Right Place, Right Time . . . .Right Documentation?

Utilization Management is a major contributing factor to maintaining a steady revenue cycle.

Why is that important? Most of us are in the recovery industry because we genuinely desire to empower the distressed, to elevate the downtrodden, and to combat the devastating effects of addiction and mental health problems. We know enacting change on a societal level, starts by treating an individual. To be able to continue serving our clients, for many of us our life’s work, we have to be compensated. We want our clients to be able to have access to the services they need to improve their quality of life. Our clients need insurance premiums to be affordable. Insurance companies need their expenditures to be reasonable. They have to have a model of quality assurance in place to ensure their funds are being applied to the right treatments, and that those treatments are being administered in the right way and at the right time. There has to be a symbiotic relationship between you as the provider, your clients, and the insurance companies.

From the moment your client walks through the door to your office, clinic, or residential facility, that client’s insurance is working to determine if they REALLY need to be there. If they decide by using internal criteria that your client can be treated at a less intensive level than the one you are providing, they will not pay for that breakthrough group therapy session. This could leave your client responsible for a hefty bill they may or may not be able to pay. That unexpected financial stress can influence your client’s decision to continue treatment, interrupt their healing process, and affect the morale of your team.

By being on-top of Utilization Management, you are facilitating an important factor of treatment: lessening or removing the barrier of financial burden. With proper attention and follow through, your Authorization Specialist at Threshold Billing Solutions can work with your client’s insurance company and give you a heads up if the service you are offering doesn’t quite match up with the insurance company's definition of medical necessity. This opens the doorway of investigation, and sometimes finding that even though you are providing the right service at the right time for the right person, your clinical documentation and presentation is simply formatted in a way that is not easily understood by the client’s care manager.

Having a team that is removed from the metaphorical trenches of working directly with clients, allows you to have an aerial view of Utilization Management. By the time your client is finishing their treatment episode, and equipped with new tools to tackle life again, you can feel confident that their insurance benefits were maximized, and so was the time you spent doing the heavy lifting of recovery with them. Our team is proof that your efforts can change lives. Because of services like yours, people like you, many of the individuals at Threshold have experienced recovery first hand. We know on an empathetic level that the longer a client can receive services, the more healing can take place. Is a healthy revenue cycle the most important part of your business? The short answer is “No”. Having a healthy revenue cycle will allow you to optimize and do more of what you do best. Bring your focus back to your passion, your clients. We specialize in Utilization Management. Let us help.