Category: Adolescent Behavioral Health

The reality

It’s a typical Friday morning, birds chirping, blue skies and sun is shining. The only thing on my mind was if I was going to work at home or to set up shop on the beach because I could already feel the heat coming in from my open window. As I do my morning ritual, which is to check all my social media platforms, (hopefully I’m not the only one who does this), the first thing I see is a post saying, “Anthony Bourdain, world-traveling chef, and TV star, dies at 61 in an apparent suicide.”

Immediately all I could think of was how influential he was to me in particular. I’m an aspiring chef, and of course, I enjoy writing and love seeing the world through the eyes of those who are not like me. Anthony Bourdain embodied all of these qualities and more, and then shared them with the whole world so they could see, feel, taste and touch different cultures in ways we never thought were possible.

I believe he did this because he was a true humanitarian. He was unbelievably intelligent with his articulation and pulling in your attention, also one of the most real and raw speaking public figures I’ve ever seen on television. Please don’t get me wrong, I’m not comparing it to those reality shows that have no substance or positive influence, you know what I’m talking about..take your pick.

I say all of this to point out, that we as “humanity”, lost a very significant influential character that strived to make our world a better place to live, make us feel more alike than different, and showed us it’s ok to know the unknown. No pun intended.

So now let’s talk about the real problem at hand. The elephant in the room that everyone knows is there and continues to grow bigger and bigger as we speak. Suicide! Just days before Anthony Bourdain’s death, successful and well-known American fashion designer, Kate Spade, took her life also. It’s a reality that has become a loud cry for help.

We can’t forget that not all suicides get the publicity like celebrities’ get. Normal families across the nation are losing loved ones because of this very serious problem. Rather it is due to substance abuse, mental health, or whatever…there is no explanation good enough that could justify taking your own life.

We sometimes think that we have to emulate and try and live this, “perfect life”, and are ashamed or scared to talk about our problems with someone. Just like anything that you plant, that bad seed is going to continue to grow and start to invade every aspect of your life if you realize it or not. That’s one reason why it’s so important to discuss your problems with an outside perspective. A lot of the times we lose sight or get so submerged in the maze, we need that light at the end of the tunnel so we know what direction to head.

The numbers

The CDC (Centers for Disease Control and Prevention), analyzed the increase of suicides in the United States, using data from the National Vital Statistics System research from 1999 to 2016, and shows that suicide has increased 25%. This includes twenty-five states experiencing a 30% rise in suicides across the nation.

Dr. Anne Schuchat, principal deputy director of the CDC, states that more than half of those who died from suicide were not even medically diagnosed with a mental health condition.

“These findings are disturbing. Suicide is one of the top 10 causes of death in the US right now, and it’s one of three causes that is actually increasing recently, so we do consider it a public health problem — and something that is all around us,”  –Dr. Anne Schuchat.

Her statement is a rude awakening and hits close to home for all of us. If we don’t intervene, these numbers will, unfortunately, reach catastrophic numbers.

Just in 2016 alone, 45,000 deaths were lost to suicide. Taking a look at individual states Delaware ranging from a 6% increase and nearly a 58% increase in North Dakota, researchers say.

Data collected from the National Violent Death Reporting System shows that 54% of individuals who committed suicide in 2015 did not even have a mental health condition. What’s more alarming is, researchers found that different circumstances such as relationship problems or loss of someone triggered more suicides than those who were medically diagnosed with a mental health condition.

Get help

We are all vulnerable to this reality, and we need to be there for those who need it and when they need it. If you notice someone may be dealing with this problem, speak up and talk about it. There are professional, confidential and friendly organizations that can help. Places like the National Suicide Prevention Line, are here to help those who need it. You can also call 1-800-273-8255, and they are available 24/7 every day.

If you want to reach out to a Mental Health facility, do your research to see which one will be the best fit for yourself or whoever is seeking help. Hundreds of treatment centers across the United States, for you to choose from, and they all have well-qualified therapists and doctors that are trained to get your life back.

