Panacea Billing

6 Revenue Cycle Management Mistakes That Drain Behavioral Healthcare Profits

Tue, 22 Jul 2025 19:49:00 GMT

Revenue Cycle Management (RCM) is the backbone of financial health in any medical practice, but it’s particularly critical for behavioral healthcare providers who face unique challenges. Between evolving regulations, complex payer requirements, and high patient volume, even small missteps in RCM can lead to major revenue loss.

Below are the six RCM mistakes draining behavioral health providers’ profits—and how to avoid them.

Inadequate Insurance Verification
Failing to verify insurance eligibility before a patient visit can lead to denied claims, delayed payments, or unexpected out-of-pocket costs for patients. Behavioral health services often require prior authorization, and skipping this crucial step causes reimbursement delays or denials. Automating this process or outsourcing it to a billing partner ensures timely verification and fewer errors.

Incomplete or Inaccurate Documentation
Clinical documentation must align precisely with billed services. Behavioral health coding can be nuanced, especially with time-based codes or group therapy sessions. Inadequate documentation leads to claim denials or underpayments. Providers should receive ongoing training, and documentation should be reviewed regularly to ensure compliance with payer requirements.

Delayed Charge Capture
Every day a charge goes unrecorded is a day closer to lost revenue. Behavioral health practices often experience delays in recording services, especially in busy group settings. Using integrated EHR systems and mobile tools can ensure charges are entered promptly and correctly.

High Denial Rates and Lack of Follow-Up
Claim denials are inevitable, but failing to analyze and appeal them is a costly oversight. Many providers lose thousands by not following up or understanding the root causes of denials. Behavioral health claims are often denied for documentation gaps, incorrect codes, or missing authorization. Implementing a robust denial management workflow can drastically improve recovery rates.

Underutilized Data and Reporting
Behavioral health practices rarely leverage their billing data for operational insight. RCM data can reveal trends in denials, patient no-shows, average reimbursement rates, and provider productivity. Ignoring these insights means missed opportunities to optimize performance and increase revenue.

Outdated Technology
Many behavioral healthcare providers still use outdated billing software or manually track RCM processes. This leads to missed deadlines, errors, and inefficiencies. Modern cloud-based RCM platforms streamline billing, flag potential issues, and offer real-time analytics—ultimately improving cash flow and compliance.

Final Thoughts
Improving RCM is not just about reducing administrative burden—it’s about protecting the financial viability of your behavioral health practice. By identifying and correcting these common mistakes, providers can significantly increase profitability while delivering better care to their communities.

Are you a behavioral healthcare provider in need of medical billing services?

At Panacea Healthcare Services, our mission is to provide a “one-Stop Shop” solution for your healthcare business needs. As you focus on patient care and the growth of your business, let us manage your operational needs. Panacea provides a full suite of services that includes premier claims management in addition to an array of services that are vital to your healthcare organization’s stability and growth.
Some of our services include:
► Billing & collecting
► Utilization Review
►Appeal Management
and much more

Can hiring a medical billing company reduce errors and increase revenue?

Wed, 25 Jun 2025 16:31:00 GMT

Undoubtedly, billing for behavioral healthcare is a complex field filled with mistakes and mismanagement. As the costs of managing medical billing processes in-house rise, so does the pressures of keeping up with the industry’s ever changing rules and regulations. In fact, your treatment facility’s compensation depends on accurate and efficient coding and the submission of medical claims. That’s why it is critical to hire the right medical billing company to understand your organization’s specialized needs and provide proven solutions.

Some of the benefits of hiring a medical billing company:

Reduced Billing Errors

Hiring a medical billing company will assist you in reducing the possibility of errors in form submissions and insurance claims. Almost four of every five medical bills contain errors of some kind, jeopardizing your ability to receive timely reimbursement from insurance providers for services rendered.

According to NerdWallet’s research, approximately 49% of all Medicare claims result in errors. Other errors include mishandled underpayments, incorrect procedure codes, missing information, and upcoding.

Outsourcing medical billing services to a professional medical billing company will assist you in preparing and distributing error-free documentation and processing insurance claims quickly. Using their billing experts means better office management and compliance, fewer coding and billing errors, and higher savings per patient.

