Pain Point: Need Authorization Management
by Leigh-Ann Renz, 3.3.16
Treatment Over Time
Mental health treatment is usually most successful in a series of sessions. Like other types of therapy (PT, OT, SLP / speech therapy, etc), behavioral health sessions can be minimally useful if only applied once; and often need the repetition of multiple treatments, over time, to be most effective.
While there are acute situations that require a one-time solution, behavioral health treatment is usually applied more than once. This length of time might be a few weeks, months, years – or for a lifetime, depending on the patient’s diagnosis and mental health needs.
For this reason, therapy and psychiatry is endorsed and reimbursed by payers in a series: for example, an insurance company will agree to pay – or authorize – 20 sessions of a particular CPT code (the treatment administered) for a certain ICD code (the client diagnosis that supports the treatment).
This means that most mental health providers have to track the approved authorizations for each client, and if they bill for a session that isn’t covered by an authorization – whether it’s expired or all of the approved auths have been used up – the invoice won’t be reimbursed! This puts a lot of pressure on practices to manage their auths.
Paper Vs Software
Tracking session authorizations on paper is one reason that mental health practices often seek out electronic practice management. While it may not be a big deal for small practices or providers who see a small number of patients; larger organizations can be crippled by ineffective auth management.
That being said, just because a system is electronic, doesn’t mean they’ve got a good handle on the auth process. If authorizations are a driving pain point for you, be sure to ask each program you’re considering to demonstrate how their tracking system works and how it can help eliminate this common behavioral health headache for you.
How Does PIMSY Handle Auths?
PIMSY’s authorization management capabilities are a perfect example of how using an integrated, streamlined system can save time. In PIMSY, if a provider starts to write a session note for an expired or used up authorization, the CPT bill code won’t even show up as an option for them to use!
With PIMSY, your clinicians will literally not be able to process an invalid authorization, helping you to never again bill for an ineligible session.
Each time a valid authorization is used, PIMSY automatically decrements the master list, sending you an alert when it’s time to re-up. You can choose when and how to be reminded: when you’re down to a certain amount of unused auths left; within two weeks of the expiration date, etc.
While you have control over how PIMSY reminds you; with authorization management, electronic eligibility verification, note scrubbing, easy electronic billing, and comprehensive reporting, PIMSY helps make sure that every session is covered.