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5 Steps to Lead an Effective Behavioral Health RCM Process

Jun 20, 2023 9:30:00 AM / by Altruis

5 Steps to Lead an Effective Behavioral Health RCM Process


Efficient payment collection starts early, from the patient’s first interaction with your behavioral health organization. As you follow them through their healthcare journey, every stage should reflect an effective revenue cycle management process in medical billing.

Revenue cycle management (RCM) dramatically increases your rate of successful payments through wise behavioral health billing strategies. With the right behavioral health RCM processes in place, your organization will issue bills and receive payments smoothly and profitably. 

This article highlights the 5 most important steps to take for revenue cycle management process improvement.

#1 Use Billing Software Built for Behavioral Health RCM

Does your behavioral health billing software support efficient RCM? An outdated or insufficient system becomes a major roadblock to reliable receivables. Your staff wastes time and energy fighting with the billing software instead of providing excellent patient care.

The right billing software is built for the healthcare industry, including behavioral health. It should be able to trace patient care from registration to the final payment without errors or glitches to slow things down.

Ensure your software is pre-built with the correct behavioral health codes your staff will need to use to claim reimbursements from insurance, government programs, and regulatory authorities. Check to make sure your software is regularly updated with the latest information from ongoing changes in the healthcare industry, including new behavioral health CPT code changes in 2023.

#2 Preverify Everything

Preverificiation is a must for behavioral health clinics. By preverifying patient, provider, and coverage information, you increase your odds of securing reimbursements and receiving full payment every time.

Here’s a brief checklist of preverification tasks:

  • Determine which coverage is involved - private insurance, Medicare, Medicaid
  • Check utilization management to ensure they have not exceeded their limits
  • Verify required prior authorizations are in place
  • Verify mental health benefits
  • Verify substance abuse benefits
  • Verify specific clinician/provider coverage in-network/out-of-network
  • Check whether all patient information is correct and up to date
  • Ensure your staff is conducting proper record-keeping and clinical note-taking, including using the correct behavioral health codes

#3 Get a Grip on Your Denials, Rejections, and Resubmissions

Reimbursement depends on an efficient claims management process. Your clinic or healthcare organization may need to engage with certain entities to conduct negotiations into payment rates. Examine reimbursement rates at all payment levels, including:

  • Inpatient Treatment
  • Intensive Outpatient (IOP) Treatment
  • Partial Hospitalization (PHP)
  • Residential Treatment (RTC)
  • Routine Outpatient (ROP)

As you submit claims for reimbursement, pay close attention to denials vs. rejections. Some claims are rejected initially but can be resubmitted within a certain window. Notably, missing the deadline can make it difficult or impossible to claim reimbursement.

#4 Engage in Constant Follow-Up

Denials management, including checking underpaid and missed claims, is the key to stronger behavioral health clinic revenue. Follow up on all denials and rejections, monitoring them as they make their way through the process of claims and resubmissions. When necessary, write appeals and follow up on them to increase the odds of success.

Keeping an eye on these claims is important because some insurers have a history of rejecting valid behavioral health claims. In 2015, the U.S. Court of Appeals gave greater power to patients and healthcare providers by ruling that insurers could be sued for improper rejections.

A 2022 Kaiser Family Foundation study found that between 2% and 49% of in-network claims are still denied regularly. Fewer than two-tenths of 1% of these claims are appealed, but upon appeal, approximately 40% are approved instead of being denied.

Reporting and analytics can help you understand how these kinds of numbers might be impacting your organization. Run regular reports showing the percentage of claims paid, denied, and so forth. Investigate any irregularities or areas where successful claims are far too low. 

#5 Partner With an RCM Expert for Behavioral Health RCM Solutions

Handling behavioral health billing can be a full-time job in itself. If your staff is overwhelmed with the vast array of RCM tasks, consider working with a billing partner to optimize your revenue cycle management.

Your partnership with Altruis frees you from focusing on your RCM so you can focus on providing outstanding patient care. We use the latest technology and techniques to maximize behavioral health profitability and minimize the hassles that come with medical billing and reimbursement.

Altruis handles all aspects of RCM. Turn to us for credentialing, coding reviews, payment posting, denial management, appeals, AR resolution, KPI analysis, reporting, training, and much more.

See what’s possible with Altruis. Schedule a call with us today.


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Topics: Behavioral Health, Revenue Cycle Management


Written by Altruis

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