The most common way to understand the medical billing process is by taking the perspective of employee roles and dissecting each task. For example, the front office is in charge of scheduling and check-ins, clinicians handle charging, and the back office facilitates billing, coding, and insurance. Unfortunately, this leads to a siloed view of the revenue cycle management (RCM) process in behavioral health.
Today, healthcare, including behavioral health, is taking a more patient-centered approach in all aspects of practice management. Therefore, we’d like to examine the medical billing process through the lens of the patient's experience.
From pre-appointment planning and point-of-care workflows to billing and utilization review, you’ll learn how RCM works. Plus, we’ll include industry best practices and behavioral health technologies you can use to keep your business on solid financial footing.
What Is Revenue Cycle Management in Medical Billing?
RCM in medical billing is the method of tracking patient encounters through the billing cycle. It’s possible to use stand-alone practice management software designed for each task, including electronic medical records (EMRs), billing, coding, accounts receivable, insurance denial management, and patient relationship management software.
These tools may get the job done, but having a complete revenue cycle management solution integrated with electronic health record (EHR) software can streamline administrative workflows, improve productivity, and reduce missed charges. In addition, patient portals and communication tools can enhance the patient experience while boosting retention and ultimately improving patient outcomes.
Revenue cycle management in behavioral health is even more complex, requiring a depth of understanding that general RCM may not offer. ContinuumCloud specializes in providing behavioral health organizations with expert health IT services and software like EHR and RCM solutions that simplify the billing process and help speed up the entire revenue cycle.
During this phase of revenue cycle management, activities are critical to running an efficient practice. They ensure that your clinicians have more time to spend with their patients and the information necessary to make the best decisions. They also affect your ability to collect timely payments from the patient and insurer. Often, it’s the first opportunity to impact the patient experience.
According to the American Medical Association, effective pre-visit planning can mean the difference between a clinic where your clinician and team are overwhelmed, and a clinic that is able to deal with the inevitable problems that may arise. Pre-visit planning includes the following RCM activities.
Today's behavioral health practices leverage technology from the moment of contact. ContinuumCloud's electronic health record (EHR) solution improves productivity by including a patient portal where patients can self-schedule, reach out with questions, and request refills or referrals.
Gather Patient Information
This step in revenue cycle management enables you to record demographic information, clinical data, and insurance information. You can also use this opportunity to convey financial expectations, including payment policies.
With ContinuumCloud’s RCM-integrated EHR system, you can email or text each patient a questionnaire to complete before their appointment. The pre-appointment questionnaire will become a part of the EHR system. This will allow the entire behavioral health team to see what is most important to the patient, and help the clinicians plan ahead. It can include a medication list for the patient to review and edit before each visit.
Verify Insurance Coverage
Eligibility verification involves gathering patient information and verifying it with the payer through an online clearinghouse. It's important to confirm the patient's insurance coverage and benefits and to get authorization in advance so the clinician understands what services are covered. Verification maximizes your cash flow, minimizes the number of denied claims, and keeps your patients satisfied.
Verifying eligibility is automated in ContinuumCloud's behavioral health RCM solution. What's more, the mobile app supports remote access so that clinicians can verify insurance coverage in real-time before seeing a patient while in the field.
Send Appointment Reminders and Follow-Ups
A patient's behavioral health and your system's financial health are both affected by missed appointments. In a survey done by the Medical Group Management Association, 88% of respondents reported using automated appointment reminders. You can measure your return on investment (ROI) in several ways, such as:
- Increased profitability
- Reduced no-show rates
- Enhanced compliance
- Improved staff efficiency
- Boosted capacity to see more patients (improved patient access)
Many practices have team members make phone calls or send letters directly from the office to remind patients of an upcoming appointment. This is helpful, but it’s time consuming and inefficient. ContinuumCloud's EHR solution automates appointment reminders, allowing you to send emails or text messages days before your patient's appointment.
Can follow-ups be a part of pre-appointment planning? Following up with patients who miss an appointment is equally important for the financial health of your practice. Follow-up also improves the patient experience and ensures that patients don’t fall through the cracks.
ContinuumCloud's EHR solution and cloud-based RCM technologies include applications to extend your reach with workflow automation like follow-up questionnaires. Now you don’t have to wait until a patient misses an appointment to plan the follow-up — the entire process is automated and triggered when a patient misses an appointment.