Awareness of this topic can never go unknown, and you can help by re-posting, commenting, by just starting a dialogue on your social media platforms may just save someone’s life.

Helping someone who has an addiction can be a very challenging task, especially when it comes to a loved one.  We have put together a simple yet effective little guide to help you get started.

  1. Call attention to the situation.

Family members are often more in denial than the addict themselves. Talk about it. Put the elephant in the room on the table. You know it’s a problem and everyone can see and feel it. Now it’s time to take action and do what you have to because you love and care them, sometimes more than they love and care for themselves.

  1. Get on the same page.

There will be hostility. Show a united front and get on the same page to have the greatest impact. This may mean hiring interventionist to lead an intervention. The addict will not welcome nor consider any type of help if they feel they are being attacked or forced to do something. Get a common understanding and express your love and concern so they understand your worry for their well-being.

  1. Act immediately

It is extremely important to get an addict into drug treatment the moment they are ready – and before they change their mind. A new environment and professional care will help your loved one get better for good. Reassuring them that you will be there for them once they get out of treatment and expressing how proud you are of them for committing themselves to treatment.

Following these three steps can be of great help when approaching a loved one with an addiction. The addiction can sometimes be the layer on top of the real issue with the addict, and going to treatment and getting the care they need and deserve will allow those problems and or issues to surface to be talked about.

We hope this was informative and helpful in your journey of helping your loved one with an addiction. There are many treatment centers and options to choose from, finding the one that works for you and them is as simple as reaching out and doing some research to find which one you’re most comfortable with.

These simple fixes could save thousands of dollars and dozens of headaches. Work them into your billing processes!

Is your treatment center experiencing financial difficulties? There are many billing errors that can cause claims to be denied. Payments being delayed, incurring fines, and revenue loss can all happen due to errors not being caught before submitting claims. So before you start sending your claims out, beware or the most common mistakes.

 

  1. Having a brain lapse and forgetting to verify insurance

Believe it or not, the top reason why most claims are denied is because there was no initial verification of benefits and coverage. We all know insurance can change for whatever reason. So it is crucial that the provider verifies it every time services are rendered. When you don’t verify insurance properly, things like are overlooked like.

  • Members coverage may be terminated
  • The service isn’t even authorized in the first place
  • The plan benefit doesn’t cover the service being rendered
  • The Lifetime Maximum benefit has been met

 

  2. Inaccuracies in the Patient’s File

You would be surprised how something as simple as a patient’s name being misspelled, or having the wrong date of birth, or is this the patient relationship status to the insured correct, also using a policy number that is invalid can cause claims to be denied upfront. However there are some pieces of information that aren’t so clear and easy to notice like.

  • The claim requiring a group number to be entered
  • Making sure the diagnosis code matches with the procedure code
  • If there are multiple insurances, making sure the primary insurance is right for coordination of benefits

You don’t want to have to miss one of these simple pieces of information — making the claim go from say a 1-2 week turnaround, to a 30 to 45 days before the claim is paid.

3. Not using the Correct Diagnosis or Revenue/HCPC Codes on Claim

Like stated above making sure the diagnosis and procedure codes match are very important, but more importantly you want to be sure the codes being used are actually correct. This is how the insurance company knows the symptoms, disorders and how they are being treated by the facility. Incorrect information can result in a immediate denial of the claim for not being medically necessary, or it doesn’t match the authorization given for treatment.

Couple of things to consider as to why the wrong diagnosis or procedure code could be submitted resulting in denial.

  • Your Coding books are out of date and you’re using old protocols that have been revised. They can be pricey but is it really worth losing revenue on avoidable denial errors?
  • You might laugh, but if you handwriting is not up to par and causing claims to be denied because of horrible penmanship, you should really consider switching from paper claims to a electronic submission.

