As the behavioral healthcare leaders drive community collaboration, they might also need to take a new look at collaboration within their own four walls, says Adrianne Trogden, LAC, CCS, LPC-S, chief clinical officer for ACER, LLC, an agency in the New Orleans area that provides multiple levels of care. Specifically, many organizations today are challenged to align their business staff and clinical staff collectively to capture all the documentation needed for payment. It’s especially critical now with the rise in managed care payment sources, but all too often the staffs operate in independent silos.
Trogden says she’s seen the clinical/business divide at ACER within its three sites. Over the course of a year, however, she successfully deployed a workflow model for the 30 staff members to ensure revenue is not lost because of simple coding issues.
“In our agency, we had a disconnect with the clinical side where they didn’t understand how billing works and didn’t know anything about coding to make sure the services they delivered were documented,” she says. “In the same vein, the billing department didn’t understand how clinical services worked in order to understand why they didn’t have all the components needed to bill appropriately.”
She will be presenting a workshop on how to align clinical and billing staff, maximize billable moments and audit the process for quality assurance at the Behavioral Healthcare Leadership Summit in St. Louis, August 22 to 25, 2014. The workshop will outline the model, including methods to track the commonly missed clinical services and billing codes. Helpful tips for avoiding pitfalls will also be reviewed.
Once ACER clinicians understood the rationale behind the coding break down, they were more likely to include all their “billable moments” in their documentation to ensure correct payment, Trogden says. And missed payment opportunity isn’t just a peripheral issue.
“They could be missing things every day and every week, and part of the key to that is having a good auditing process,” she says.
Not only will the auditing process catch missed payment opportunities, it can also help organizations avoid potential fraud risk, which can be costly if penalties are assessed. Today’s payers, both public and private, will increasingly seek to verify business transactions with providers of all specialties.
“In behavioral healthcare, it depends a lot on the contract,” Trogden says. “If you’re billing with a third party insurance company, there’s some limit to what you can bill for.”
For example, under some contracts, case management is billable, but under others, it’s not, she says. And with dozens of different contracts—or more, depending on the size of the organization—staff can’t just rely on memory to know what and how to bill. It’s a substantial task for clinical and office teams to track all their services to ensure they are paid where payment is available.
Trogden also says EHRs aren’t the ultimate solution to maximizing billable moments because intuition, critical thinking and workflow must come from the staff and then be applied to the technology tools. Some of the tools she designed for ACER, such as spreadsheets to track information, could be put in place immediately by other organizations hoping to replicate the model, she says, but full alignment could take a year or more.
Attend BH03 “Maximizing Billable Moments in Behavioral Health Organizations: Getting Your Business Office and Clinical Functions on the Same Page” on August 23 at 2:15 p.m.