Strategies for Future-Proofing Mental Billing Management System

Whether it's a prior authorization requirement or a medical coding error, everyone sometimes gets a delayed insurance claim.

Data shows 31% of commercial payers haven't paid inpatient claims for over three months.

You know how you want to keep your revenue flowing smoothly in your practice, but sometimes there's a problem with getting your claims sorted out. For some mental health clinicians, it can take up to 5 months to get paid, which is more like a big problem than a regular process.

To fix this, you need to act quickly. The first thing to do is figure out the main reasons why your claims get denied or delayed. Also, learning the top tactics for timely reimbursement will help you keep your revenue cycles turning in the right direction.

Top Reasons for Claim Denials in Mental Health Practice

Let's look at six typical reasons your claims may be denied and not paid:

  • Failure to submit a claim within the time frame specified
    Failure to follow insurance preauthorization rules.
    Incorrect subscriber identification.
    Noncovered services.
    Bundled services.
    Incomplete coding or does not follow ICD-10.
    Incorrect modifiers.
    Inconsistencies in data.

Top Tactics for On Time Reimbursement for Mental Health Practice

To mitigate such delays in reimbursements and maximize revenue, healthcare providers need to take a proactive approach to medical billing.

Here are some timely reimbursement tactics:

Create a Clear Collections Process

By ensuring patients understand their financial commitments, a transparent collection approach helps boost revenue cycles. Establishing clear conditions, collecting patient information, confirming addresses, obtaining permission to leave messages, reminding patients about co-pays, verifying eligibility, collecting upfront payments, and sending out reminders should all be part of the process. Specialty practices may need to tailor their procedure to their specific needs, with a priority on new-patient orientation, validation, and notification.

Manage Claims Efficiently

Approximately 80% of medical bills contain mistakes, which result in denied claims and late payments. To reduce this, claims should be correct and complete the first time, with inaccuracies double-checked before submission. Errors are commonly caused by erroneous patient, provider, and insurance information, duplicate billing, and inaccurate documentation. Upcoding and undercoding can also happen, either purposefully or unintentionally, and should be avoided.

Handle Denied or Rejected Claims Quickly

As a result of errors, claims get rejected, and denied claims will be deemed unpayable due to a violation of the payer-patient contract or an error after processing. Both should be handled as early as possible, with discussion with a payer representative to speed up the remedial process.

Reduce Coding Errors

Coding errors might arise as a result of inadequate diagnostic codes or inappropriate modifier application. These mistakes might lead to missed reimbursement or reduced payments. Before submitting codes, medical coders should double-check them, call providers if the process description is not clear, and cross-check with medical coding resources.

Look for Opportunities to Improve

Accounts receivable should be tracked, medical billing standards and regulations should be followed, problem areas should be identified, and medical billing should be outsourced to third-party specialists where appropriate.

To Conclude

Every practice struggles with medical billing denials. But the best billing departments know how to handle claim denials and can get this number down to 8% or lower.

Wondering how an expert RCM partner can help your practice with claim denials?

At BillingMD360, we render expert help to practices in developing solutions that revitalize and empower their revenue streams. We know exactly what to search for in order to maximize your earnings.

Schedule a session with us for a mental health billing check, and our experts will inform you about potential missed income. Thereby, we reduce denial issues, and sooner you get back to enjoying what you do—caring people.

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