Know What’s Happening With Every Unpaid Claim

Why Outsourcing Your Behavioral Health Billing Is Beneficial

Healthcare is complicated, especially with many regulations that constantly add additional layers. Healthcare providers spend more time and resources organizing patient care and can use this time better. Using a qualified, outsourced behavioral security billing company can serve you well while reducing your workload, experiencing less disruption, and increasing your profitability.

10 Benefits of Outsourcing Your Behavioral Health Bills

1. Reduce staff costs.

When you outsource behavioral/mental health billing, you are not responsible for employee health care, acquisition costs, PTO (Paid Time Off), and other employee costs. The resources required to manage the behavioral health insurance process are high. Another point of using this behavioral billing solution is the cost-sharing model. It allows billing costs based on your size and revenue. It is advantageous if you have a low-income month; no fixed price will be associated with your billing.

2. Improve the revenue cycle.

As behavioral health providers’ legal and administrative terms grow and the claims process becomes more complex, working with a skilled and trained behavioral health billing company can provide significant relief. RCM, or Behavioral Health Revenue Cycle Management, is a specific application explicitly designed for practices that treat patients with behavioral issues. It helps with payment methods and claims processing more than a generic billing app. It will significantly improve revenue cycle management.

3. Keep patient data secure.

Internet security is one of the main concerns preventing doctors from outsourcing medical billing. Protecting patient and practice data is critical. All professional medical billing companies are responsible for safeguarding all patient information (HIPAA compliance).

4. Reduce employee errors.

Even the most minor fatal mistake can cause an insurance company to deny a medical billing claim; someone on your staff will correct the error, resubmit the application and wait for the revised application to be accepted and processed. Working with a specialized provider reduces employee errors, as they have more experience working with invoicing and have gone through a much greater training process than your in-house team.

5. More consistency.

Due to unplanned staff changes or staff absences, internal billing is at high risk of disrupting your practice revenue. Our outsourced medical billing services provide an entire team of experienced people to ensure your claims are prepared efficiently, reducing the likelihood of disruption to your practice cash flow.

6. Better handling of claims.

Prompt and accurate payment of each insurance claim is essential to optimizing the medical office’s cash flow. Time is precious, and healthcare workers typically do not have the luxury of reviewing and following up on every claim. Let’s face it, healthcare professionals and their support staff are often pulled in different directions. But you must submit these claims as quickly and accurately as possible the first time. Otherwise, unpaid claims can quickly deprive the office of resources you can apply elsewhere. Forcing you to make numerous phone calls to insurance providers only wastes more time and increases frustration. Healthcare providers should consider outsourcing this function to reduce the administrative burden on support staff. Good medical billing companies are quick, consistent, and accurate in filing and processing insurance claims.

7. Transparency.

Others think outsourcing billing means relinquishing control and power to your practice, but that’s only partially true. When you outsource billing, you get more control and transparency. You may review the data collected or monitor the processing at any time at your discretion. It gives you an up-to-date assessment of how and when to handle your clinic bills.

8. Increase profits.

Due to inefficient, inadequate, or incorrect claims, medical providers lose revenue. However, this is not the case if you outsource billing to a pool of eligible behavioral health billers. 

These outpatient behavioral health billing professionals are simply experts and far more skilled than your in-house staff. They are adept at handling appeals and reversing denials. They have the insight and experience to identify specific areas of weakness, reduce recurring claims errors and ensure more claims are completed (paid) on the first attempt.

9. Knowledgeable.

Behavioral health external billing solutions come with a wealth of knowledge. They understand the various intricacies of invoicing insurance and know to check trends and spot industry shifts. Longevity is not unusual in this niche area; However, it is necessary. The results from longevity and experience are priceless. Understanding historical trends for each insurance company, the amount paid, accurate printing of documents, etc., can significantly impact your BHO’s ability to collect insurance.

10. Fast action.

Automating routine administrative tasks makes your work more productive and valuable. Automating the same-day claims submission process will increase cash flow. A certified paper claim can take at least two months to travel through all channels before you receive payment. Submitting a clean claim, properly coded for maximum benefit and supported with electronic health records, can result in full reimbursement in a shorter period.

Conclusion

There are many great reasons to outsource your behavioral health bills to a professional group. It makes sense to outsource revenue cycle management services to a third party, which puts less strain on your internal resources. DENmaar provides behavioral/mental health billing services to many behavioral health treatment centers and has many years of experience.

We, DENmaar, can provide these services quickly and affordably, with all kinds of benefits that will accrue to your practice. It has a skilled team of billing and certification professionals dedicated to your medical practice with the expertise in medical billing, accreditation, EMR, and EHR you need. Call us now!

Accurate and timely acceptance of medical insurance is essential for obtaining payment from insurance companies. It’s complicated, time-consuming, and can cost thousands of dollars if you get it wrong. That’s why it’s important to partner with a medical billing company that has experience and a proven track record of success.

What is Medical Insurance Credentialing?

Insurance companies check that medical providers are legitimate and eligible to be compensated for services rendered. When a particular payer credentials a service provider, they can bill the payer directly and receive compensation.

What types of medical professionals require credentialing?

Every practice you want to bill an insurance company for must be approved. These include hospitals, clinics, doctors, dentists, physical therapists, behavioral health therapists, optometrists, etc. The term “In-network” (inside the network) means that the provider is currently credentialed by a particular insurance company and is eligible to file claims for reimbursement.

How difficult is it to get credentialed?

It is very complex and time-consuming. It usually takes 20 hours or more to apply to a single-payer. Every country has different needs. Specialists may also require unique documents. These variables make it effortless to miss a step, add the wrong document copy, or make a mistake.

Why are credential errors so common?