Greater Revenue for Providers

Due to denied insurance claims, healthcare providers frequently experience significant revenue losses on an annual basis. According to the AARP, one out of every seven claims is denied, resulting in over 200 million daily denials. This happens for numerous reasons, such as missed deadlines, claim form errors caused by inaccurate information, incorrect medical coding, insurance coverage issues, and many more. According to reports, approximately 30% of all insurance pay outs are either neglected or denied.

Medical billing companies enhance the net revenue collection and rectifie any shortcomings within the pre-existing revenue cycle. In-house administration costs, along with the errors in form submission that can lead to lengthy delays with insurance claims, are significantly reduced.

Greater Accountability

Almost every medical biller relies on smart software to streamline and automate the entire revenue management cycle. This ensures the highest level of accuracy and prevents the human error from interfering with your practice’s financial performance.

Hiring experienced medical billers eliminates most of the capital costs associated with purchasing and operating new software. Furthermore, medical billing companies are entirely HIPAA compliant and adhere to all regulatory standards. A reputable medical billing company will also help your practice stay current on state laws and regulations, market trends, and codes.

Higher Financial Transparency and Analysis

Transparency in medical billing is difficult to achieve. Hospital staff and healthcare professionals can significantly improve the patient experience by streamlining the critical billing and payment processes.

A healthcare practice can quickly reduce costs and delays by hiring a professional medical billing company. An experienced billing company can boost cash flows and enhance operating margins by automating and restructuring your billing operations. The resulting operational transparency and financial efficiency will assist you in improving the patient experience, thereby enabling business success.

Are you a behavioral healthcare provider in need of medical billing services?

Some of our services include :

► Billing & collecting

► Utilization Review

►Appeal Management

and much more

Contact us today for more information:

866-731-6777/ info@panaceahcs.com

How Medical Billing Providers Help Behavioral Healthcare Providers Grow

Tue, 20 May 2025 18:24:00 GMT

Running a behavioral healthcare practice is a challenging yet deeply rewarding endeavor. Whether it’s counseling, psychiatry, or substance abuse treatment, providers focus their energy on improving patients’ mental and emotional well-being. However, managing the business side of the practice—especially medical billing—can be time-consuming, complex, and prone to error. That’s where professional medical billing providers come in.

Outsourcing billing services is not just about convenience. For behavioral healthcare providers, it’s a strategic decision that can lead to significant growth. Here’s how:

1. Maximizing Revenue and Cash Flow

Medical billing providers are experts in coding, claims submission, and insurance follow-ups. In the behavioral health field, where billing codes and documentation requirements can be particularly nuanced, this expertise ensures that claims are accurate and compliant from the outset.

Fewer denials and rejections mean faster reimbursements and more consistent cash flow. Billing companies also track unpaid claims and work aggressively to collect outstanding balances, reducing the amount of revenue lost to write-offs.

2. Reducing Administrative Burden

Behavioral health providers often wear many hats—clinician, administrator, and sometimes even front-desk staff. Delegating billing responsibilities to professionals frees up valuable time that can be redirected toward patient care, staff training, or expanding services.

This reduction in administrative overhead also allows providers to scale their operations without the proportional increase in internal staffing costs or workload.

3. Improving Compliance and Reducing Risk

Insurance companies and regulatory bodies impose strict rules on billing practices, especially in mental health and substance use treatment. A mistake in coding or documentation can trigger audits, fines, or even loss of credentials.

Billing providers stay up-to-date with changing regulations, payer policies, and coding guidelines. Their knowledge protects behavioral health practices from compliance pitfalls, giving providers peace of mind and long-term stability.

4. Enhancing Reporting and Strategic Planning

Growth is hard to achieve without clear insight into your practice’s financial performance. Medical billing providers typically offer detailed analytics and reporting dashboards that show which services are most profitable, which payers reimburse the fastest, and where there are inefficiencies.

Armed with this data, behavioral healthcare leaders can make informed decisions about staffing, marketing, service expansion, and payer negotiations—all of which are critical to scaling successfully.

5. Enabling Focus on Core Mission

Ultimately, the heart of behavioral healthcare is patient connection and clinical excellence. When providers are bogged down by billing tasks, that focus suffers. By outsourcing to billing professionals, practices ensure that administrative functions don’t detract from their mission.

Whether it’s expanding to a new location, adding telehealth services, or hiring new clinicians, growth depends on the ability to focus on what matters most—quality care.

