In the behavioral health field, effective revenue cycle management (RCM) is crucial for an organization’s financial health and operational efficiency. However, this is one of the most significant challenges ABA organizations face. According to Behavioral Health Business’ 2023 Behavioral Health Outlook, reimbursement and payment challenges were the 2nd greatest financial strain to the behavioral health industry in 2023, second only to staffing. Improving RCM workflows can have a considerable impact on an organization’s sustainability.
ABA Revenue Cycle Management Challenges
ABA is still a relatively new field, with insurance and Medicaid only beginning to cover services in the last 10-20 years. As such, many complexities still need to be ironed out. Many providers struggle to navigate the intricacies of coding, often resulting in high claims denials. Another common challenge is the variability amongst payors. Reimbursement rates can vary significantly from payor to payor. It is also not uncommon to have variability in how each payor interprets CPT codes, resulting in varying policies and requirements. As most companies work with multiple payors, maintaining compliance with each requires substantial time and effort.
Improving RCM Workflows
Considering the complexities of billing, establishing and maintaining strict RCM workflows is critical. According to CR CanaryBI data, companies are missing out on substantial revenue. On average, organizations with 5-30 million in annual revenue are leaving 1.2 million dollars in revenue on the table each year. As Chris Plante, SVP of CR BillMax, stated in a recent webinar, “Being able to increase your collections by 5-10% can have major effects as far as the ability and the quality of care that you’re able to provide, but ultimately just the overall health of your business.”
Data-Driven Approach
ABA providers know firsthand the critical importance of tracking and analyzing data to make decisions about the progression of care. Taking a data-driven approach to ABA revenue cycle management in medical billing is just as vital. The first step is understanding the most important data to track and analyze.
A few of the most beneficial key performance indicators (KPIs) to measure financial well-being and operational efficiency are:
- Gross collection rates
- Average days in AR
- Percent of receivables past 120 days
- AR by category–Payor, service code, location, etc.
- Clean claims rate
- Denial rate
Consider benchmarking your organization’s financial performance against industry standards and best-in-class practices. Understanding where you compare to others within the industry lets you stay competitive and forecast future business plans. If your organization is not achieving at least average industry performance, a thorough data analysis is warranted to identify barriers and implement data-driven modifications.
Quality Staff Training
An organization’s financial performance depends on a well-trained team. All staff, from behavior technicians and behavior analysts to administrative employees, must be adequately trained to ensure compliance with funder regulations and legal requirements. Each team member is responsible for meticulously understanding their role in the process, from verification of benefits to writing session notes and submitting claims. Establish company-wide quality standards, including initial and ongoing training, quality assurance measures, and systematic internal audits.
Leverage Technology
Technology and automation can be used in many ways to enhance a company’s RCM strategies and improve its financial health. Leveraging technology in RCM can increase efficiency, reduce manual errors, enhance data accuracy, and improve billing and collections speed.
ABA organizations can utilize technology in RCM workflows to:
- Verify eligibility in real-time
- Automate claims submissions
- Increase visibility into denials and payor trends
Optimize Your Revenue Cycle for Financial Success
ABA practices must optimize their revenue cycle management to achieve financial success in 2024 and beyond. While this takes a multifaceted approach, the key lies in leveraging the data and utilizing technology to enhance RCM strategies.
Learn more about the essential components for driving financial success in our on-demand webinar
Turbocharge Your Revenue Cycle for 2024–Key Insights and Strategies: Join SVP of CR BillMax, Chris Plante, as he shares practical insights and actionable strategies to enhance revenue cycle efficiency.
Posted in Billing, Practice Management
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