“FIRM RCM helps our hospital resolve our unique and complex behavioral health denials which helps us to drive more money to our bottom line”
Attorney and Clinician Driven Denied Behavioral Health Claim Resolution
As razor thin margins challenge even the most adept providers, behavioral health providers face a deck stacked even more heavily against them. Shrinking patient benefits, increased deductibles, and seemingly arbitrary denials all squeeze your bottom line.
At FIRM RCM we specialize in assisting behavioral health providers, by using attorney and clinician driven follow-up, to review stalled and denied claims. We also review claims that you are going to write-off because you believe that they are uncollectible. Our significant expertise with behavioral health payers and issues, combined with our robust behavioral health clinical review team produces results that will benefit your bottom line.
We are experts in the specific issues that lead to behavioral health denials and have significant success with the following issues:
- Coordination of Benefits
- Double Prime Payments
- Custody/Divorce Issues
- Ward of the State
- Involuntary Holds
- Missing or invalid patient information- Annual updates, Injury reports, TPL, Health care questionnaires
- Medicare/Medicaid vs Supplement Plans
- Incarcerations Affecting Patient’s CWF
- Social Security Benefit Updates- Application process.
FIRM RCM’s clinical staff is also trained to defend behavioral health medical necessity denials utilizing increasingly common customized standards.
- Optum BH Guidelines
- Beacon BH Guidelines
- ASAM-American Society of addiction medicine
- NCADA-Texas commission on Alcohol and Drug Abuse
- New Directions
- Cigna
- Magellan
- Blue Cross Blue Shield
- Colorado Access – Using ASAM for Substance Abuse
- Criska – Using ASAM for Substance Abuse …and many more