 

4. Duplicate Billing

Duplicate billing is just what it sounds like, billing for the same service or treatment  on more than one claim. It can also be considered as billing for a procedure that wasn’t even performed in the first place. It is very key to perform Chart audits for all patient’s to ensure claims are being billed out correctly. Ultimately you want to try and limit this to none, as facilities are fined each year for these small mistakes and considered as committing fraud. Ouch!

 

5. Misrepresenting Level of Care

This occurs when you the level of care is incorrect in order to receive a higher reimbursement rate from the insurer, also referred to as up-coding. Claims are looked at in fine detail to it’s better to just not do, or once again it will deny and stall the claim payment.

Revenue Cycle Management 101

Like many other industries, drug rehab and mental health treatment facilities’ financial solvency depends largely on their ability to collect payment in a timely fashion. In order to ensure your receivables are collected in a timely fashion, it is imperative to either have an in-house billing team that runs like a well-oiled machine, or find a stellar third party billing partner.

When it comes to operations in the behavioral health industry, Revenue Cycle Management is not normally the first thing that comes to mind. However, as this industry continues to become more competitive, streamlining your billing operations is crucial. This guide will help outline this process.

Revenue Drivers for Behavioral Health

Hopefully, during the strategic planning of your program, key revenue drivers have been established. These revenue drivers are dependent on your program’s specific type of business model: inpatient or residential vs. outpatient.

There are similarities in foundational revenue drivers in terms of substance abuse and mental health insurance reimbursement. These start even before a potential client steps one foot in the door and can continue long after they are gone:

The ability of your program to execute all these tasks in a consistent and efficient manner is directly reated to the amount and timeliness of which you will receive reimbursement.

  • Staff-to-client efficiency
  • Census level
  • Cost of programming
  • Claims reimbursement from both Medicaid/Medicare and private health coverage
  • Client claims (coinsurance, copayments, deductibles, etc.)
  • Collections

These internal drivers are all controllable and can be easily improved upon with some consistent processes and follow-through. Where many organizations struggle is dealing with the more external variables, like collecting from insurance carriers, patients/families, and other payers.

When trying to optimize your revenue cycle, you have to take into consideration the existing setup of private and insurance pay processes. Insurance carriers can take weeks to reimburse stays at behavioral health facilities.

Each individual entity will have their own method of checks and balances to both make sure their policy member is in need of treatment, and how much and how often reimbursements will be paid.

There are many facilities that operate from a dated business model: payment can be made after services have been rendered. Although this approach can help with increasing census, it will end up with longer collection times and ultimately a payment level that equals less than the full cost of care.

 

Pre-paying and Reimbursements

Claims, claims, claims. There is a reason third party billing exists, and that there are experts within all the different areas of billing. Insurance claims reimbursement—especially for mental health and substance abuse—is not a simple process. It is also an increasing, major portion of a facility’s overall revenue (compared with private cash pay).

  • Claims reimbursement starts with proper claims management.
    • This process involves meticulous note-taking
  • Reimbursement rates negotiation – all levels of care including:
    • Inpatient
    • Residential Treatment (RTC)
    • Partial Hospitalization (PHP)
    • Intensive Outpatient (IOP)
    • Routine Outpatient (ROP)

The negotiation of contracted rates for behavioral health reimbursement can vary state-by-state and region-by-region. There are different laws and regulations that govern not only how care is administered, but also how it is paid for and reimbursed by insurance carriers.

Navigating these waters is a full-time job in and of itself. If your program does not have room or resources for a dedicated staff member or in-house team, it is best to connect with outside experts.

This includes an organization that is knowledgeable and understands:

  • The lengthy legal appeals process
  • The ins and outs of coding
  • The subtleties of mental health and addiction language
  • Timely filing and follow up
  • Quality assurance

appeal letter for insuranceA common occurrence with insurance claims is that they are either fluctuating and underpaying or not paying at all. If someone is not watching these claims on a day-to-day basis, it can be difficult to keep your revenue cycle management on point.

A recent in-depth report by 60 Minutes found the claim denial rate often exceeded 90% by Anthem in cases it reviewed.

