How to Navigate Contracted Rates in Behavioral Healthcare

Written by teamlogik
17 Sep, 2020

Providing behavioral healthcare to patients can be a rewarding experience. Staff should be able to focus on and take pride in the fact that their contribution improves the overall quality of life for each patient that comes in contact with their facility. Like in many other healthcare settings, there are hurdles that must be conquered for behavioral health clinics to provide top notch care – and insurance and contracted rates are one of them. 

Contracted rates are the rate that the insurance company agrees to pay, and don’t necessarily cover the patient’s entire bill. These discrepancies can potentially cause roadblocks for behavioral healthcare billings departments.  

For example, you have a patient who requires a behavioral health service that costs $200, and the insurance company accepts the patient’s need for the treatment.  The contracted rate states insurance will only finance two-thirds of the bill, leaving the remaining amount to be covered by the patient or healthcare center.  

Since each patient has a different type of insurance, and each insurance company has different contracted rates, figuring out who to bill and how much to charge can create some serious cash flow problems. With many behavioral health centers and providers already dealing with an assortment of financial problems, knowing how to identify and navigate contracted rates is a key component in keeping their facilities financially sound. 

The Problem: Contracted Rates, Delayed Payments and Strained Staff 
Navigating contracted rates, dealing with insurance companies, reimbursements and patient communications can be especially hard on providers with  limited staff, or who lack a billing specialist. Having current, up-to-date contracted rates can make a difference as providers decide what to charge for their services, but can be hard to get from the insurance companies. 

Another issue faced by many providers is the delay in payment. In many cases, it takes about 30 days between the time the facility sends the bill to the insurance company, and when the payment clears. Disputes over contracted rates and approval of treatment by insurance companies create further delays. Each delay can wreak havoc on the facility’s financial situation and require additional attention from staff.  

Setting Aside Time to Regularly Investigate Contracted Rates 
Many behavioral healthcare providers assume that there isn’t anything they can do about contracted rates and simply accept them, which is understandable. You’re already strapped for time and resources, the last thing you want to do is spend even more time trying to figure out the complex system the insurance companies have created. 

Exploring your options when it comes to insurance providers ensures the health and viability of your behavioral health practice. 

To stay up to date on the latest policies for your chosen insurance partner,  make sure you know who has been assigned as your main contact from that company, and keep in touch with them regularly.  Be prepared for your meetings with questions for them to answer, and try to be helpful to them as well by offering any information that may help them provide better service.  Another option would be to utilize the services of a dedicated billing specialist who could handle the entire billing process for you, including insurance claim submission and rejections.   

Interested in Logik taking all billing related tasks off of your plate? Contact us today! 

There are several reasons why you should occasionally set aside time to review the insurance companies you work with and study their contracted rates. 

  1. Simply Accepting Contracted Rates Could be Costing You 
    While it might mean a little more phone time, there is always an option to negotiate your contracted rates with the various insurance companies, and speak with them about the issue of delayed payments. Taking time to speak to the insurance company could mean you reap some financial advantages. 

    Discussing contracted rates and knowing how the insurance company handles them helps you determine which language you should use when you submit the bill. Using the right combination of words can increase the odds of the insurance company paying more – taking some of the financial burden off your patients, and reducing the risk of rejected claims. 
  1. Identifying Payment Patterns 
    Your practice depends on having a steady flow of income. Ideally, insurance companies should all pay within 30 days of receiving your invoice, but it does not always happen this way. Regularly comparing which companies quickly settle their invoices and which ones don’t allows you to adjust your business plans accordingly. The same process also enables you to identify which claims go through smoothly and which claims regularly create problems between you, your patients, and the insurance company. This information can also come in handy when it’s time for you to determine which networks you wish to stay with and which ones you should leave. 
  1. Confirm You’re Getting Paid Your Fair Share 
    Many behavioral healthcare workers have been surprised to learn that the contracted rates for the services your clinic offers are actually more than what the insurance company has been paying. This happens when the facility accepts a reimbursement amount that is lower than the contracted rates. This is common when the insurance company has adjusted the company’s contracted rates but fails to notify health care centers. Going through the insurance paperwork a few times a year and really studying the contracts decreases the odds of you accepting an unfair reimbursement. 

Navigate Contracted Rates with Logik  
Logik has worked with many billing managers to understand the frustration that comes from working with various insurance companies and constantly fluctuating contracted rates. Thats why we created Medik Online, a software to help significantly reduce lost revenue, and save you time. Our solution is easy to learn and set-up, and can be easily integrated with your existing EHR or other services.  With Medik Online you can compile complete invoices that yield high acceptance rates, and even organize insurance company information such as contracted rates, payment policies and payment history.  

Contact us to learn more about our healthcare billing software, and see how it can improve your practice today.  

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Team Logik

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