Transforming Behavioral Health with Effective Utilization Review
If, like me, you are devoted to effectively and compassionately serving as many Behavioral Health patients as possible, you know the importance of financial reimbursement.
In my many years as a behavioral health leader, I’ve seen the importance of getting UR right – for patients to receive the length of stay they are clinically entitled to, for UR staff who serve and support them, and for the financial stability of facilities that provide care.
When a patient is admitted, Clinicians must rapidly assess and document findings and initiate treatment to provide the highest quality care. Meanwhile, UR nurses scramble to collect the strongest EMR evidence to secure authorization.
Every Behavioral Health facility relies on insurance authorization to keep its doors open.
This complex utilization review process undermines successful insurance authorization by:
- Requiring UR reviewers to shuffle through documents searching for medical necessity criteria
- Disrupting collaboration while staff constantly chase clinicians to provide documentation
- Wasting time manually gathering supporting evidence
- Lacking an understanding of what is and isn’t working with your current UR process
- And lacking quality control of documentation at each step
An effective UR process supports your key objective of insurance authorization, by:
- Prioritizing and scheduling time-sensitive activities
- Quantifying and classifying criteria scoring
- Properly preparing UR staff for insurance reviews
As Director of Product Management for ARGO and a former Healthcare Administrative and Clinical Leader with decades of experience in Behavioral Health, I understand the challenges you face:
- The desire to provide excellent patient care with effective Utilization Review
- Ensuring timely and accurate documentation
- Reducing stress on clinicians
- And minimizing unfunded days
Not every institution succeeds in reaching these goals, but I assure you they are achievable!
Success means reducing the burden of the UR process while improving the evidence of medical necessity. Today, every insurance phone call requires lengthy preparation, often hunting for clinicians over missing or incomplete documentation, all the while striving to be cost-efficient while satisfying regulatory and compliance requirements.
This complex, time-consuming, and frequently frustrating process is central to guaranteeing quality patient care.
If your experience is anything like mine, you’ve been challenged by:
- Discovering incomplete documentation too close to the UR call, damaging insurance cases
- Lengthy screening time for UR nurses searching clinical documents for evidence to support authorization
- Lack of timely clinical communication
- Having to physically locate clinicians to complete documentation
- And an absence of metrics to identify processes or personnel requiring improvement
ARGO’s Behavioral Health CareChain addresses these challenges and more!
Our CareChain solution supports your Utilization Review process by:
- Maximizing insurance reimbursement to improve patient care for those who will benefit from longer stays
- Improving staff efficiency by streamlining processes so deadlines are met
- Aggregating volumes of patient data for review and presenting relevant information based on diagnosis
- Accessing and providing summary evidence
- Ensuring readiness for concurrent reviews to reduce insurance provider declinations
- Minimizing uncompensated stay financial loss
- And improving practice management through KPI metrics
Behavioral Health CareChain from ARGO gives your organization all the tools necessary to streamline the Utilization Review process!
BHCC automates UR workflow, streamlines UR insurance call preparation, scores medical necessity evidence, integrates EMR data, and produces over 20 management KPIs for performance insight.
It promotes best practices, improved payor accountability, write-off prevention, compliance adherence, and patient length-of-stay management and supports accreditation and documentation completion.
Minimize your unfunded days and help patients receive the length of stay they’re clinically entitled to with the only UR software created and designed by and for Behavioral Health nurses and leaders.
