Find the Best Billing Company for Your Treatment Center

Transcription

1 Find the Best Billing Company for Your Treatment Center Evaluate new billing and collections companies for your substance abuse treatment facility so you can find the best match to increase accuracy, maximize efficiency, and provide high levels of client care. 2017

2 Introduction As the owner or operator of a substance abuse, behavioral health, or addiction rehabilitation facility, you know how complex this industry can be. Not only does your facility have unique clients who have their own special requirements, it s also an unusual business mix of hospital and hotel. Keeping clients safe and comfortable can be a challenge and it s often the little things that keep your business running smoothly. Keeping the attention of staff and management on what is most important helps your facility stand out from the rest. Critical Systems Top-notch scheduling software, practice management software, and Electronic Medical Records (EMR) are just a few of the systems that are critical to the business. Another crucial system is a financial clearance and billing system for your services. This is the foundation of your revenue generation and cash flow. Without a high performing financial system, the entire organization can crumble. Finding the right vendor to help you select, develop, and maintain the systems used in your facility is essential for the efficient operation of your center. This ebook, provided by Inspira Financial, will help you choose the vendor that best suits your needs for Revenue Cycle Management (RCM) or billings and collection functions. It is our goal to help you sort through what matters the most to you and your center so that true needs can be addressed while still finding options for the nice-to-have functionalities useful to the addiction and abuse recovery industry. We highly recommend that, rather than assign a numerical score to each company or function, you use this guide to allow the desirable characteristics of an updated system to surface from your organization s staff members. A Starting Point These lists of wants vs. needs will be a solid starting point as you find a new system that will serve your organization well into the future. We are pleased that you have accepted our invitation to use this guide to find the right system for you and we wish you the best in your endeavor. 1

3 Dollars and Cents Whether you are looking to replace your billing company or you want a more comprehensive Revenue Cycle Management (RCM) solution, there are some very important questions you should ask as you make your decision. This handy checklist will help you ask the right questions to guide you during conversations you ll be having with prospective vendors and will help you in obtaining all of the information you need: q Is the vendor familiar with the special requirements for substance abuse and/or rehabilitation services? q What percentage of their business is in that part of the industry? q What percentage of total billings do they collect for rehabilitation facilities? q Are they equipped to collect old debts owed to you (e.g. aged Accounts Receivables?) q What is their success rate with old debt collection? q What do they charge for this function? q How quickly can the vendor perform Verification of Benefits (VOBs), particularly on weekend or off-hours? q What is the average length of stay, by level of care, they obtain for their customers during pre-authorization? q For concurrent reviews? q Do they integrate with your current Electronic Medical Record (EMR) or do they require you to use their EMR? q If EMR is not included in their features, be sure to include the cost of your current EMR provider in this calculation. q Fees q What is the recurring monthly fee they charge? q Are there additional one-time or recurring fees? q Training q What type of training do they provide to different levels of employees? q Is the training content and number of hours per staff member adequate for your business? If no, be sure to consider any additional costs. The answers to these questions might not be as straightforward as you had hoped, so some judgement on your part may be needed. For instance, if one company claims they can provide a higher percentage of billings they collect compared to another, but their fees are significantly higher, you may need to compare if the cost justifies the extra revenue. If the company representative you speak with doesn t know the answers to these questions, you should be concerned. This is especially true if that person is unable to answer the questions specific to the addiction and abuse treatment industry. See our helpful chart on the next page... 2

4 COMPANY 1 COMPANY 2 COMPANY 3 % of their business focused on addiction rehab % of billings they collect for rehab centers OLD DEBT COLLECTION Success rate Fee VOB TIMES Weekdays Weeknights Weekends LENGTH OF STAY BY LEVEL OF CARE (PRE-AUTH / CONCURRENT) Detox RTC PHP IOP OP Monthly fees Other fees Cost of EMR system (monthly) Cost of training your staff (hours x wage x staff) FEES AND COSTS 3