Conclusion

For behavioral healthcare providers aiming to grow, partnering with a medical billing service is more than a cost-saving measure—it’s a growth strategy. These partnerships optimize revenue, reduce risk, and provide the operational support needed to scale confidently and sustainably. With billing off their plate, providers are empowered to do what they do best: help people heal.

Are you a behavioral healthcare provider in need of medical billing services?

Some of our services include :

► Billing & collecting

► Utilization Review

►Appeal Management

and much more

Contact us today for more information:

866-731-6777/ info@panaceahcs.com

Panacea Healthcare Services – A Trusted Solution

Fri, 01 Nov 2024 22:26:00 GMT

The behavioral healthcare industry has changed. From facilities and individual providers to investors and operators… many are finding it difficult to survive and provide quality care while struggling with limited reimbursement rates and aggressive payer practices.

Panacea Healthcare Services was founded on the principal that an end to end solution for all the challenges of the healthcare industry is essential to your success.

Panacea brings together a complementary team with over 3o years experience to deliver a broad portfolio of solutions that will assist facilities and providers throughout the entire revenue management and business process.

Our unique approach is based on over 30 years experience combined with a comprehensive model focused on pr oviding not only claims management but additional necessary service solutions to the healthcare community.

Panacea can provide assistance for established facilities and new startup organizations by improving financial, clinical and operational outcomes. We partner with our clients to mitigate operational challenges and simplify the transition to a value-based care model, while remaining focused on the integrity of the care and culture of our partners.

Through our comprehensive suite of services Panacea is positioned to better respond to our partners needs and to deliver next-generation innovations in revenue management and more.

With traditional revenue cycle management failing, the healthcare community needs experts that provide real time solutions to overcoming their challenges. Private insurance carriers continue to reduce the rate of reimbursements across the board and are making it impossible to maintain high quality care models.

We believe a new paradigm is needed to help healthcare providers not only survive but thrive in these trying times. Our systems and services offer real time solutions to the reimbursement challenges presented in the healthcare industry by moving you out of the traditional cycle of poor reimbursement into a new, end-to-end solution for success and longevity.

Our mission is to provide a “one-Stop Shop” solution for your healthcare business needs. As you focus on patient care and the growth of your business, let us manage your operation needs. Panacea provides a full suite of services that includes premier claims management in addition to an array of services that are vital to your healthcare organization’s stability and growth.

Some of our services are:

Billing and Collections
Utilization Management
Licensing, Credentialing and Accreditation
Insurance Contracting

Appeal Management
Accrued AR Services
In-house revenue management

Through our comprehensive suite of services Panacea is positioned to better respond to our partners needs and to deliver next-generation innovations in revenue management and more.

For more information about how Panacea can assist your behavioral healthcare organization…

866-731-6777 | panaceahcs.com

Key Benefits of having a behavioral healthcare billing partner

Fri, 01 Nov 2024 09:00:00 GMT

Billing Services for Small behavioral healthcare Practices involve the comprehensive management of the billing process, from submitting claims to insurance companies to following up on unpaid invoices. Effective billing services ensure that the practice receives timely payments for the services provided, reducing the risk of financial instability and allowing healthcare providers to concentrate on patient care.

Key Benefits of Bill ing Services for Small Behavioral Healthcare Practices

Cost-E ff e ctive So lutions:

Outsourcing billing services can be more cost-effective than managing an in-house billing department. Professional billing companies offer scalable solutions tailored to the size and needs of small practices, ensuring that they only pay for the services they need.

Improved Cash Flow :

Professional billing services ensure that claims are submitted accurately and promptly, reducing the time it takes to receive payments. By minimizing delays and denials, small practices can maintain a more consistent cash flow, which is crucial for meeting operational expenses and investing in growth.

Reduced Adm inistrative Burden :

Managing billing in-house can be time-consuming and divert resources away from patient care. Outsourcing this task to a professional billing service frees up staff to focus on clinical duties, enhancing overall productivity and patient satisfaction.

Access to Adv anced Technology:

Professional billing services utilize state-of-the-art technology and software to manage the billing process efficiently. These tools can streamline operations, provide real-time reporting, and offer valuable insights into the financial performance of the practice.

Are you a behavioral healthcare provider in need of medical billing services?

