Key Ways to Avoid Behavioral Health Payer Denials | Insurance Claim Approval 101 скачать в хорошем качестве

Key Ways to Avoid Behavioral Health Payer Denials | Insurance Claim Approval 101

Behavioral health organizations deserve to get paid for the services they provide —as quickly and efficiently as possible. For this to happen, they need to make sure payers are approving their claims. SimiTree Behavioral Health RCM expert Jeanna Boyer, Business Development Executive, knows what it takes to ensure payers don’t deny your behavioral health organization’s claims. From positive communication to staying up to date on regulations to leveraging your technology to its fullest potential, Boyer walks you through some of the top ways to prevent claims denials. Want to know more about how SimiTree Behavioral Health can improve your behavioral health organization’s financial health? Call us today at 800.949.0388. To learn more about our behavioral health business solutions, visit https://bit.ly/simitreeBH. Follow us on social! LinkedIn: https://bit.ly/SimiTreeBHLinkedIn Facebook: https://bit.ly/SimiTreeBHFacebook #behavioralhealth #mentalhealth #substanceusetreatment #payers #insuranceclaims #healthinsurance #revenuecyclemanagement #rcmbasics #payerbasics Full Transcript: Hello, my name is Jeanna Boyer, and I'm with SimiTree Behavioral Health. Today, I would like to talk to you about key ways to avoid payer denials. Let's start with education and communication. Make sure that your front office staff, your clinicians, and your billers are all on the same page. This would include your practice or facility's policies and procedures being thoroughly understood, as well as the services being performed to coordinate with the billing codes that you are using. Make sure that your intake staff are collecting the most up-to-date and complete patient information and develop a workflow with your staff for checks and balances. Verify insurance prior to services being performed. Ineligibility accounts for almost 24 percent of all up-front denials. Understanding your patients' benefits and how they relate to the services being performed is crucial to your claim being paid appropriately and from the initial submission. Knowing your payers. Verify if a payer needs a referral, an authorization, or a medical necessity determination. Obtaining this information on the front end will drastically reduce your upfront denials. Now, even though obtaining this information is not a guarantee of payment, if it is required, it will initiate a denial if not obtained. The payer may request additional information to support that medical necessity, so make sure that your documentation supports the services that you are requesting. If you have in-network contracts, make sure that your clinical staff and your billers are aware of the particular guidelines required for certain services and the coding that has been detailed in your contract is used appropriately. Documenting accurately and appropriately. Make sure that you are using the most current version of CPT, HCPCS, and ICD-10 codes. Make sure that you're coding to the highest specificity. Remember that it is fraudulent to bill for services that are misrepresented, even if it is an honest mistake, so clear and concise documentation helps to ensure that proper coding is done the first time. Corrected claims that are sent can add 30 to 60 days to your reimbursement and open you up for medical review by the payers. Put in place key performance indicators, or KPIs, and conduct random chart audits to reduce your risk. Make sure that you do provide feedback and hold in-services to keep your clinical staff up to date on any changes or new requirements from your payers. Leverage your technology. Use your technology to its full potential. The more automated your processes are, the less likely the claim will have to be touched manually before it is submitted. Build in alerts and scrubbers and try and base those on your individual payers. Use your technology to monitor and analyze trends. This will give you a heads-up into any challenges you may be experiencing with your payers and identify it quickly to reduce your future denials. And lastly, learn from your mistakes. Identify and resolve as soon as possible. Everyone makes mistakes but understanding the what's and the why's will help you to be more proactive and not as reactive in the future. Thank you for joining me today, and I hope this information has been helpful to you.