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Top 10 Best Practices for Credentialing in Behavioral Health Revenue Cycle Management

Sep 20, 2022 10:47:06 AM / by Altruis


 Improve your behavioral health revenue cycle management plan by following these 10 best practices for proper credentialing.

Every healthcare organization faces the challenge of getting paid. Fast and accurate reimbursement involves the complex task of credentialing, which ensures providers are properly qualified for payments from insurance providers and government agencies.

Behavioral health credentialing is particularly arduous when it comes to working with Medicare and Medicaid. Any delay or error is cause for denial. To ensure reimbursement happens without hiccups, the process must be streamlined and carefully monitored.

Is your organization handling its credentialing as efficiently as possible? Here are the top priorities for credentialing in behavioral health revenue cycle management.

#1. Don’t Procrastinate

The #1 priority should always be to stay within the required timeframes for healthcare reimbursements. Medicaid and Medicare claims must occur within 12 months or they won’t be paid. 

Physician credentialing happens within an even shorter period. Optimally, physician credentialing can occur within 90 days, so aim for a 120-day maximum window to keep things moving along swiftly.

However, there are many ways this process can slow down or grind to a halt without proper payment management. It’s common for physician credentialing to take up to 180 days in a suboptimal credentialing process.

#2. Set Firm Deadlines

Refine your credentialing process by establishing new deadlines that keep everything on track. Set a hard deadline, then backdate each step in the process to create an entire calendar of deadlines for each person to follow.

When a new counselor joins your behavioral health practice, for example, generate a set of deadlines to support fast and smooth medical credentialing as they come on board. Before the counselor sees their first patient, ensure the background work is already done, and there will be no roadblocks moving forward.

Whenever there’s a concern that a newly-hired doctor’s credentialing might take too long, adjust their start date with the organization. This is a common behavioral health revenue cycle management practice that saves hassle and prevents reimbursement issues.

#3. Digitize the Data

Although it’s called “paperwork,” it shouldn’t involve much actual paper. To minimize errors, digitize everything. 

Use electronic data entry and data sources at every stage of the process. This allows easy entry, tracking, transmission, and confirmation of all credentialing information. 

Digitization eliminates the need to scramble around to find missing files and documents. Even when a particular patient or doctor is still determined to use handwritten letters, scans, or faxes, these documents can be uploaded into a digital platform that serves as a central source of credentials.

As you digitize, make sure your medical billing partner or platform is set up to work with Federally Qualified Health Centers (FQHCs). This prevents medical billing errors and omissions, ensuring you’re always getting the most out of your digitized approach.

#4. Verify Your State’s Regulations

In addition to federal laws, each state has regulations for medical credentialing. These laws don’t stay evergreen and are constantly changing due to new legislation.

This means the credentialing process you followed just a year ago could already be outdated. Check for updates constantly. And if you use a medical credentialing partner or platform to make this process easier, ensure they always stay ahead of regulatory changes.

#5. Utilize CAQH Effectively

The Coalition for Affordable Quality Healthcare (CAQH) is a database for providers that sets forth uniform credentialing protocols. Doctors should keep their information up to date with CAQH to make the entire credentialing process faster and easier. 

In the best case scenario, CAQH has all licensure and background information a provider or physician needs for credentialing. Payers can go straight into CAQH to get the information they need to facilitate payment.

Many healthcare and behavioral health organizations require their doctors to update CAQH regularly. Check to ensure all new hires have fresh and accurate CAQH information and double-check that every doctor’s data is reviewed for updates on a fixed schedule.

#6. Keep Full Doctor Profiles

This point goes hand in hand with gathering information for the CAQH. Keep your own database of additional information that might not be CAQH-required at this time, but could support reimbursements and other communications in the future.

Go beyond the basics of a doctor’s background and education. Include details from their resumes like professional organizations, previous contracts, community volunteerism, and connections to local healthcare and educational facilities. This information comes in handy whenever there’s a question about their background the doctor isn’t immediately available to answer.

#7. Remove Redundancy

Any duplication in the credentialing and reimbursement process is a problem. Duplicates take extra time and resources, plus they create the potential for denials.

Identify points of redundancy in your process. Are you asking for the same information twice? Are there places where duplicate data is entered into two different systems?

You can also use redundancy to your advantage, in some circumstances. When a doctor already has Kaiser or Anthem credentials in one state, it might be easier to credential them for another state. 

#8. Investigate References

Professional references are a common part of the credentialing process. If even one of these necessary references is missing, everything else waits on this bit of information.

Work proactively to gather and store your doctors’ professional references in advance. If three references are required, gather five. This way, you’ll have extras in case one is no longer applicable or you can’t acquire information in time for a certain deadline.

#9. Get It Right the First Time

Is your organization experiencing a high rate of reimbursement denials? Industry estimates show that about 85% of all medical credentialing applications contain incorrect information. 

Plus, credentialing-related denials are on the rise. According to the Medical Group Management Association (MGMA), 54% of medical practices have experienced an increase in denials in the past year. 

This highlights the importance of submitting correct information the first time and every time. One of the best ways to accomplish this is through savvy medical billing partnerships like the example discussed below.

#10. Leverage and Optimize Technology

In the modern healthcare landscape, technology is revolutionizing behavioral health revenue cycle management. New credentialing software platforms and medical billing partners are making the process faster and easier than ever.

Altruis is an example of a best-in-class medical billing cycle management service. It’s much more than a platform, using partnerships to custom-match services to needs and accelerate reimbursements. This empowers organizations to find success through synergy.

To learn more about streamlining your healthcare provider credentialing and reimbursement process, connect with Altruis.


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Topics: Revenue Cycle Management


Written by Altruis

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