In our new weekly blog series, "Dashboard Driven Decisions," we'll be examining how addiction recovery, substance abuse and behavioral health organizations can greatly benefit from monitoring patient claims electronically, specifically via the use of a claims dashboard. Electronic claims management is faster, more organized and less error-prone than traditional methods, allowing your back office to work more effectively and you, in turn, to focus on growing your business.
In our second installment, we look at how electronic utilization management provides the tools to both better understand payer rules and to project received amounts to provide patients with the critical care they need.
Foster A Deeper Understanding of Payer Guidelines
One of the key components of effective utilization management within your revenue cycle management department is understanding payer guidelines. In addition to nationally recognized medical necessity criteria, each payer has their own specific guidelines as well. Familiarizing yourself with the payers with whom you most commonly work gives you an advantage when it’s time to call or fax in a request for additional authorization. It's highly recommended that each member of your team familiarizes his or herself with the major payers you work with and their medical necessity guidelines by level of care. This helps ensure all patients receive the care they need.
Always Remember: Every Payer Is Different
It’s important to have processes in place to track average lengths of stay for each level of care so you know what to expect when admitting a patient, and to communicate these expectations on the front end to that patient and his or her family. Project what you'll likely be receiving based on data patterns, allowing you to build a strong treatment plan and get the most from the time a patient will be under your care.
Treatment Is Shifting Focus Toward Care Quality
Clinical documentation and utilization management need to be better than ever, and more aligned than ever. Greater integration between EHR and practice management platforms help cut down on the time it takes when documentation is needed.
Check out our "7 Things Your Back Office Should Be Doing" webinar video and slide deck for greater insight into how dashboard-driven decisions can help you get the returns you deserve.