Health Assets Management, a billing and practice management company in Kingston, N.Y., previously only worked with a couple of public-sector clinics on billing issues. But Carmel Gold, the organization’s president, said they have received calls from four surrounding counties requesting information on changes in the Affordable Care Act.
“What’s going on is most are finding they are less and less dealing with straight Medicaid, which is what they were used to in the public sector and now Medicaid is being shepherded into managed care, so there are commercial plans that they aren’t used to,” she said.
[See also: Operational considerations for becoming a behavioral health home]
The ACA has ushered in a whole new world for back-office management at behavioral health centers. Providers are accepting new payers and collecting co-pays; there will be new billing cycles and issues like eligibility and empanelment that they have never had to consider before.
Mohini Venkatesh, vice president of practice improvement for the National Council for Behavioral Health, said things will be particularly problematic for providers in 2014 with marketplaces opening and Medicaid expanding in some areas. She also said it is a great opportunity to access payments from a new range of payers – it will just require a whole new business model than they have used in the past.
The council is helping providers wade through the changes with their new tool, the Mastering Back Office Management Learning Community. The nine-month program will walk participants through assessing their current billing process, co-pay collections, and implementing strategies to appropriately bill any potential payers.
There are a host of things behavioral health providers are going to have to know, one of which is credentialing. At many of these organizations, the providers won’t have the credentials needed to be empanelled. That becomes a workforce issue.
Another challenge with insurers is carve outs. In commercial insurance, mental health benefits may be managed by a different company than the physical health plan. Claims could go to different places and co-pays could be different, Gold said.
“These are all little things they need to pay attention to,” Gold said. “When it was a big government entity (Medicaid), they would take care of you, but little companies are sticklers for things like getting bills on time.”
Providers are also going to have to determine how they will take part in the marketplace. Michael Flora, senior operations and management consultant at MTM Services, said organizations should look at their catchment area, see who the largest insurer is, and get on their panel. Providers will also need to look at their patient population and anticipate any changes that might be coming down the road, he said.
Venkatesh said this is the time to look at a strategic plan or have board discussions regarding what an organization’s payer portfolio will look like in the next five years. Providers will need to create a work plan to understand billing requirements, co-pays and empanelment for the different providers to prepare in advance. Speaking with other behavioral health providers about their back-office practices and billing is a good way to understand any changes an organization might need to make, Venkatesh said.
One of the most challenging elements for behavioral health centers will be co-pay collections. Those that do so already will need to improve their efforts because of high co-pays on some of the exchange plans. Organizations that don’t currently do it may have to as they begin taking plans outside of Medicaid.
Flora said to improve collections, behavioral health centers will have to stop thinking of themselves as a social service organization and instead like a specialty healthcare provider.
“That is one of largest barriers we see with our providers,” he said. “They serve everyone regardless of their ability to pay … and they are writing off hundreds of thousands annually in bad debt or uncollected fees.”
One of the organizations he works with budgeted $2,000 a day in uncollected co-pays. They didn’t take co-pays at the front desk; instead they sent out monthly statements and were collecting less than 50 percent of client balances.
Many organizations have a plan to collect fees, but do not apply it consistently. He said organizations should set a target of 95 percent of co-pays at the front desk and work toward that goal.
Training and scripting for the front desk can be important. When the organization calls to confirm an appointment, remind the patient that a co-pay is collected at the time of service. Ask for the funds when a patient checks in. And have policies in place for contingencies, such as patients saying they only get paid on the first and 15th of the month.
Finally, Flora said creativity will be required. Some clinics, he said, have done things like have case managers take machines that can swipe a debit card on home visits to collect co-pays.