
Reporting and Benchmarking
Are you a behavioral health provider looking to improve the quality and efficiency of your services? Then you’ve probably heard of reporting and benchmarking. These
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Home » Utilization Review Management
Billing for substance use disorder (SUD) is often combined with broader behavioral health billing, and while there is definitely overlap, assuming SUD billing is the
In behavioral health billing, 99214 is arguably the most widely submitted established patient E/M code—and also one of the most challenged. Many providers are sure
Few billing and coding decisions carry the same impact as whether to assign 99213 or 99214 for an established patient behavioral health visit. Code too
Not every patient who needs care will have an insurance plan that fits neatly into your existing contracts. A prospective client may have out-of-network benefits,
Every behavioral health practice generates data. Patient visits, claims submitted, payments posted, authorizations requested, denials received — the numbers are always there. But data without
If you’ve spent time in healthcare billing, you’ve likely seen the terms preauthorization and precertification used in similar ways. Some payers use them interchangeably, while
Ask most behavioral health providers what they got into the field for and you’ll hear a version of the same answer: they wanted to help
Clinical documentation and financial performance may seem like two separate worlds, with one belonging to clinicians and the other to the billing team. In reality,
The behavioral health sector has seen a significant wave of investment activity in recent years. Private equity firms, health systems, and strategic acquirers have taken
If you run a behavioral health or substance use treatment program, you’re already familiar with the ASAM criteria—the American Society of Addiction Medicine’s framework for
When a behavioral health claim comes back denied, the reason code on the explanation of benefits may seem like it should tell you exactly what

Are you a behavioral health provider looking to improve the quality and efficiency of your services? Then you’ve probably heard of reporting and benchmarking. These

Utilization Review (UR) and prior authorization are two critical processes that play a vital role in determining the scope of behavioral health services available to

Medical documentation is necessary to claims being paid quickly In today’s healthcare world you need to develop the necessary organizational controls to develop successful processes

Working in the behavioral health revenue cycle management field behind the scenes performing utilization review and utilization management, advocating for those struggling with Substance Use