National Substance use and addiction statistics 2024

Tue, 28 May 2024 20:06:00 GMT

Drug and substance abuse continues to be a major problem across the United States, with 1 in 4 Americans over the age of 12 admitting that they used illicit drugs in 2022. While alcohol, tobacco and marijuana represent the most popular drugs among Americans, many struggle with more illicit drugs, including cocaine, methamphetamines and heroin, according to the most recent Substance Abuse and Mental Health Services Administration (SAMHSA) survey.

Below, we’ve compiled comprehensive drug, substance abuse and addiction statistics that demonstrate the pervasiveness of the issue — and the importance of quality, affordable health insurance that offers substance abuse treatment.

Key points

25% of Americans (70 million people) admitted they use illicit drugs, according to the most recent National Survey on Drug Use.
48.7 million people nationwide struggle with substance abuse according to the same survey.
Alcohol is the most commonly used drug, followed by tobacco and marijuana.
Health insurance policies sold on the Affordable Care Act (ACA) Marketplace or provided by Medicaid are required to cover substance abuse.

How many people use drugs in the U.S.?

Nearly 25% of Americans ages 12 or older say they used illegal drugs in 2022. That’s 70.3 million people nationwide. ¹ Approximately 50% of Americans 12 or older admit they used illegal drugs in their lifetime.

The breadth of the problem is detailed in the most recent SAMHSA survey, which asked participants about their drug use habits. The survey included questions about current use (defined as using a substance within the month prior to taking the survey) as well as lifetime use.

Current use

Based on survey results and the definition of current use:

16.5% of those who used illicit drugs in the survey year used marijuana, making it the most common illicit drug among those surveyed.
3.4% of respondents admit to using marijuana and other illicit drugs within a month of taking the survey.
Central nervous system stimulants and prescription psychotherapeutics (misuse) were the second most common illicit drugs, each representing just under 2% of reported use.
LSD, PCP, ecstasy and sedatives account for the lowest percentage of use, each representing 0.1% or less of illicit drugs used.

Lifetime use

47% admitted to using marijuana at some time in their life, making it the most common illicit drug among lifetime use statistics.
Hallucinogens were the second most widely used illicit drug, with 17% admitting they used them during their lifetime.
Cocaine was the third most commonly used illicit drug, with 15% of participants admitting to using it over their lifetime.

What is the most popular drug in the U.S.?

Alcohol is the most popular drug in the U.S., with nearly half of Americans ages 12 and older saying they used it in the last statistically available month, based on the SAMHSA survey. Nearly 22% admitted they engaged in binge drinking in the past month at the time of the survey.

Tobacco use is also prevalent in the United States, with more than 1 in 5 Americans consuming tobacco in some form in the last statistically available month — and nearly 17% specifically smoking cigarettes.

While harder drug use is still a problem, less than 2% of Americans ages 12 and older reported having used cocaine in the past year. It’s even lower for methamphetamines (1%) and heroin (0.3%).

How many people die from drugs?

The U.S. has experienced a rising number of drug-related deaths for more than a decade, according to the latest National Safety Council Data. There were 108,490 drug-related deaths in 2022, according to preliminary data. That’s slightly lower than those reported in 2021 (106,699 deaths) but a 141% increase over the last decade and a 494% increase since 1999, the first year for which NSC data is available.

This data includes drug-related deaths by suicide, homicide and undetermined intents. Of those 108,490 deaths, 92% (100,105) were categorized as preventable drug overdoses.

Opioid overdoses are the most common cause of drug-related deaths, but even cannabis (marijuana) has resulted in preventable deaths.

How many people struggle with substance abuse?

Nationwide, 38,679,000 American adults reported having a substance abuse disorder in the last statistically available year.

Montana has the highest self-reported rate (19.2% of adults) of substance abuse. Oregon , Washington , South Dakota and Kansas round out the top five.

Georgia is the state with the lowest rate of self-reported substance abuse (11.31% of adults).

What percentage of Americans abuse alcohol?

Alcohol abuse can be defined in two ways: binge drinking and alcohol

use disorder (AUD).

The Centers for Disease Control and Prevention defines binge drinking as five drinks on one occasion for men and four drinks on one occasion for women.
The National Institute on Alcohol Abuse and Alcoholism defines AUD as a medical condition wherein someone cannot stop or control their alcohol intake, no matter the consequences.

