Healthcare Billing priorities for a more prosperous new year

Setting new healthcare billing and collections priorities for 2023 could unlock a more prosperous new year for behavioral healthcare providers.

Tracking certain key performance indicators and setting in place a system to better manage the claims process could boost a behavioral health organization’s bottom line by as much as 30 percent next year, according to the revenue cycle experts at Infinity.

“Behavioral health billers tend to fall short in a few key areas, including addressing aging claims, tracking denials, and following up in a timely manner. Underperformance in these areas can result in significant revenue losses,” says Eloy Paez, Executive Vice President of Infinity.

Outstanding receivables are notoriously higher for drug rehabilitation treatment centers, substance abuse counselors and behavioral health providers than other healthcare providers, he points out.

“Unfortunately, it’s not uncommon at all for behavioral health providers to see high numbers of unpaid claims in accounts receivable,” Paez says. “Their in-house billers often lack the knowledge or the time to adequately pursue these claims. This is money the organization has already earned, but those claims are just not getting paid.”

Addressing aging claims is first on a list of priorities Paez recommends healthcare billing providers have their billers follow up on to ensure an infusion of cash as the calendar flips to a new year.

Priority No. 1: Address aging claims

In a season where “out with the old and in with the new,” is heralded, prioritizing older claims is the best route to infusing the new year with new revenue.

With the clock ticking on the timeframe for payment, financially healthy healthcare billing organizations make certain claims older than 60 to 90 days account for less than 20 percent of total Accounts Receivable, Paez notes.

“Aging AR is one of the key performance metrics behavioral health organizations need to focus on, with an internal system for their billers to track and act on problem areas like reducing the number of aging claims,” Paez says.

Read more about four metrics every behavioral healthcare organization should regularly track.

Priority No. 2: Accuracy

Tracking denials to determine what the organization is doing wrong and taking steps to address and prevent those errors is another important route to increased profitability, according to Paez.

Is the organization experiencing missing or incomplete documentation? Are therapists and support staff properly documenting all encounters, admissions, and discharges? Is additional staff training needed to underscore the importance of documentation to reimbursement? Is coding accurate?

Incorrect coding of behavioral health encounters remains a primary reason for financial losses among behavioral health providers. 

Insurance reports indicate medical necessity denials continue to be a problem for behavioral health organizations as well. The Centers for Medicare and Medicaid Services (CMS) requires HealthCare.gov insurance plans to report denials based on lack of medical necessity. In 2020, of approximately 765,000 medical necessity denials, 20 percent were for behavioral health services.

Priority No. 3: Seek healthcare billing help

The best way to address misunderstandings and lack of knowledge leading to revenue loss is through adequate training. healthcare billing organizations should prioritize full compliance assessments to identify vulnerabilities and provide necessary education to ensure a more prosperous 2023, Paez recommends.

Learn more about full compliance assessments, and how they help behavioral health providers.

Many healthcare billing organizations lack the time to set in place necessary procedures to track and pursue aging claims, track denials and follow up in a timely manner. Staffing shortages exacerbate the issue, requiring constant compliance training for new employees to mitigate risk and ensure accuracy and efficiency of claims processing.

Outsourcing billing and collections, or management of the full revenue cycle, can be the answer. Clients generally see a 20 to 30 percent increase in overall revenue when they turn billing and collections or overall revenue cycle management over to Infinity, according to Paez.

Learn more about making the decision to outsource here.

Infinity can help

Our team of professionals can provide revenue cycle outsourcing services for timely and optimal reimbursement. We work hand in hand with the industry’s leading network of healthcare compliance experts to drive your cash flow and optimize profitability,

Use the form below to begin the conversation about how to get paid faster, more reliably while boosting your margins.