Behavioral Health Revenue Cycle Managment System Design & Implementation

Revenue Cycle Management involves the entire process of generating revenue from patient services. It comprises activities that enable payments for medical services received from a healthcare facility, from registration, verification of insurance information, claims submission, and reimbursement. The revenue cycle in healthcare also involves communication with different health insurance companies and government payer services. A proper revenue cycle in healthcare must ensure that correct billing protocols are carried out following best practices.

Behavioral Health Clinic Certification, Payer Contracting, Billing Configuration & RCM Support:

• Meetings & Communication with the Office of Medication Innovation (OMI)
• Policy & Procedure creation
• Onsite Review & Inspection
• IMPACT Enrollment
• Managed Care Contracting & Credentialing
• Billing configuration, testing and ongoing Revenue Cycle Management support

Managed Care Support:

• Contracting with all desired MCO’s
• Credentialing Services for Licensed Agency Providers
• Electronic Medical Record & RCM Software evaluation, optimization & reporting
• Billing/Claim Team Training & Support
• Billing Assistance and Troubleshooting
• Compliance Education and Assistance
• Solidify relationships with MCO’s & Commercial Payers
• MCO/Commercial Insurance contractual review, resolution & oversight
• MCO/Commercial Insurance credentialing & contracting
  • Facility Credentialing
  • Professional (Clinical Staff) Credentialing
• MCO/Commercial Insurance coding review, resolution & oversight
• Claims review & escalation to MCO/Commercial Insurance Leadership for payment

Contracting & Credentialing:

• Credentialing & Contracting Agency with all desired MCO/Commercial Payers
• Review & resolve the following with all MCO/Commercial Payers to ensure accuracy clean claims & maximum profitability:
  • Contracts on-file
  • Site loading
  • Site Services
  • Coding & Configuration

Outstanding Claim Recovery:

• Outstanding claims resolution & recovery
  • Source & solution
    • If Agency is the source for resolution, instruct billing team on coding & configuration procedures
    • If MCO/Commercial Payer is the source for resolution, capture all outstanding claims, work directly with the MCO/Commercial Payer claim configuration team & escalate to MCO/Commercial Leadership for expedited payment
  • Recover outstanding claims which includes:
    • Coding & billing review, resolution & oversight
    • constant communication with the MCO/Commercial Payers and quick resolution of issues as they arise
    • dispute all denied claims
    • resubmission of rejected claims

Staff Training & Support:

• Clinical Staff:
  • Managed Care overview training available:
    • What is Managed Care
    • Think Like an MCO
    • MCO Care Management
    • Prior Authorization & Importance
    • Medical Necessity
    • Documentation
    • Treatment Goals/Interventions
    • Progress Reporting
    • Authorization Request Follow-up
    • Appeals & Process
    • Retrospective Reviews
• Billing/Claims Staff:
  • Accurate Billing & Payment Processes
    • Revenue Cycle Management (from service delivery to payment)
      • Process evaluation & optimization
      • Service Coding (CPT & HCPCS)
      • Denials & Rejections
        • Troubleshooting
        • Appeals