Nationwide, an average of 21.7% of people reported having engaged in binge drinking in the past statistically available month, and 10.8% said they had dealt with alcohol use disorder in the last statistically available year.

States with the highest alcohol abuse

North Dakota and Wisconsin are the two states with the highest rate of binge drinking, with 25.99% of people ages 12 and older reporting binge drinking in the past month. ³ Nebraska , Vermont and Iowa also have high rates of binge drinking.

North Dakota also leads the country in alcohol use disorder, with more than 15% of individuals 12 and up reporting struggling with AUD in the past year. Montana , New Mexico , Oregon and Alaska round out the top five states with the highest rate of reported alcohol use disorder.

How many people die from alcohol each year?

In the United States, 178,000 people died from alcohol in the last statistically available year (2021). That’s 488 deaths every day from alcohol.

Of those 178,000 deaths:

117,000 deaths are attributed to chronic conditions related to long-term alcohol use.
61,000 deaths are attributed to alcohol-related car crashes, alcohol poisoning or suicide.

What percentage of Americans use tobacco?

Across the U.S., an average of 21.2% of people ages 12 and older reported tobacco use in the last statistically available month. More specifically, 16.82% reported smoking cigarettes. ³

States with the most smokers

Kentucky is the state with the most tobacco users; more than one-third of Kentuckians ages 12 and older report using tobacco of some kind in the past month. Kentucky also leads the country in cigarette users, with 1 in 4 people self-reporting smoking cigarettes.

More than 1 in 5 people sm

oke cigarettes in West Virginia , Missouri, Wyoming , Louisiana and Arkansas . West Virginia, Missouri and Louisiana are also close behind Kentucky for overall tobacco use as well.

Only 13.01% of Californians reported having used tobacco in the last statistically available month. Cigarette usage is even lower in Utah, where just over 10% of the state’s population reported cigarette usage.

How many people use marijuana?

On average, more than 13% of Americans ages 12 and older reported using cannabis, also known as marijuana, in the previous month.

However, the most recent statistically significant data comes from 2021 to 2022. It’s important to note that since then, several additional states have legalized marijuana both medicinally and recreationally, which may lead to an increase in usage.

States with the highest rate of marijuana use

Vermont leads the nation with the highest rate of marijuana use; just over 22% of people 12 and up reported using marijuana in the last month. Recreational marijuana has been legal in Vermont since 2020. ³

Alaska , Colorado , Oregon and Maine round out the top five states for marijuana usage. Recreational marijuana has been legal in Alaska and Oregon since 2014, Colorado since 2012 and Maine since 2016.

Oklahoma is the state with the highest rate of marijuana usage (16.61%) where recreational use is currently not legal.

How many people die from marijuana usage?

Preliminary data for 2022 indicates that there were 1,183 linked to marijuana and its derivatives, in the U.S., which marks an increase over the years prior. The National Safety Council specifies that marijuana derivatives can include THC, CBD or their synthetic derivatives.

What percentage of people have used cocaine?

Nationwide, an average of 1.7% of people ages 12 and older reported having used cocaine in 2022, the last statistically available year. ³

States with the highest rate of cocaine use

Vermont is the state with the highest rate of self-reported cocaine use, with 3.2% of people 12 and up saying they used the drug in the year prior. New York , Maryland , Massachusetts and Rhode Island make up the remaining top five states.

The state with the lowest cocaine use is Texas, with just 1 in 100 Texans self-reporting cocaine use.

What percentage of people have used methamphetamines?

Nationwide, an average of 1% of people 12 and older reported having used methamphetamines in the last statistically available year. ³

States with the highest rate of methamphetamine use

Nevada tops the list of states with the highest rate of methamphetamine usage. More than 1 in 50 people ages 12 and up reported using this drug in the last statistically available year. Self-reported meth use is also high in Tennessee , Iowa , Mississippi and Alabama .

Connecticut and Flori

da have the lowest rate of methamphetamine use; just 0.52% of residents self-reported usage in the last statistically available year.

What percentage of people abuse prescription pain pills?

Nationwide, an average of 3.12% of people 12 and older reported having abused prescription pain pills in the last statistically available year.

States with the highest rate of prescription pain pill abuse

Tennessee leads the country in prescription pain pill misuse. More than 4% of the state’s population, ages 12 and older, reported having abused pain relievers in the year prior.

