Category: Revenue Generation

Avoid These Common Revenue Pitfalls

We are in an era of complex healthcare billing that can cost providers lost revenue due to lack of knowledge and proper training. Without these much needed tools, providers are faced with significant loss of revenue for their company. The good news is many of these mistakes are avoidable with proper checks and balances in […]

Single Case Agreements 101

Single case agreements are contracts between an insurance company and an out-of-network health care provider for specific patients for billing in particular cases. They allow out-network patients to benefits. from in-network billing benefits. There are two ways for billing after the approval of SCA. First, the insurance company provides the allowed amount, finalized as per […]

Mental Health vs. Substance Abuse

There are all sorts of therapies and rehab programs to treat substance abuse these days. However, recent studies and observations indicate substance abuse not always being a standalone problem. This information also implies that, for decades, it’s not just substance abuse that has been a problem, but also the way patients undergo treatment.  Providing proper […]

Ancillary Services 101

Ancillary services are additional services, which are important to run an organization (not to be confused with ancillary services – electrical). They are set up to provide full service to the customers and also help increase revenues an organization’s revenue. In hospitals, ancillary services are the ones other than room, nursing, medical, and board services. […]

Current Trend in the Behavioral Healthcare Industry of Going In-Network

Currently, many behavioral healthcare providers are turning toward the option of going in-network rather than away from it. For those who don’t know, the term in- network refers to the option of connecting with certain health programs and/or insurance companies at a negotiated rate in order to provide care to individuals who are covered by […]

Changes in the Lab Industry Regarding Lowered Reimbursements and Current Challenges

Protecting Access to Medicare Act (PAMA) became a part of law on 1 st April 2014. The purpose of the act includes extending payments of Medicare physicians and other provisions. Instead of solving problems for healthcare facilities and clinical labs, these changes only complicated matters. PAMA introduced some vivid changes in the Medicare Clinical Laboratory […]

What Behavioral Health Providers Need to Know about Value-Based Reimbursements

Value-Based Reimbursements change the game by offering outcome-based incentives to In-Network providers. Learn more about this important trend.Value-Based Reimbursements give In-Network providers an incentive to remain in a payer’s network, while tying a portion of their payments to patient outcomes. In doing so, the Value-Based system could help bring the cost of healthcare under control.And that’s not the only reason providers should embrace outcomes-based reimbursements. As of 2018 The Joint Commission will require outcomes-based data as a conditioned for accreditation. Other accreditation bodies are sure to follow suit.In this report, we look at how Value-Based Reimbursements, AKA “outcome-based reimbursements,” work and how providers can adapt to get out in front of this massive industry change.Insurer reimbursements are changing once again. This time, payments are being tied to outcomes. We see this as not a “trend” but a long-term solution to the issues that have long plagued payer-provider relations, the biggest being the disparity between In-Network and Out-of-Network payments.Traditionally, In-Network providers received a reduced rate for services, with the trade-off being that insurers funneled more patients to their practices. Out-of-Network providers, however, could charge whatever they deemed appropriate. This meant a huge gap between what In-Network and Out-of-Network providers were being paid for the same service, and led to In-Network providers crying foul.In theory, Value-Based Reimbursements change the game by offering outcome-based incentives to In-Network providers.In this report, we look at how Value-Based Reimbursements, AKA “outcome based reimbursements,” work and how providers can adapt to get out in front of this massive industry change.

5 Reasons You Should Diversify Your Payer Mix

To run a successful healthcare practice, it’s important to diversity your payer mix. Here are 5 reasons why payer mix is more important than you thought. In Healthcare, having a solid and diverse payer mix can be the difference between running a thriving business and closing your doors. Having a diverse payer mix takes the power away from any one insurer. This gives you more control of your cash flow, and enables you to better predict how much money you’ll have at any given time.While this is a simple concept, it’s important to understand precisely how the differences in payer operations and guidelines can affect your practice.

Improve Insurance Reimbursements by Improving Documentation

The entire business model of a substance abuse treatment center depends upon accurate, complete and timely insurance reimbursements.  Unfortunately, many treatment centers struggle to accurately and effectively document patient care in order to get the reimbursements they need to stay afloat.With that in mind, we put together this simple cheat sheet for improving patient documentation. For a more in depth look at this issue, we invite you to download our e-book, 3 Reasons Your Documentation is Costing You Money – And What to Do About It.

Three Big Reasons for Claims in Aging & How to Improve Reimbursements

Claim aging is one of the biggest issues in healthcare today – especially in behavioral health, where there is so much subjectivity when it comes to medical necessity. This is why it’s important for providers to understand why their claims go into aging – and what they can do about it.Here are the top three reasons for claim aging