“There are people who have behavioral health issues, psychiatric issues, they have substance abuse issues, eating disorders, the list goes on. These people need treatment.”
According to SAMHSA, Any Mental Illness (AMI) is defined as having a diagnosable mental, behavioral, or emotional disorder, other than a developmental or substance use disorder. Any mental illness includes persons who have mild mental illness, moderate mental illness, and serious mental illness. In 2021 19.00% of adults are experiencing a mental illness. Equivalent to over 47 million Americans. 4.55% are experiencing a severe mental illness. The state prevalence of adult mental illness ranges from 16.14% in New Jersey to 25.25% in Utah. The pandemic has changed how patients see providers, how care is delivered, and how an organization’s infrastructure needs to adapt to serve the needs of patients and providers.
Therapy Brands is a leading provider of Healthcare IT (Information Technology) solutions and services serving the mental, behavioral, and rehabilitative health markets. We are committed to helping providers have a greater impact on the world. We stand in service to the underserved. Demand for more mental health and therapeutic care is on a dramatic rise, but the people who stand and face these crises are being forced to do more with less. Less funding. Less technology. Less support.
We’ve made it our mission to change that.
We sat down to discuss mental health billing, and the unique challenges providers face with Lou Ann Thompson as part of our behavioral health spotlight series.
Lou Ann Thompson, Revenue Cycle Management (RCM) Director at Therapy Brands and the General Manager of Logik Solutions, has been part of the behavioral health financial world for years.
After graduating from college with an accounting degree, she started her career as an AP Clerk and AR/Biller at a psychiatric clinic in 2005. In fact, she had only worked at the clinic for a week when the biller left, and Thompson took over the job. “I’m self-taught. I learned clinical billing as quickly as I could, and my accounting background really helped.”
“I am drawn to puzzles and logic. I became an accountant, and then moved into mental health billing and software solutions, because I like to take apart, and then reassemble, financial puzzles,” Thompson shared. This mindset is key to her success in evaluating client billing processes for efficiency and revenue potential.
After several years working on the frontlines of psychiatric billing, Thompson was recruited by Logik Solutions, an enterprise billing platform for behavioral health organizations, in 2008. She became an integral part of the Therapy Brands Team in 2019 when Logik joined TBH’s Accelerated Business Solutions segment.
With everything going on in the world today, even within healthcare, why does behavioral health billing matter?
The bottom line? If psychiatric clinics and institutions, or substance abuse treatment centers, or community health organizations are not paid for their services, they cannot keep their doors open. Mental health providers must be paid, and in a timely manner, to remain in service to their clients. They cannot provide needed mental health services if they are not open.
Think about the world today. I mean, even before COVID mental healthcare was vital to the well-being of our population. With COVID, the stress levels and the psychological impact on our personalities, our lifestyles, mean even more mental health challenges across the world.
Even before COVID many of our psychiatric facilities were already at financial risk, the closures during the pandemic have only added to that strain.
Mental health organizations faced a different crisis during the pandemic than traditional hospitals. The shortage of ICU beds and ventilators, being over census, and struggling for resources: those were problems traditional healthcare providers and facilities faced. Psychiatric facilities faced closures or lower bed counts than they could afford to operate at to accommodate safety regulations during COVID. Telehealth options were successful for primary care physicians during COVID, but many mental health clinical modalities must be in person.
Many psychiatric facilities that were stable prior to COVID were forced to close permanently for financial reasons during COVID. All these factors have resulted in a lack of access to mental health care across the United States.
Let’s talk about access.
Yes, there are people who have behavioral health issues, psychiatric issues, they have substance abuse issues, eating disorders, the list goes on. These people need treatment. They might need time in a hospital, a rehab program, inpatient treatment, partial hospitalization programs, or intensive outpatient therapy. There is a real need in this world to provide those services, and if you’re an organization serving these populations, you must have a sound financial foundation. That brings us back to the topic of behavioral health billing.
Our conversations often return to that topic!
To stay in business and provide mental healthcare services, facilities or practices need to be able to bill insurance companies and government programs correctly. Or I should say, to be paid, organizations must process their billing the way the insurance companies or programs require. That process can be different from insurer to insurer, from state to state. Behavioral health organizations have to set up and maintain their provider-specific billing workflows for optimal collection rates. It’s the only way to grow your business and continue to provide those desperately needed mental health services throughout our country. Behavioral health billing is complex and requires expert knowledge. Whether your organization has an experienced team who know clinical and institutional billing and software inside and out, or you employ a third-party billing service, expertise is required.
What’s one piece of behavioral health billing advice you can offer?
Know your payor matrix. Know your services, know your payers, know who you are in-network with.
At Logik we start new clients off with a discovery checklist so that we can implement their billing workflows correctly.
So, the first question is going to be: What services do you render? Then we are going to ask: Who are your payers? Are you in-network with those payers? What specific types of contracts do you have with those payers and what type of facility are you registered as in your state?
This matters because, depending upon where their facility or practice is legally registered—and what classification they hold–may impact how that payer requires them to bill. In many cases established institutions will not have all the answers to this initial list of questions, and they will have to reach out to their payers for answers to fill in the payer matrix overview.
During this process, my team will also ask new clients to identify commercial payers, Medicaid, Medicare, etc. If they tell our team that they have Medicare and render inpatient services, then we are going to immediately ask them: “Do you need the DRG calculator?” It’s common for reimbursements to be based off of the DRG calculator in these circumstances. The list goes on and the client’s answers dictate billing workflows, the specific overrides that need to be programmed, and more.
Having a complete grasp of the intricacies of your organization’s payer matrix sets you up for financial success. That would be my best piece of advice to CFO’s and Billing Team leaders within behavioral health. Know your payer matrix.
Great, we’ll end with that piece of wisdom. Thank you for sharing your experience and advice.
To learn more about behavioral health billing solutions or to connect with Lou Ann please visit https://therapybrands.com/billing-solutions