If you’re already using NextStep, our billing and revenue cycle management module works seamlessly with the rest of the software. Rather than using an entirely separate system to manage, billing becomes just another part of our complete, user-friendly EHR. There are four major components to this module.
Smart Billing Engine
Behavioral health billing is extraordinarily complicated, and even the smallest details can have a huge impact on payments. Our smart billing engine takes over the heavy lifting, translating complex data into the proper billable codes and generating validated claims that are far less likely to be rejected by insurers.
The onboarding process is extensive and thorough, as we work with you to create a smart decision tree that compiles all of the insurance codes, provides a limited number of code options to clinicians, and sends each data point through a variety of calculations, checks, and validations to arrive at a final, billable claim.
On the clinician side, a billing box is attached to each therapeutic note. The clinician simply chooses the code for the specific type of activity (such as individual therapy or group therapy) from a dropdown box that limits the options according to the type of note. The system takes over from there. The billing department can set up as many rules as needed, such as to bill one payer a specific portion and another payer a different portion, and code as needed for each, but the clinician will still use the same basic code for each type of service.
Automated Complex Billing Scenarios
For the billing department, the NextStep billing engine vastly simplifies their work, especially in complex billing scenarios. The system follows the rules you provide during onboarding (which can be updated at any time) to generate the right codes for each insurer and route each bill appropriately. It also provides numerous ways for the billing department to override or make changes as needed.
A common scenario occurs when a patient has both Medicare and private insurance. If the private insurer doesn’t require the bill to go through Medicare first, it can simply route directly to the private company for items that Medicare doesn’t cover. Likewise, if all of a client’s bills are required to go through Medicare, the system can send them there and then bill the private insurer after receiving Medicare rejection.
The billing department will still need to manage claims, maintain updates to information in the system, collect copays, and address any errors that the system finds. However, the billing engine performs the vast majority of billing tasks automatically, dramatically reducing claim rejections and freeing up billing staff to focus on those items that require the human touch.
After the billing engine creates a billable claim, all you need to do is click to automatically send it to your chosen clearinghouse. Unlike many vendors, while we do partner with TriZetto, NextStep does not force you to use a particular clearinghouse. Our system will send claims to whatever clearinghouse you specify.
Our billing module is fully integrated with the rest of the NextStep EHR. Reporting is a breeze, allowing you to take a deep dive into your data in just a few clicks. This improves compliance, helps you understand where to focus your efforts, and makes it easy to provide detailed statements to both clients and insurance companies.
Today’s behavioral health facilities must be flexible and agile, but everchanging insurance requirements and benefits make it easy to get bogged down in billing matters. At NextStep, our goal is to provide state of the art technology that supports evolving, value-based and evidence-based behavioral healthcare.