One of the key factors to becoming a successful Certified Community Behavioral Health Clinic (CCBHC) will be to have an efficient and effective Medicaid CCBHC demonstration service code billing cycle. If billings are not accurate or timely, cash flow will squeeze quickly. To have an effective billing cycle you must have accurate and timely encounter chart notes, an experienced billing team, proper oversight and self-audit procedures, and a billing system that is user-friendly with a robust reporting mechanism.
High Quality Chart Notes
The quality of a CCBHC billing cycle will only be as good as the provider chart notes documented for each encounter. Chart notes initiate the whole process and if you’re off track on step one, you’re already setup for failure. Chart notes can often be under-documented or overly-wordy.
Providers, operations management, and key billing staff should corroborate to find the balance that best works for your CCBHC and meets Medicaid demonstration program service billing standards. Focus on the main service areas that act as trigger words for billing. For assistance with this, Oregon Health Authority (OHA) has provided a helpful demonstration service key.
Quality chart notes will directly lead to quality billings. This means less rebilling, better capacity for providers and billing staff and reliable program cash flows.
Self-Audit and Reporting Metrics
An essential part of a self-sustaining billing cycle is adequate oversight. There should be personnel available within the organization that have the accountability and capacity to spot check billings before submission to Medicaid. This team member can also look at encounter data and compare it against collections to identify any weak areas.
The answers to these questions provide great data to share on a monthly dashboard report alongside the monthly financials:
How many encounters are providers experiencing on an average working day?
Are encounters increasing at a higher rate than collections?
How does encounter procedure code census data looked compare to last month, quarter, year?
Who are we encountering and why?
How do writes offs and contractual adjustments look as a percentage of gross charges?
How does our accounts receivable aging look?
Does our allowance seems reasonable compared to our experienced write offs?
Further, a member of management outside of the billing team should perform a periodic audit of the billing cycle, or when the data points above identify a weak link. Select a random sample of encounters and walk through the billing cycle to ensure proper quality control.
Compare the chart notes to the CPT code billed for continuity; vouch the CPT code billed in the billing software to the explanation of benefits received from the payer; vouch the explanation of benefits payment to the gross charge, write off, and net collection in the billing system and to your accounting records; and ensure patient name, date of service and provider match in all reports. These steps can drastically improve the quality of your CCBHC’s billing cycle and will provide essential training to your staff.
In order to draft valuable dashboards, accurate financials and self-audit your billing cycle, you must have a good billing system in place. One that allows management to digest data through complete, reliable and consistent reports.
The software must also allow for unique client IDs traceable between your chart note software and your billing software, and allow for reporting of encounter populations, gross charges, write offs, collections and encounter history based solely on a static date of service.
If a billing software allows for reporting to be based on variable or manually overridden dates of service or posting dates, then you’ll end up with reporting that doesn’t not allow management to obtain accurate cutoff and aging reports. A unique client ID and a static encounter date that reports a web of data attached to that singular encounter is the best (likely only) way to get complete and accurate patient population data to use for your analysis and self-audits.
Unfortunately, these key reporting piece are often overlooked when creating or choosing a billing system. Many times this leads to custom reporting functions within the software that have to be created by IT or management, ultimately resulting in a time suck and “almost good enough” data.
Removing the guess work and uncertainly from you billing cycle is one of the best ways to sustain your mission and ensure the needs of your community are met.
OHA has a supplemental guide that provides a high-level roadmap of the Medicaid billing cycle for CCBHCs. It’s a quick and good read, available at: https://www.oregon.gov/oha/bhp/CCBHC Documents/CCBHC-Billing-Guide.pdf
We are committed to staying abreast of developing news and updates regarding these Behavioral Health developments. We recognize that many aspects of the regulation are subject to change.
Mathew Hamlin, CPA is a member of the Jones & Roth Behavioral Health team. He specializes in working with clinics who rely on grants and payer system revenue streams and provides audit, reporting and compliance advisory services for Behavioral Health clinics across Oregon & Southwest Washington.