Prescription pain pill abuse is also high in Arkansas , Nevada , Louisiana and Alabama .

Nebraska is the state with the lowest rate of self-reported pain pill abuse (2.39%).

What percentage of people have used heroin?

Nationwide, an average of 0.3% of people ages 12 and up reported having used heroin in the last statistically available year.

States with the highest rate of heroin use

Heroin use is most common in the state of Delaware , where 0.6% (that’s more than 1 in every 200 residents) of people ages 12 and up reported having used heroin in the year prior. The only other states with a rate higher than 1 in 200 are Maine , Vermont and Alaska .

Texas is the state with the lowest rate of self-reported heroin use: Only 0.15% of Texans 12 and up reported having used the drug in the most recent statistically available year.

What percentage of people have abused opioids?

Across the country, an average of 3.3% of Americans ages 12 and up reported having abused opioids in the year prior.

States with the highest rate of opioid abuse

Tennessee has the highest rate of opioid abuse in the U.S. Nearly 4.7% of people in the state reported having engaged in opioid abuse in the last statistically available year. Arkansas , Alabama , Louisiana and Nevada round out the top five.

Nebraska has the lowest rate of opioid abuse in the country, with only 2.4% saying they had abused opioids in the year prior.

States with the highest number of overdose deaths

West Virginia has the highest rate of overdose death in the U.S., with 84 overdose deaths for every 100,000 people. Nebraska and South Dakota has the lowest rate of overdose deaths, with 9 deaths for every 100,000 people.

Overdose deaths are on the rise in West Virginia (up by 7.3%) but on the decline in South Dakota (down by 16.7%). Oregon has seen the biggest increase (41.5%) in overdose deaths over the last statistically available 12 months.

What drug causes the most overdose deaths?

Opioids are involved in more overdose deaths than any other drug. In 2022, there were 108,490 drug-related deaths — and just over 75% of them (82,234 deaths) involved an opioid.

Fentanyl is by far the deadliest opioid. Of the 82,234 opioid-related deaths, 70,601 of them involved fentanyl.

Health insurance and substance abuse

Substance abuse disorders represent a dangerous health condition — one that deserves the proper care and treatment. Yet 93.5% of Americans with a self-reported substance abuse problem do not seek help.

If you or someone you love is suffering from substance abuse, know that there are options available. Many health insurance plans include coverage for mental health and substance abuse. If you purchase health insurance from the ACA Marketplace, the insurer is required to cover substance abuse counseling and treatment. Medicare will also pay for treatment of alcoholism and substance use disorders, though its coverage is not as extensive as it is for other services.

If you’re not sure if your current health plan covers mental health surveys or substance abuse counseling and treatment, contact your insurer to discuss your benefits.

The Pile up! Top Reasons for Aged Claims in behavioral healthcare billing

Mon, 20 May 2024 21:30:00 GMT

Providers lose millions in unpaid claims. Here’s why your claims are aging, and what you can do to improve reimbursement rates. Claim aging is one of the biggest issues in healthcare today – especially in behavioral health, where there is so much subjectivity when it comes to medical necessity. This is why it’s important […]

HOW TO SURVIVE DEDUCTIBLE SEASON

Wed, 17 Jan 2024 20:50:00 GMT

It is that time of year once again and, while the New Year may bring new opportunities to save lives for healthcare providers , it comes with a caveat: Deductible Season.

If your treatment program does not already have a strong system in place for collecting Place-of-Service (POS) payments, you may have noticed an increase in your patient AR over January—accompanied by smaller checks from Medicare and your major commercial payers. The good news is that it is not too late for you to mobilize and concentrate your practice’s efforts to conquer your cash-flow.

Understanding Patient Benefits

With healthcare billing collections, knowledge is power and understanding how a patient’s benefits work is the first step in deciding how much to collect in the office for their visit. There are 3 different areas of patient responsibility that can apply to a claim’s payment:

Copay
Coinsurance
Deductible

Copays are a set fee established by the insurance plan that a patient is responsible for any time they receive that particular service—a $45 office visit copay, or $200 outpatient surgery copay, for example.

Co-insurance represents a patient’s share of liability for the service or, more simply, a set percentage of the procedure’s allowed amount (established by the payer’s contracted fee schedule)—if a patient has 20% co-insurance on radiologic imagery and an x-ray of three views of the knee is ordered, they are responsible for 20% of whatever the payer allows for the 73562 CPT code.

