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Since many behavioral health providers are independent, billing and RCM take on additional urgency. At the same time, many behavioral health providers, and especially independent behavioral health professionals, lack the infrastructure required to ensure all claims get paid.

UNDERSTANDING THE STEPS OF RCM IN behavioral HEALTH SERVICES

1. Obtain referral from primary care provider

2. Determining medical necessity

3. Documenting and verifying medical necessity

4. Performing the tests

5. Waiting for claims to be paid

The Mindset of an Independent Business Owner

As an owner or partner in an independent behavioral health practice, billing and RCM are ultimately your responsibility. But of course, that doesn’t mean doing the work yourself. Rather, you need to assemble a team of skilled people on your team, whether in-house or an outside partner. It’s usually most efficient to establish a relationship with a medical billing company, preferably one that specializes in billing for behavioral health providers, or at least has substantial experience working with behavioral health billing.

Billing and revenue cycle management for hospitalists is a very complex accounting process, with many quirks and idiosyncrasies. In our experience, most hospitalists don’t fully understand the billing process, and underestimate what is required to navigate this process successfully.

Of course, billing and RCM are not the primary focus of any hospitalist, or any medical practitioner for that matter. While providing vital care to improve patients’ lives, billing insurance and getting paid is not necessarily top of mind - nor should it be.

The good news is that a diligent and skilled billing service can greatly reduce this burden, on your team who are tasked with collecting what you’re owed.

For independent medical practices, choosing a medical billing company can be a confusing process.

The first step to gain clarity is to understand the industry. In general, there are three categories of independent medical billing companies:

• Large companies with more than 100 clients

• Mid-size companies with 25-100 clients

• Smaller companies with less than 25 clients

Viewed from this perspective, it’s easier to see patterns in the industry. In each tier, a medical company will be more likely to have certain strengths as well as weaknesses, and will be more likely to offer certain services as opposed to others.

Once you know what to look for, you’ll be in better position to select the best billing partner for your practice.

Let’s get started.