Eyes Wide Open to the Financial Opportunities
Maximizing Revenue, Avoiding Losses
- Maximizing Revenue: The team at BHS worked diligently in June to put together another curriculum focused strictly on coding, billing, and documentation for behavioral health. Topics covered include: CPT, Add-on codes, Modifiers, CMS documentation requirements, BH coding risk matrix, coding manual development, & effective compliance programs. One consensus from the audience: "We are not billing for everything we can!" On the flip side, knowing how to hang onto the money is just as important. Knowing the documentation elements for the CPT codes makes all the difference in the world for retaining the revenue through audits. Finally: this training is not just for "billing" people-- in fact, its the clinicians who carry the heaviest burden. By having the clinical and billing departments in weekly interdepartmental meetings, "maximizing revenue" will take on a whole new (and exciting) meaning!
- Avoiding Losses: Messages about payment reforms or payment "adjustments" were deleted, and many are now beginning to see payment adjustments (i.e.: "penalties") for not participating in certain CMS programs. Besides leaving a hefty chunk of (easy) money behind by not participating in the EHR Incentive Program, provider organizations may not notice these adjustments on Remittance Advice's. Look closely for Claim Adjustment Reason Code 237: "Legislative/Regulatory penalty." BHS's recommendation: Do not look at these programs as "just another regulatory program we must participate in." Instead, adopt the attitude that these programs will inevitably contribute to population health and proving your value proposition in the market to payers. This is an extremely exciting (and critical) time for provider organizations to improve, leverage, and prove their worth by leveraging information systems.
- Value-Based Population Health, Payment Penalties/Incentives, and Payment Reform: Sick of hearing these words? Confused by their multiple meanings, interpretations, and applications by various entities? "Will someone PLEASE just put it in sensible, understandable, & actionable terms?" Here's the deal:
- Before you jump into a CMS program (i.e.: MACRA), you must understand what it will mean your organization, the number of providers it affects and it's impact on workflows. You cannot just begin these programs when the business, clinical or infrastructure operations are not in place to support it.
- You must have a certified EHR that is truly capable of working well with these initiatives.
- Analyze your service lines and the percentage of revenue generated by Medicare. Some organizations have decided not to participate after conducting a cost/benefit analysis.
- That said, NOT participating will also put you at risk. Determine those risks in the context of your Strategic Plan.
- Organizational culture and tone must strive for clinical excellence, interdepartmental and team-based interdisciplinary collaboration. Is your staff ready for this?
- When/if you bring in someone to help you out, make sure they know the world of behavioral health AND they can present the information in a truly understandable way.
- Compliance: Lisette completed her Graduate Certificate in Corporate Compliance mid-June. The program consisted of 18-credits of law school courses, yikes. Already incorporating her new-found knowledge into her work, she presented some material recently--especially in the context of coding and billing compliance. The QA folks were giddy, no surprise! Compliance programs are significantly more complicated than you thought. Saying "compliance program" has taken on a whole new meaning! Are you understanding it correctly? If not, ask us to help you out.
Coding & Documentation Compliance for the ICD & DSM: A Comprehensive Guide for Clinicians: Scheduled for release by Taylor & Francis, January 2017. Special discounted rates for pre-sales will be posted soon. Picking out a textbook cover is really cool!
Draft ICD-11CDDG: The draft ICD-11Clinical Descriptions and Diagnostic Guidelines is available for review and feedback. We are getting very close to having a comprehensive, seamless ICD system that is free! For more information: ICD-11 Diagnostic Criteria
Lisette Wright, MA, Licensed Psychologist
Executive Director, Behavioral Health Solutions
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