Even the slightest mistake in the credentialing process results in claims being denied, which means significant delays in the provider’s revenue stream. Timing is important. 

What are the requirements for the credentialing

Providers have 30 to 90 days to submit the claim after the day of service, depending on the state and purpose. Then, the payer has 90 to 120 days to file that claim. If the claim is rejected and resubmitted, the waiting period starts again. But denying a claim does not reset the 90-day clock for payment. Providers may experience timely application problems if they see patients not credentialed adequately by payers. 

Are there other ways providers lose money due to credentialing errors?

Large payers may make up a more significant percentage of a practice’s revenue. If most of your claims are delayed for three months, you may not have enough income to keep the doors open. You may need to stop seeing customers until the problem is resolved. On the other hand, they could not recover the lost revenue due to the expiry of the application period. 

How most credentialing systems do manage?

Medical practices typically hire one person to handle the credentialing process, which involves gathering about 20 different documents, ensuring the data is accurate and submitting them one by one to other payers. This person will ideally be responsible for re-credentialing in subsequent years. But if that person leaves, gets reassigned, or even gets busy and forgets the approval order, organizational knowledge is lost, and the deadline is missed.

So many practices choose to use credentialing software or outsource the tasks to a billing company that provides this service. Outsourcing to a credentialing service such as DENmaar is an easy way to manage the process.

Why an outsourcing dependency task is better than doing the in-house with dedicated software?

Credential programs are expensive, making them out of reach for most small practices. Although users are limited to most of the tracking features, users complain that the software is challenging to locate. For example, you may fail to set it correctly and miss the re-credentialing window.

How have credentials changed since COVID-19?

The pandemic has changed the healthcare landscape, especially in behavioral health. Many new patients sought treatment and demanded that providers accept insurance. Previously, small clinics could only get away with cash services. Suddenly, they had to get credentials to fill a genuine medical need and didn’t know how to do it.

Another significant change in credential requirements was telehealth. Before the pandemic, there were not many methods of providing telehealth services, and therefore no billing processes. Then almost overnight, telehealth became ubiquitous, and its payers imposed new requirements.

In addition, telehealth allowed behavioral health providers to see more patients daily, and it took more time for a provider to do their billing or manage credentials. 

How can clinics lose patients because of credentialing

Let’s say your staff forgot to re-credential, and all your claims are denied. Rehabilitation takes 3 to 4 months. During that time, you have two terrible options. You can look after patients for free until you are credentialed. It causes a massive loss of income. Or you can close your clinic or hospital for a while. You cannot blame them for going elsewhere for treatment. 

Where to get the best insurance credentialing services?

Looking for insurance credentialing services? You’ve come to the right place! Here at DENmaar, we provide the best insurance credentialing services in the business – and at prices that are more than reasonable. Give us a call today!

Many health care providers are not recognizing that they can increase profits and save patients’ costs by paying medical insurance bills.

One of the most common questions many medical/dental billing specialists in a medical practice hear is: “Do we need to be in-network for medical insurance billing?” When dealing with this question, there are many things to consider, but the answer largely depends on the following question: What type of medical insurance policies do you want to pay for?

Types of Insurance

There are many types of insurance. Health maintenance organizations (HMOs), exclusive provider organizations (EPOs), and preferred provider organizations (PPOs) are the most common.

HMOs and EPOs are similar in that these plans require you to be in network (IN) to be billed, as they do not allow the patient to see any provider out of their network (OON). 

Sometimes they allow the patient to see an OON provider if they are in an emergency. An example is a patient with severe pain from an abscessed (infected) tooth or some trauma. The HMO/EPO may initially deny service to an out-of-network provider; however, they may pay if you appeal the claim.

If they agree to pay, these schemes will do your work to get paid. OON methods can avoid billing for these types of preventative plans.

Most residents have PPO-type medical plans. PPO plans offer in-network and out-of-network benefits to their insured patients. There is a difference in how benefits are paid to an OON provider versus an IN provider. For example, if 80% is delivered to an IN provider for a procedure, it is usually paid 60% or less to an OON provider.

Discounts are another significant factor. It is essential to know that not all actions apply to the opponent. An example of this is ratings. 

Tell your patients that their drug payments will begin after the deductible is met. You’d be surprised how many processes don’t apply to deductions. One of the significant variables will be plan quality. There are good and not-so-good dental policies, but the same goes for medicine. You do get what you pay for.

This benefit reduction is not reflected in most practices as allowances (the amount allowed for a procedure/service) are much higher than for dentistry (which is included in the contract fee schedule). Most procedures cost double what dental policies pay for.

Credentialing with medical insurance

Getting approved for access to IN medical insurance is similar to getting approved with dental plans. It is vital to ensure that the medical carrier understands that you intend to engage in IN medical services, not dentistry and that you provide many services that do not include dental treatment and are more medical. However, you may find that many medical plans only allow oral surgeons to go IN.

Numerous dental practices are ignorant that in some states if you are IN with dental, you’re automatically IN with medical. In this case, you could easily bill medical and be refunded more than double for your services. It helps provide dental benefits to patients for dental procedures. You can bill both medicine and dentistry; They are separate policies that your patients pay for and have benefits.

Medical bills are here to stay. There are many services you offer that may be billed for medical services, such as evaluations, surgery, sleep, or TMJ treatment. Whether in IN or OON, being strategic in your approach will grow your practice group and lower your patients’ out-of-pocket costs.

Who provides the best medical insurance credentialing Services?

Since 2008, we, Denmaar provide mental health care and practices with valuable services and tools that enable increased revenue, reduced management time, and an improved patient engagement experience. Using an in-house IT system explicitly designed for the mental healthcare specialty, unparalleled efficiency allows us to deliver our services at lower than typical medical care rates.