Point-of-Care: Administrative and Clinical Workflows
A patient's appointment day can be divided into two workflows: administrative and clinical. Both are important to revenue cycle management.
Whether due to safety concerns or convenience, some healthcare organizations have switched to contactless check-in. According to one survey, 78% of patients prefer it over face-to-face check-in. And 85% want to make their payments online. This is great news if you have the technology to support your transition.
ContinuumCloud’s behavioral health EHR system and end-to-end RCM solution includes a patient portal that automates the entire four-step check-in process:
Verifies the information on file is correct and updates it as needed
Collects patient responsibility fees, including copay or coinsurance
Prepares the patient for their appointment
Notifies your clinical staff that the patient is ready
The primary clinical workflow during the patient appointment is charge capture. This is the process used by behavioral health providers to get paid for their services by recording information which is then sent out to different payers and insurance companies for reimbursement.
The Medical Billing Process
The billing and claims process is the next step in the revenue cycle. It involves creating, processing, and paying medical bills. This step causes the most worry and anxiety for the patient. After all, no one likes to get a surprise medical bill.
Research shows that the key to patient satisfaction and loyalty is the "financial experience." In fact, 93% of patients say a poor financial experience will cause them to look for a new provider. A satisfying experience reduces patient collections as well.
ContinuumCloud's integrated EHR and RCM solutions help to bridge siloed processes and enable medical billing while reducing the likelihood of denied claims and surprise bills.
1. Medical transcription involves converting voice reports dictated by doctors and other healthcare professionals into text. Consider an electronic health record that digitizes progress or therapy notes directly into the EMR in order to eliminate transcription and reduce human error.
2. Medical coding converts patient treatment records into language that insurance companies and government payers are able to understand. An EHR should enable your coders to have the information they need without delay.
3. Charge entry is the process or set of processes by which medical procedures and other services that are performed on patients are charged to their insurance companies. This involves providing a detailed account of the services rendered as well as important clinical information. Charge entry is simplified with an EHR that automates data entry. With ContinuumCloud's revenue cycle process automation, billing becomes more accurate with fewer lost charges and charge lag days.
4. Claims submission is when an insurance company receives an electronic claim. Choosing an EHR/ RCM solution that automates claims management helps reduce the risk of denials and ensure clean claims before submission.
5. Accounts receivable follows up with insurance companies and other payers. Patients who carry a balance after reimbursement will also be billed in this process. An automated RCM solution can keep track of accounts receivable follow-ups to ensure timely responses and accurate patient billing.
6. Claims denial management plays a key role in RCM because it increases revenue by addressing denied claims and by improving the speed of payment. Reduce denials with an EHR/ RCM that uses automated claims management like ContinuumCloud.
7. Payment posting involves reviewing and recording payments from insurance companies, and government payers like Medicare. Payment posting data paints a picture of your organization's financial picture. Look for RCM software that can automate correspondence, manage bulk payments, and handle insurance revenue posting.
Utilization Review and Reporting
Utilization review is the process of reviewing behavioral healthcare services to ensure they are being used appropriately and efficiently. It is set to be a key component of value-based care. Utilization review can help practices identify inefficiencies that impact revenue cycle management.
For instance, a health system may discover they can save time and optimize scheduling of patient care appointments if they plan ahead. The practice could then implement a checklist to prompt the healthcare provider to choose an "interval until next appointment" as well as any associated labs that are needed.
Reporting is another important part of value-based payment systems. Users can access over 1,200 types of report templates using the company's RCM reporting dashboard. Scheduling, billing data, behavior reports, cycle summaries, and treatment plans are some of the most commonly used templates.
ContinuumCloud also provides a range of revenue report templates, billing and reimbursement reports, and staff efficiency reports. You can also customize reports and templates.
Revenue Cycle Management Solutions to Improve Patient Experience
In behavioral health, successful revenue cycle management starts with pre-visit planning and continues through utilization review. Thanks to new technologies like integrated EHR with RCM, the patient’s experience can be improved through enhanced communication, streamlined appointment scheduling, and boosted team efficiency before, during, and after all patient visits.
At ContinuumCloud, we specialize in helping clients in the behavioral health, human services, and substance use recovery industries streamline and improve revenue cycle management. ContinuumCloud offers end-to-end RCM solutions, interoperable EHRs and other products to help you provide efficient, safe, and quality care.
To find out how we can help improve the patient experience (and your bottom line), connect with an expert today.