Behavioral Health Outsource Revenue Claim Denials

How to Stop Losing Money from Claim Denials – Today

By Billing Solutions Team on April, 9 2021

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Billing Solutions Team

Just as no two individuals with substance use disorder are alike, behavioral health treatment plans vary substantially from person to person. It’s almost impossible to standardize treatment when it comes to behavioral health. For that reason, it’s also been nearly impossible to standardize the billing. Insurance companies have done their best to try to impose an artificial order on things by instituting limits on length of treatment and other restrictions. The end result, however, is that behavioral healthcare providers are often at war with insurance carriers over how much they are owed and how extensively they can treat their patients. The most significant point of tension comes with a claim submission. Whether your claim is approved or denied can make a huge difference for your patient – and for your bottom line. Here’s how to stop losing money from claim denials today.

1. Prepare & Prevent

It’s much easier to prevent a claim denial than it is to appeal one. You can set your team up for success by knowing which insurance plans offer what benefits ahead of time. Most facilities do a Verification of Benefits (VOB) before the client even enters treatment. Then, when the client is at the facility, make sure that you know which codes to use and when to use them. That can be a bit of a trial and error process for beginners, but working with a team like Billing Solutions means that you’ll reap the benefits of nearly fifty years of combined experience. We have the data to show you the best way to proceed.

2. Do It Right the First Time

Submitting a successful claim means getting the right code to the right insurer, in the right format, and in the right timeframe. Do you feel confident that you and your team can execute that successfully? A solid claim submission process starts with comprehensive education of your team, so that they avoid errors as much as possible. From there, you should be running ongoing audits and compliance studies to make sure that your coding is accurate. 

3. Learn from Your Mistakes

So, you got a denial. Resist the urge to chalk it up to the cost of doing business, because denials can add up quickly: Recent studies indicate that more than $200 billion in revenue is lost each year in the healthcare industry due to denied claims. If you accept the insurance company’s denial, collecting directly from your client can be a long, costly, and ultimately unsuccessful process that cuts into your profit margin. At this stage, it’s essential to understand the root cause of your denial, so you can avoid future issues. Reviewing historical information also can help you launch a more successful appeal.

At Billing Solutions, we have the industry’s largest collection of claims and coding data. We can help you get the appropriate length of treatment approved for your client, and we can help you get paid for it. Our team also is skilled at mounting appeals, if that becomes necessary.

Do you know how much money you lost last year due to denied claims and unsuccessful appeals? Our best-in-class software, Nectar, pulls all your data together in real-time, offering 24/7 transparency on the strengths and weaknesses of your revenue cycle

Let us show you how it could work for you. Contact us for a free account analysis, and capture more revenue, faster.

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