Deductibles, however, are a set amount that the patient must pay before insurance kicks in and make payments for any services that are subject to the deductible.

Medicare Part B is the simplest example of the deductible/coinsurance benefit system. Medicare Part B, for 2016, has a $166 deductible and, after that is met, 20% co-insurance. Commercial plans, however, may have benefits that include a yearly deductible, copays for specific services, and co-insurance for which the patient is responsible after they meet their deductible. For this reason, it is extremely important for your front office staff not to throw in the towel after they verify patient eligibility and to go the extra mile to record a benefit summary in the patient’s chart i.e. John Smith’s benefit for physician services-office are 100% of the allowed amount after the specialist copay of $30; or, Jane Doe’s benefits are 20% co-insurance subject to an in-network deductible of $500. For these examples, the front desk would know to only collect John Smith’s $30 copay and all other charges will be covered 100% by his insurance; whereas, Jane Doe must meet her $500 deductible before her insurance will pay a dime.

Knowing and understanding the patient’s benefit will only get you so far. The hard part is deciding if, and how, to collect the money. Copays are easy, but deductibles and co-insurance present serious challenges. For this post, I am focusing on deductibles and will present you with some strategic policies you can consider implementing in your practice.

For Medicare patients, POS collections have a few simple steps:

Call the IVR—this will tell you:
1. If the patient is eligible
2. If they have elected an HMO (and therefore to file to the HMO and NOT Medicare)
3. How much of their Part B deductible has been met
Do they have a Medigap Medicare Supplement plan?
1. Unless they are on a Plan C or Plan F, they still owe the deductible **see the table at the end of the post for more information**
2. If they have another commercial secondary: try and collect, but give the patient the benefit of doubt if they insist their plan will cover it
Look at the superbill
1. I recommend making a chart of the Medicare fee schedule for level 3 and 4 office visit for a New and Established patient, and the most commonly used radiology and injection codes used in the office.
2. Compare the superbill to the fee schedule and to the remaining deductible
3. If the estimated Medicare allowable for the visit is higher than the deductible, go ahead and collect the full amount remaining on their deductible
4. Here is an example of how that should work: Jane Doe has $112 remaining on her Part B deductible. She has a Medigap Plan K policy through AARP and was seen as a new patient. She also had 2 views taken of her left shoulder. I know that Plan K will not cover her deductible and, looking at the Medicare fee schedule, that the allowable for her visit is at least $112; therefore, I will ask Ms. Doe if she does not mind paying $112 today and we will bill her for any overages.

Commercially Insured Patients

For patients with commercial plans, you have a few ways of going about the collection process. Option 1: you can go about it the same way as Medicare, but this would require knowledge of the fee schedule. Depending on your payer mix, you may choose this method for your top commercial plans.

Otherwise, the best option to consider is a deposit system. For the deposit strategy, you are still going to need to research their benefits. If they have an office visit or outpatient surgery copay, it is usually best to just collect that and bill the patient for the remainder later. However, if the patient has a strict deductible/co-insurance plan, you may want to establish a deposit policy for certain services. An example of this strategy: Mr. Smith has an 80/20 plan with a high deductible. He must meet his $2000 deductible before his insurance will kick in and cover 80% of his fees. If Mr. Smith comes in for an office visit only, we collect $50; $75 for an office visit and x-rays; $200 for a fracture treatment; we will charge cost+25% on any DME he receives; collect a $500 surgery deposit before he is ever scheduled for the procedure. In any of these cases, Mr. Smith will probably still end up being billed for the remainder of his charges, but the important thing is: we at least collected something. The idea of the deposit strategy is to minimize the risk associated with billing patient’s after-the-fact.

Cash Flow Conquered

With these tools at your disposal, you now have the opportunity to control your own destiny—to some degree—as far as your average collection period is concerned. Think of this: by employing these methods, you can collect $75 immediately for Mr. Smith’s exam and x-ray vs. before when you would file his insurance, wait 30 days for the EOB, and then bill Mr. Smith for the $100 that was applied to his deductible…and hope he is an upstanding gentleman who pays his bills on time (or at all). As healthcare providers, you assume a financial risk anytime you provide a service and let a patient walk out the door without paying. Unfortunately, that is just part of the business we are in; but, as we have shown you here, you do have the opportunity to minimize that risk as much as possible if you put the right policies in place.

