes the case, eligibility and authorization have to be reconfirmed monthly.

Stay on Top of Network Requirements

Medicare Advantage contracts continue to get more specific and limited with who’s in-network and who isn’t. For many patients, it is difficult to find multiple IPAs covered in their plan within their region, so staying on top of it is a must to get reimbursed.

Work with an RCM Provider Specialized in Behavioral Health

A behavioral health system can work with any revenue cycle management provider, but not all providers are knowledgeable about how behavioral health coverage and needs change constantly. That’s why working with a partner like Strivant Health can be the differentiator in your ability to collect payments. We are working with clients with the same, specific issues other behavioral health providers are having, and we can help.

If your organization finds itself looking for a new RCM provider tailored to these needs, contact Mike Schiller, VP of Business Development, today to see how Strivant Health can help.

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