Providers’ compensation standards are evolving

The ACA created various mandates for mental health and addiction treatment that were to be covered by mandatory premiums and governmental funding. Unfortunately, the Supreme Court gutted the premium mandate, putting the healthcare insurance industry in a bind. In addition, the program turned out to be more costly than expected. This led insurance companies to seek greater accountability from providers while limiting their financial exposure through various mechanisms.

To rein in costs, standards of care had to be set. This became a reality in 2017 when outcome surveys became required. To this day, outcome surveys remain poorly implemented because they are perceived as an additional cost without immediate benefits for providers and clients alike. In addition, insurance companies are moving from a guaranteed paid fee per act to a fee that is performance-based. And finally, linking efficacy standards to claims payment is now on the horizon for full implementation by 2023.

With these facts in mind, the question is who is the most knowledgeable and best positioned actor to ensure optimum claims payment?

· Billing matters:

To ensure optimum payments, billing and collection processes must be efficient and constantly updated. For many providers, this is so burdensome that third party billing companies are better equipped to handle this key aspect of their business.

· Efficacy surveys handling and reporting:

At first sight, Providers themselves should be best positioned to cover that need. Experience has shown that it is not necessarily true, and in many cases a third-party performing outcome and aftercare surveys is better positioned to ensure quality and reliable data.

What are Providers’ potential shortcomings? Overtime, we noticed the following factors contributing to poor outcome data collection and use thereof: undedicated staff, untrained staff, permanent cost, and management’s focus on expense reduction rather than constant care improvement.

· The benefits of having a third party handling surveys and reporting thereof:

Providers greatly benefit from a third-party handling and reporting efficacy surveys because, (i) it is a variable cost, (ii) the staff handling surveys and reporting is highly specialized and knowledgeable in the field, (iii) data is collected by an independent third-party, making the data more credible and useful for improvements as well as for marketing, (iv) data is handled through proprietary software that is constantly improved, (v) software maintenance and data safekeeping is handled by a third-party, removing this additional burden from Providers, and (vi) quality third-party outcome survey companies provide reports that are useful to management, outreach, marketing, and billing.

Billing companies are uniquely positioned to efficiently provide a service that combines these two aspects of Providers’ optimum compensation, or at the very least point to a third-party outcome survey provider meeting healthcare insurance’s requirement.

Providers’ optimum compensation is the result of optimum quantitative claims (correct billing code, correct claims, etc.) combined with optimum qualitative claims (utilization reviews AND outcome reporting).

Billing companies are perfectly equipped and organized to provide optimum quantitative claims, and in some instances (to a lesser extent) to provide optimum qualitative claims. Combining these services with the same level of consistency will certainly help Providers in handling their claims and collection thereof.

To facilitate this merger of services that will create economies of scale and increase reliability, Seven Seas Ventures, Inc, a consultancy company formed 30 years ago with a focus on SUD and mental health treatment providers, created a licensing program and a referral program that hinge on its proprietary software S4Success™. To learn more about this opportunity, do not hesitate to contact us at info@seed4success.com