So, I challenge you: mobilize your staff; hold a meeting and educate them on the strategies I have discussed; put the procedures and policies in place; and, together, we will make through deductible season.

Need assistance with revenue cycle management?

Do you have questions concerning your billing & collections?

Let us help!

Contact us today…

866-731-6777 – info@panaceahcs.com

Avoid These Common Revenue Pitfalls

Mon, 06 Nov 2023 10:00:00 GMT

We are in an era of complex healthcare billing that can cost providers lost revenue due to lack of knowledge and proper training. Without these much needed tools, providers are faced with significant loss of revenue for their company. The good news is many of these mistakes are avoidable with proper checks and balances in place. Noted below are a few fundamental areas to pay special attention…

VERIFICATION OF BENEFITS

Accurate, upfront verification validation is a crucial step to avoid any future denials and loss of revenue before services have been rendered. Proper training and knowledge of the most vital questions to ask when validating covered services on insurance policy plans is the first necessary component (i.e., does the member have Out-Of-Network benefits or does the member plan include behavioral health benefits, etc.?).

Keep in mind that you rely on the representatives from the carriers to provide precise and accurate data. Furthermore, unless you have the knowledge to identify inaccurate information being provided, the chance of you receiving invalid information at times may be significant.

It is also just as important to begin to have familiarity with the most common payers that you accept so that you may be able to have a knowledge base of the reimbursement pattern.

UTILIZATION REVIEW

Another vital component in this industry is the utilization review process; which encompasses obtaining authorization for proposed dates of service. This is a stringent, meticulous process that compares requests for medical services to actual treatment guidelines set by various carriers. This process also sets the tone for the recommended direction of treatment. Obtaining authorization will essentially ensure that the services are deemed medically necessary and are in fact payable, which will also minimize loss in revenue. As a result, documentation is a key aspect, clinical documentation must be accurate and important information must be documented accurately.

BILLING & COLLECTIONS

Submitting claims with inappropriate coding is another major pitfall that providers are faced with. It is essential to have staff experienced with coding knowledge when billing to carriers to avoid upfront denials or decrease in reimbursement. Researching each carrier’s requirements will also help to assist in claims submission, but be mindful that their requirements can change frequently, so it is important to stay abreast of the changes when applied.

The most common pitfall is having inexperienced collectors that do not have a strong background in the area of specialty. It is imperative to have a team with the specialty skillset to handle claim denials and appeals in a timely fashion for reconsideration so that monies will not be left uncollected.

With that being said, it is crucial to have a strong internal and/or external team with the knowledge base of handling all aspects of your revenue cycle management needs to ensure maximum reimbursement for ongoing growth.

Need assistance with revenue cycle management?

Do you have questions concerning your billing & collections?

Let us help!

866-731-6777 – info@panaceahcs.com

Understanding Cobra Plans

Wed, 01 Nov 2023 03:48:00 GMT

What is a COBRA plan?

A COBRA plan is a private insurance option that gives people who may have just lost their job, time to find a new job, new insurance, and remain covered. COBRA is typically for when a patient is terminated from their job or they have to leave their job, and it is insurance that will cover in their grace period.

Several events that can cause workers and their family members to lose group health coverage may result in the right to COBRA coverage. These include:

Voluntary or involuntary termination of the covered employee’s employment for reasons other than gross misconduct
Reduced hours of work for the covered employee
Covered employee becoming entitled to Medicare
Divorce or legal separation of a covered employee
Death of a covered employee
Loss of status as a dependent child under plan rules

*COBRA is applicable for six months, paid out-of-pocket and acts as a buffer for insurance coverage.

How can it affect your treatment center?

If someone comes in with a COBRA plan, and they had a previous plan that you billed, then you would continue to bill them as normal. It may take a while for the coverage to kick in, and the patient may be inactive when you call the insurance company, but then they will backdate that COBRA. The claims may be denied for a bit until the COBRA coverage kicks in, but then COBRA will back date the claim.

What happens if a patient stops paying the COBRA?

The claim will not get paid. COBRA gets renewed on a monthly basis, so you may want to call and check to see if they are verified under COBRA

Need assistance with revenue cycle management?

Do you have questions concerning your billing & collections?

Let us help!

866-731-6777 – info@panaceahcs.com