During this time of uncertainty, we’re all looking for ways to maintain stability across our organizations and ensure that operations remain successful. Let’s take a look at a few tips that can help your treatment facility streamline operations, improve claim processing, optimize collections, and leverage new technology to increase compensation.

Audit Your A/R

 

When auditing, the main effort is to understand your payer mix, how each process claims, as well as how often and why payers deny claims. Once you have an understanding of these, you can prioritize your efforts and operations accordingly, ensure you’re submitting claims in the best format, and make precise projections for the future.

Here are some questions you’ll want to answer in your audit:

• What payers are denying more frequently?
• What insurance companies are paying directly to the patient, and more importantly, are you receiving those payments?
• Which CPT and Rev codes pay at better rates?
• Are your allowables and payments consistent with historical data?
• How long is it taking for my payments to process, and how are my collectors working on these accounts?

Using the billing reports in Sunwave (such as the Dynamic Report, Payments Report, Collections Report, and AR Report) can help you answer all of the above. The reports in Sunwave RCM are explicitly designed with treatment facilities’ financial needs in mind.

Keep Clinical Documentation Clean

 

Claim processing and clinical documentation go hand in hand. Making sure that all forms are completed with signatures can be the difference between a payment and a future appeal.

First, implement a consistent process to audit forms and ensure signatures have been applied. In Sunwave, you can use the Signature Audit feature to complete that quickly.

Next, you can create an alert on any form requiring completion within a specific timeframe. JCAHO and insurance companies often require completion of items within a certain amount of time, such as a biopsychosocial. Receiving alerts can help your team get ahead of these items before records are requested, help you process claims more successfully, and ultimately receive payment faster.

Ensure Timely Authorizations

 

Following up on authorizations and keeping a record of review dates will give you the best chance of successful claim processing. Without authorization, a claim will likely be denied, and the chance of payment decreases dramatically. Being able to keep records of past and continuous authorizations, along with notation, will make your claim processing and collections more successful.

In Sunwave, you can track authorizations, as well as run reports on payments by authorization and insurance company. Your team can understand which Utilization Review representative is getting approved for more extended stays and compare authorizations between representatives. Knowing this information can help you implement additional training to address any gaps.

Additionally, we recommend that each reviewer pulls a daily list of reviews that are due. This will help ensure that authorizations are being done effectively and promptly.

Utilize Telehealth to Continue Care

 

Social distancing can be difficult when you are in a facility setting, but it doesn’t have to be. Throughout the COVID pandemic, many behavioral health providers are leveraging Telehealth to host individual and group sessions. Telehealth gives you the ability to connect with your patients and ensure they remain on the path to recovery while abiding by HIPPA regulations.

Sunwave’s Telehealth module also has features that allow you to securely collect payment as well as manage forms and signatures electronically. This will help keep the clients taken care of and will allow you to continue getting compensated for services – ensuring your operations can help more and more clients for a long time to come.

Follow up with Alumni

 

The alumni team is essential to any facility, making sure clients are continuing care and step work post-discharge. It’s important that clients don’t feel alone after leaving a facility, and that is where the alumni efforts play such a significant role, engaging with clients regularly.

Sunwave’s alumni management module makes this easier and more efficient for your team. Scheduled follow-ups are automatically created, letting each representative know when a client is due for follow up. This system allows the alumni representative to ensure they are reducing the risk of relapse for their clients. In the event a client should happen to relapse, alumni representatives can get them into the care they need immediately. During this challenging time, it is critical to ensure clients are supported, especially alumni.

We’re here to help you and your team. While the future seems unclear as to when we will go back to business as usual, let’s look at how Sunwave can help serve your facility even more so. Call us and let us show you how to leverage your behavioral health EMR software better and utilize all it has to offer.