Even facilities that are running their billing operations as smoothly as possible can still face an uphill battle to keep a solid, timely, and full amount of reimbursements coming in.  Rejection rates are going to continue to rise as insurance becomes more and more expensive.

The other factors involved in keeping a solid revenue cycle from insurance reimbursement are the other payables: deductibles, co-pays, and co-insurance. Because of the recent spike in health insurance premiums, there is a correlating rise in people taking on more of the share of the cost.  This means that your cash pay collection processes will be put to the test as well.

 

Collections and Margins

In order for any type of collection to make sense, it has to make cents. It does no good to go after receivables or debts that cost you more to get them then they are worth.

More than likely, the lion’s share of your revenue will come from reimbursement; however, most of the work put into collections will be in getting private pay clients to pay for services rendered.

You have to realize that private health insurance paying for drug rehab or therapeutic boarding schools is a relatively new concept. This option essentially did not exist before the Affordable Care Act was put in place. Because of this, debt collection from insurance reimbursement is now a severe pain point for behavioral health facilities.

For instance, with Blue Cross Blue Shield, all reimbursement checks are sent to the family and not the facility. This creates an additional step in the process, and a huge problem/delay in revenue collection. Because the insurance process is complex and cumbersome, many parents do not realize that the reimbursements they receive are not theirs, and it puts tension on all parties involved.

There was and still is a huge learning curve for proper and diligent insurance billing. In order to maximize allowable amount of reimbursement, it is essential to closely watch the accounts owed for all of the major insurance carriers.

It takes a serious amount of resources, including staff who can:

A good revenue cycle in this industry should never get beyond 40-50 days.

If there are enough resources allocated to keeping things organized and processes flowing smoothly, this should not be a problem.

To summarize, a facility must streamline:

  • Verification of benefits
  • Collection of any co-insurance, co-pay, or deductible up front
  • Utilization reviews
  • Referral management system
  • Claims follow-up
  • Denials management

 

The Right Resources for the Right Job

The world of healthcare and healthcare billing is a complex one—a world that, by its very nature, works backwards, and involves extreme delays in payment cycles. Even with these long payment cycles, you should be taking some steps to accelerate the process, or to at least minimize unnecessary delays. Otherwise, an average of 40-50 days for payment can turn into 90-120 days.

Here are some tools you can use:

Roadmap

Think of billing as a chain-linked process. All of those involved with an insurance pay client, including the initial touchpoint, have to understand the entire roadmap from start to finish.

Everyone involved needs to be able to understand what codes will be used, the process of filing a claim, and whether or not their health plan will be a good fit upfront.

Software, The Web, and Being Mobile

  • Electronic Health Records
  • Client Relationship Management
  • HIPAA Compliance
  • Mobile Friendly

Knowing these technical terms is instrumental not only in streamlining a facility’s revenue cycle, but also in conducting overall operations. There are many options in the HealthTech world, and which software you want to use will depend on the size and needs of your facility.

Once you choose the correct technologies for your needs, here are some helpful hints to speed up the revenue cycle:

VOB

  • Verify insurance online through the carrier portals in order to avoid long call wait times, and be sure to double-check benefits.

Payments

  • Collect all insurance payables upfront and offer to reimburse clients after insurance has made payments.

Tracking Patients

  • Training therapists and support staff to properly document their client encounters, admissions, and discharges with quick notes and details.
  • Make sure clients have primary diagnoses as well as secondary diagnoses if warranted.

Insurance Billing

  • Once you have submitted a claim, make sure someone is following up within at least 72 hours to make sure it has been accepted by the clearing house and processed by the carrier.
  • Insurance billing reporting will allow you to forecast financials and show trends in health care plans, diagnoses, payment cycles, and much more. Make sure whatever billing software you use has a solid reporting functionality.

This is all easier said than done. It requires a quality team of reliable professionals dedicated to keeping your facility running as efficiently as possible. Your revenue cycle management should be a living, breathing process that is constantly revisited, adapted, and updated. Don’t get complacent!