5 Quality and Capabilities Once your questions in reference to financial information have been fully answered from the prospective vendors you are evaluating, your next step will be to explore what it will be like to actually work with these different companies and if they are a good match for your organization. The next set of questions are qualitative in nature so an exact comparison between companies may not be possible. We recommend that you use a scale based on quality or completeness of the process (e.g. a 1-10 scale). A scale will provide a consistent measure for comparison across different prospective providers. Keep in mind you may need to go beyond the information on their website in order to obtain highly accurate information. Different Roles Have Different Needs Do keep the various roles found in your organization in mind while finding the answers to these questions. You may find that different functional areas should be assigned a different scale value. q How easy are their tools to use? How quickly will your staff be able to find what they need or perform routine tasks? q Will their practice management and EMR solutions meet the needs of your facility? q Does the product provide role-specific views? q Are the tools easily customizable? q Can the customizations be performed by your in-house staff or must you go through the vendor to have the work completed? q Does the application provide a built-in scheduler? q Will it be effective for your facility or will work-arounds be required? q Will any scheduling software manage staff, patient, rooms, and bed schedules? q What is the process for capturing claims to ensure you can bill for all services provided? q How do they ensure accuracy in the claim submission process? q How robust are the reporting capabilities? q Will the reports provide the data you need for all of the areas of your business? q Will you be able to readily access the reports online? q Can the reports be customized? If so, can your staff perform this work or must the prospective vendor? If they must do this work, Is there an additional cost for that? q Will you have a dedicated company representative or would you have to contact a call center? q How are off-hours and weekend technical or service calls handled? See our helpful chart on the next page... 4

6 COMPANY 1 COMPANY 2 COMPANY 3 Tools are easy to use (scale) PM and EMR meet your needs (scale) Tools can be customized (scale) Scheduling meets your needs (scale) Claim capture process (scale) Claim submission accuracy (scale) Reporting capabilities (scale) Dedicated representative (Y/N) Additional Services Now that you re ready to uncover the finer details of your potential new vendor and system, you will want to find out if the company has additional service which can be of benefit to your organization. q Do the prospective vendors offer consulting services? q What is the typical engagement and cost for these services? q Can your staff be trained on their services? q Does the company train on other topics, for example, compliance? q Does the vendor offer the option to lend you money to cover any cash flow issues while you change billing or RCM companies? Keep in mind that a service which requires extensive training may mean it is overly complex, difficult to use, or infrequently updated. These issues could easily impede your staff from adopting the tools quickly and limit your company s ability to gain the full benefits from the system. Typical consulting engagement cost Training cost COMPANY 1 COMPANY 2 COMPANY 3 Loan amount and rate 5

7 Conclusion As you move forward with evaluating new billing and collection companies for your substance abuse treatment or rehabilitation center, remember that there is no perfect solution to your business. Every system will have positives and negatives so it is a matter of finding a solution that best fits your needs and can take you into the future. Because of the industry s unique and varying needs, we encourage you to focus your search on a company that has extensive experience with addiction and substance abuse centers. The specific requirements of this industry mean that generic or broad solutions usually lack features or processes to help these specialized facilities provide both quality care and to meet business objectives. Read more about us on the next page... 6

8 About Inspira Financial offers a full suite of billing, RCM, and financial services exclusively to the substance abuse and addiction treatment industry. Inspira combines experienced billing professionals and easy-to-use tools to provide outstanding financial clearance, billing, and collection services. Inspira s reporting and analytics will provide visibility into individual claims and insights into forecasted revenue and areas at risk. Capabilities include: Verification of Benefits (VOB) Utilization Review (UR) Aged accounts receivable collection Clinical documentation review Peer-to-peer review Inspira can customize services to your unique business needs. Our consulting and training services will ensure your staff has a complete understanding of the new tools they will be using to bring a higher level of accuracy and efficiency into your operation. We are committed to helping your company obtain and stay in regulatory compliance. Inspira helps addiction rehabilitation centers get access to working capital through loans and lines of credit. You may be able to borrow up to 85% of your accounts receivable to invest in, and grow, your business. Contact us with questions or to schedule a free consultation. We welcome your call or . Call us at: info@inspirafin.com 7