As the new year approaches, many organizations take the opportunity to reflect on the past year and make plans for the future. 

Behavioral health agencies are essential for providing care and support to individuals with mental health and substance abuse issues. However, like any other business, these agencies also need to be financially sustainable in order to continue providing services to their clients. Ensuring the financial health of the agency is a critical part of providing high quality care to clients, and can also help to identify areas for improvement or potential challenges. 

In this blog post, we will explore the importance of regularly evaluating the financial health of a behavioral health agency, and discuss some key considerations for conducting this type of review.

Be Mindful of Insurance Changes At Start of Year

At the start of every plan year, there are often changes to insurance coverage that can affect individuals and families. Some common changes to insurance coverage include:

  • Changes to deductibles and out-of-pocket maximums: These amounts may also be adjusted at the beginning of a new plan year.
  • Annual deductibles start over: If a client had met their deductible the previous year, when the new year begins, the new deductible will have to be met again.  This may negatively impact revenue in subsequent months.
  • Changes to covered services: Insurance plans may add or remove certain services from their coverage list.
  • Changes to provider networks: Insurance plans may also make changes to their network of approved healthcare providers.

It’s important to be aware of these changes, as they can have a significant impact on healthcare costs and access to care for your patients.

Beware Negative Revenue Events

One way that behavioral health agencies can ensure financial stability is by being vigilant about negative revenue events, which are events or circumstances that can negatively impact the agency’s revenue stream. 

Examples of negative revenue events might include:

  • Deductible mismanagement by patients and agencies
  • Changes in reimbursement policies
  • An increase in the number of uninsured clients 

It is important for behavioral health agencies to watch out for these events and have contingency plans in place in order to minimize their impact on the agency’s financial stability.

Understand Telehealth Billing Nuances

Telehealth appointments, or appointments conducted remotely through video or phone, have become increasingly popular in recent years due to the convenience and flexibility they offer. However, there are some insurance billing nuances to be aware of when it comes to telehealth appointments:

  • Different codes may be used for billing telehealth appointments: Insurance plans may require the use of different codes for billing telehealth appointments, as opposed to in-person visits.
  • Copays and deductibles may be different for telehealth appointments: Depending on your insurance plan, you may be required to pay a different copay or deductible for a telehealth appointment compared to an in-person visit.
  • Reimbursement may vary: Insurance plans may also have different reimbursement rates for telehealth appointments compared to in-person visits.

It’s important to be aware of these nuances when scheduling a patient’s telehealth appointment, as they can impact the overall cost of the appointment. 

Reminder (via The Centers for Medicare and Medicaid Services (CMS) released its final 2023 Medicare Physician Fee Schedule (PFS) rule. As finalized, some of the most significant telehealth policy changes include the following.  However, most of these changes will now be delayed until the latter of the end of 2023 or 151 days after the Public Health Emergency (PHE) ends.

  1. Discontinuing reimbursement of telephone (audio-only) evaluation and management (E/M) services;
  2. Discontinuing the use of virtual direct supervision;
  3. Adding five new permanent telehealth codes for prolonged E/M services and chronic pain management;
  4. Adding 54 codes to the Category 3 telehealth list and modifying their expiration to the later of the end of 2023 or 151 days after the PHE ends.

Wrapping it up

It is essential for behavioral health agencies to regularly review their financial status, particularly at the start of a new fiscal year. This helps to ensure the financial health and stability of the agency, and can also help to identify any potential problems or areas for improvement. By taking the time to carefully review their financial documents and seek out the advice and support of financial professionals, behavioral health agencies can set themselves up for success in the coming year and beyond.

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