MANAGED CARE RESOURCES

For many years, community behavioral health organizations primarily focused on two funding sources: Medicaid and local Mental Health Board funding. The billing rules were relatively straightforward. Agencies understood what services were covered, who could provide those services, and how reimbursement worked. Today's environment is very different. Behavioral health providers now navigate a complex payer landscape [...]

From time to time, we receive questions from the field that we know impact many behavioral health provider groups.  We recently received the following question from a behavioral health provider: "Our organization offers a chemical dependency IOP program and has several clients covered by commercial insurance plans. We verify benefits, obtain authorizations, and provide the services. [...]

An Intensive Outpatient Program can be fully operational, properly authorized, and billing claims correctly—and still be underpaid. For many behavioral health organizations, the problem isn't the revenue cycle. When this happens, the first assumption is often that there is a problem within the revenue cycle. Claims are reviewed. Billing workflows are examined. Coding is audited.  [...]

Why Product Line Verification Matters More Than Ever One of the most common questions we hear from behavioral health organizations is: "Are we in-network with this payer's product?" It sounds like a simple question. Unfortunately, the answer isn't always simple—and assuming you know the answer can become an expensive mistake. We've worked with organizations that [...]

One of the most common mistakes organizations make is treating commercial insurance like an extension of Medicaid. It’s not. Medicaid typically offers: Broader service coverage More predictable reimbursement Minimal patient financial responsibility Commercial insurance, on the other hand: Covers a narrower set of services Varies significantly by plan and product line Shifts a large portion [...]

This question has been perplexing private practice clinicians for the last couple of years: “Why does it feel like we’re doing more work — but getting paid less from commercial insurance?” When I talk to clinicians trying to unpack this, I usually go through my punch list: Has your overall client volume changed from the [...]

There’s a difference. And in today’s healthcare environment, it matters more than ever. If your organization isn’t actively managing, strengthening, and investing in its relationships with Medicaid Managed Care Plans (MCPs), you may already be at a disadvantage. What Medicaid MCPs Really Need Medicaid MCPs, under the oversight of the Ohio Department of Medicaid, are [...]

Nothing strikes fear into the heart of an Executive Director quite like the news that a Managed Care Organization (MCO) is coming to conduct a clinical audit! It’s important to remember that MCOs have a mission: to "bend the cost curve" on behalf of their client—the Ohio Department of Medicaid. Their role is to ensure [...]