Better Capital. Better Care. 

Dealing with insurance companies can be a pain. Whether you are a patient or provider, it is difficult to understand how insurance works, what services your policy covers and the correct reimbursement rate. As insurance premiums are at an all time high, coverage is more scarce than ever before. Below, we’ve outlined the most common […]

Collect on Unpaid Claims Many facilities and medical practices have a number of denied insurance claims that are not actively being addressed. Because most billing departments focus mostly on the claims that are easily reimbursed, thousands of dollars are left uncollected. Getting paid on old claims can be challenging so we put together a list […]

What is Prior Authorization? Prior authorization is almost always necessary for behavioral health treatment. Once your authorization team and your patient’s insurance provider agree on they type of service and approximate length of time that the patient will require, the insurance representative will give you an authorization number. Typically before a patient admits into your […]

What is ASAM? ASAM (The American Society of Addiction Medicine) Criteria is the most common set of guidelines that payors and providers use to determine what level of care and length of treatment that the patient needs. They are typically referred to by the Utilization Review Specialist and case manager while they determine a treatment […]

Medical necessity is one of the most common reasons that insurers deny behavioral health claims. It is possible to get this type of denial overturned, but to do so; there are a few essential steps to follow. Download a Medical Record Submission Kit What is Medical Necessity? The first thing you should familiarize yourself with […]

Get a Medical Record Submission Kit Providers and facilities of all specialties are subject to inspections from the Department of Health Care Services (DHCS). Auditors assess the medical practice in the following categories: Following the onsite survey, the auditor shares the score with the provider or facility. They are then responsible for correcting the deficiencies […]

Do you get authorization prior to treating a patient, yet still receive claim denials? This is a common issue that providers face on a regular basis and unfortunately, there is not a simple solution. One option is to have the claim reprocessed. Most likely, you will need to write an appeal. Learn to reverse claim […]

Why Use a Business Associate Agreement? Because healthcare providers frequently outside vendors and subcontractors, it is important to maintain a network of trustworthy partners who value the protection of patient data. Get An Insurance Reimbursement Calculator All medical practitioners should use a business associate agreement with any contractor who has access to, or transmits patient […]

Third-Party Payer Audits As the value-based care model gains momentum in U.S. healthcare, payer audits by third-party vendors are becoming more common. Insurance providers state that audits are conducted to improve the quality of service that the patient receives. This is how it works: the third-party analytics company collects medical notes with the corresponding diagnosis […]

In last week’s blog, I talked about third-party payor audits and what they mean for your behavioral health facility. Before writing the article, I interviewed a representative from Anthem and Verscend (the third-party vendor conducting audits). During my conversations, I was surprised to hear that the purpose of these new audits is not to scrutinize […]