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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 […]

Payor Initiatives Over the last few weeks, we talked about the shift in U.S. healthcare policy, what to expect from the value-based healthcare initiative and how you can prepare your medical practice/facility to comply with the changes. This article looks at the specific programs that Aetna, Anthem, Cigna and UnitedHealthcare are initiating and what kinds […]

Thanks to today’s fast Internet speeds and easily accessible video technology, telehealth services have rapidly expanded, becoming a legitimate alternative to a traditional office visit. Physicians in almost every specialty can take advantage of this more efficient, low-cost care to improve revenue and patient outcomes. Big hospital systems are taking notice and creating the infrastructure […]

Reimbursement rates for all medical services, especially behavioral health services, have changed over the last few years. In the past, many treatment facilities remained out-of-network, avoiding payor contracts that resulted in low reimbursement rates. But now behavioral health reimbursement rates have fallen across the board, even for out-of-network providers. Additionally, as claims are more closely […]

How-to Navigate Payor Contracts The process of going in-network can be lengthy and complicated. But since going in-network is becoming more financially feasible for behavioral health facilities, it’s worth your time to really understand the process and negotiate for the right rates. Learn the pros and cons of going in-network First, you need to determine […]