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Substance Use Disorder Revenue Cycle Management

We understand that providing quality care is your highest priority, and excessive administrative tasks and costs are a barrier.

Introducing Value-Based RCM!

 

We partner with our clients and support key revenue cycle tasks as our priority, freeing the facilities team to focus on patient care. We take a personalized approach to maximum your return while delivering impeccable customer service. Our innovative services help facilities to minimize their risk and maximize the potential for maintaining a healthy revenue stream, while reducing administrative burdens.

Your revenue cycle processes will be managed by experts with years of experience in billing, coding, compliance and utilization management.

We are committed to delivering our clients the timeliness, accuracy, security and compliance to federal, local and payer regulations you expect and deserve.

The first step to a partnership with Value-Based RCM is a comprehensive end-to-end revenue cycle assessment.  To learn more or schedule your assessment please contact us

Benefit Investigation

The technologies used by Value-Based RCM are innovative and data-driven. Using the latest technological advances, our dedicated professional staff leads the industry with unprecedented accuracy and turn-around times.

All calls with payers are recorded for quality, training, and to ensure appeal opportunities with payers are not lost if inaccurate information is provided.

The rigorous benefit investigation process results in your facility’s ability to make a sound admission decision using the criteria obtained during the payer encounter.

We believe the verification of benefits is not a one-time event. At Value-based RCM patient benefits are verified at a minimum of every thirty (30) days, more frequently if information provided or identified warrant a re-verification.

At Value-Based RCM, we understand “life happens”, this is the reason we have to support this key process with the best methods possible, provide the most accurate information without solely relying on payer-automated tools.

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Claims Management

Value-Based RCM clients receive services based on the most integrated and data-driven systems.

Starting with evaluating the most efficient approach to obtaining daily charges from the facility, we leverage workflows currently in place or make recommendations to ensure an efficient and effective workflow.

At Value-Based RCM posting charges and claim submission is recommended to be done daily, but we understand this may not be a workflow the facility can support. During the revenue cycle assessment, this workflow will be determined collaboratively and ensure success for everyone involved.

Rejections and denials are not simply managed at Value-Based RCM, our team of experts will work to mitigate the cause of these reimbursement delaying activities, getting to the root cause which is done through workflow assessments and/or payer interactions.

Claim acceptance is a process completed every day. It is very important to confirm the number of claims submitted are accepted and the dreaded “no claim on file” is never a reason for reimbursement delays.  The Value-Based RCM team takes a very proactive approach and will do claim status checks every seven (7) days to confirm the current status of claim reimbursement and reduce correspondence.

Coding Compliance

Our clients recognize the precision in which we utilize current coding practices including CPT, ICD-10 and HCPCS are key to compliance.

Understanding the facility’s program delivery and services rendered is key to accurate coding and optimal revenue recognition.

Highly trained coding staff accompanied by coding software will ensure the most compliant claim submission and always reflect the medical record documentation prepared to support the billable services.

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Collections Management

At Value-Based RCM we understand the impact that outstanding receivables can have on your organization. Our team provides quality claims management so you can focus on your clients and other operational priorities.

We ensure the front-end workflows are supporting a clean claim submission and permitting the collections workflow to be quick and effective. Most collection delays are a direct result of poor front-end workflows. At Value-Based RCM we commit to be in-control of the claim submission events leading up to timely reimbursement of billed services.

Strong payer relationships are a key success factor for timely collections. We communicate directly with payer representatives and escalate appropriately as needed during the collections management process.

Collections management drives a strong partnership between Value-Based RCM and our clients...if you don’t get paid…we don’t get paid…

Consulting

As a testament to our confidence in the ability of our operations, we provide you with a complimentary consultation in order to assess the needs of your operation.  There are many levels of organizational needs and our customized and individualized services begin with the implementation of a strategic solution to support your business based on your goals. We assure that your business will be compliant with industry standards and we confirm you are optimizing your reimbursement potential when compared to like service providers.

Our consulting service will help you identify opportunities for improvement and will provide you with the tools necessary to streamline your operations, optimize your processes and maximize your revenue.

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Contracting and Provider Enrollment

As the payer landscape is changing for SUD/BH providers and more are deciding to go “In-Network” with payers, our expert team specializing in “In-Network” contracting will guide you through this very tedious process. Completing the lengthy applications, negotiating provider status, representing your facility clinical programs and maximizing reimbursement rates established in your market with other in-network providers of the same specialty. Do not just settle for what the payer is offering, use this opportunity to highlight your facility as a program payers value and is willing to pay for.

Whether in-network or out-of-network, the process of provider enrollment is critical to claim submission and removing reimbursement delays. Managing facility providers licenses, CME requirements, payer registration and clearinghouse enrollment, using the most current credentialing and reporting tools available, is what the Payer Services team at Value-Based RCM will bring to the partnership.

Utilization Management

A vital component to the bottom line of any addiction treatment or behavioral health facility is the Utilization Management Department.  It is a key function to the facility’s success as it manages the authorization from insurance companies for reimbursable services and ensures a compliant revenue stream.

Our experienced UM team is trained to optimize the proper number of days in each level of care. Commonly wrong codes, incorrect codes, not understanding the diagnosis or simply human error can attribute to not receiving the correct amount of reimbursement. Our highly trained and licensed team understands the impact of accurate reporting of this information to payers.

Using a proven process of collaboration and data capture optimization, drives approval of longer stays at higher levels of care while confirming both initial and all subsequent authorizations. Our team factors into this process all aspects of your facility including your daily census, clinical protocols and programs. We assist you with ongoing implementation of required clinical documentation, outlining intensity of services and all related processes. This process encompasses a comprehensive clinically led review based on criteria established by published society specialties (i.e., SAMSHA) and payer guidelines and providing physician to physician reviews and appeals as required.

The Value-Based RCM UM team prides themselves on being an extension of the facility clinical team, supporting each patient with a UM approach as unique as they are.

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Customized Reporting

The Value-Based RCM reporting library provides you with every advantage to maximize your revenue. Our revenue cycle technology reporting platforms offer our clients the ability to have custom reports built based on the specific areas of interest.

Following our assessment of your business needs, we design a reporting package unique to your business needs. Our professional reporting analysts understand the revenue cycle continuum and are adaptable to your needs. They can make changes and/or update reports as your business requires.

Value-based RCM prides itself on providing reports that are useful, manageable, quantifiable and actionable. Using data driven reporting is the "report card" of our partnership.