1. Verify Your MIPS Participation Status
Start by checking your participation status under the Merit-based Incentive Payment System (MIPS). Starting in calendar year 2019, mental health providers became eligible clinician types under this program. This means they’re now required to participate in MIPS if they see more than 200 unique patients with Medicare Part B and provide at least 200 Part B-covered professional services totaling more than $90,000 annually.
This is potentially a big deal for mental health providers, says Heckman. Those who are required to participate but don’t could see a seven percent payment reduction for Medicare Part B services starting in 2021, says Heckman.
If a mental health provider is required to participate, the first step is to make sure they’re using an EHR—not just any EHR, but one that’s certified using 2015 certification criteria, says Heckman.
The next step is to select quality measures and a reporting method. Is the practice part of an Accountable Care Organization (ACO)? If so, the ACO may have a specific process for quality reporting and provide support in terms of measure selection. Otherwise, providers can tap into a variety of free resources and support available through the Quality Payment Program website.
“Don’t try to do this on your own,” says Heckman. “Find out if you need to participate, and if you do, go get help.” The good news is that favorable participation in MIPS could result in up to a seven percent bonus, she adds.
2. Check Insurance Eligibility
Then check it again … and again. Coverage can change in a moment’s notice as patients change jobs, lose their jobs or don’t pay their premiums, says Heckman. Best practice is to check eligibility at the time of scheduling, again on the date of the visit and once a month thereafter. Note that some plans under the Affordable Care Act include a 90-day grace period, meaning coverage will show as active for 90 days even if patients don’t pay their premium amounts.
“The payer basically pends the claim until 90 days have passed. If the patient doesn’t pay, then 90 days’ worth of services are denied,” says Heckman. At this point, providers can technically bill the patient for the contracted amount; however, their chances of collecting it are slim, she says. If they collect the copayment up front, they’ll at least recoup a portion of that money.
3. Collect Copayments at the Time of Service
This is especially important for patients with high deductible health plans, many of who are essentially self-pay until they meet their deductible, says Heckman. The last thing providers want to do is keep a running tab of outstanding balances that will add up quickly with no guarantee of payment, she adds.
It’s also important to collect payment in full from patients without insurance, a growing segment for some providers now that the individual mandate penalty is no longer in effect, says Heckman.
4. Implement a No-Show Policy
Inform patients that you’ll charge a fee for missed appointments, says Heckman. “If a primary care doc has a no-show, there’s usually someone else waiting for that appointment,” she adds. “In a mental health practice, if a patient cancels or no shows, the provider is waiting for an hour without any way to recover that revenue.”
5. Keep a Credit Card on File
Ask patients to sign a payment agreement indicating you’ll charge the card for any outstanding balances up to a certain amount after the insurance company processes the claim, says Heckman. Just be sure to store the credit card information securely in an encrypted format that meets PCI requirements, she adds.
6. Monitor Payer Denials
Common reasons for denial include lack of coverage, lack of prior authorization, and invalid or inactive CPT code. When it comes to denials, the goal is to be proactive not reactive, says Heckman. If you outsource your billing, ask the billing company to monitor denials and communicate the reason for denial to you so you can take corrective action, she adds.
7. Take Control of Your Caseload and Payers
Heckman says to think about your ideal client, and strive to attract that type of client as much as possible while limiting your availability to take on those who are frequently late for appointments or require ongoing crisis counseling. The same is true for payers. Renegotiate contracts annually, and don’t be afraid to steer clear of payers who won’t pay you fairly for your services.