Practical guides to behavioral health billing, eligibility verification, and out-of-network reimbursement, from the team that works these claims every day.
Most facilities can produce an estimate of what an admission will be worth. Very few can tell you whether last quarter’s estimates were any good.
A verification team can work every case by phone. It will be thorough, it will be slow, and it will become the reason admissions cannot
The eligibility response comes back clean. Coverage active, deductible mostly met, out-of-network benefits in place. Admissions passes it to the family as a yes. Six
Two benchmark results sit side by side on the same screen. Both name a dollar figure for the same level of care. One is worth
A facility director asks what a payer pays for PHP in their state. The billing manager can answer it for their own facility, from their
A verification confirms coverage and returns the coinsurance percentage. It does not return the allowed amount that percentage applies to, which is why an accurate verification and an unexpected payment are entirely compatible.
Two members of the same payer group can be reimbursed at rates that differ by more than four times for identical care. The four variables that move the number, and which of them you can know before you admit.
Out-of-network payers price behavioral health claims two distinguishable ways, and the gap is roughly threefold. What the claims show, and why no payer tells you which basis applies.