Magazine article Behavioral Healthcare Executive

Positive Changes Prompt Cautionary Tales

Magazine article Behavioral Healthcare Executive

Positive Changes Prompt Cautionary Tales

Article excerpt

Perhaps even Charles Dickens might agree that it is the best of times and the worst of times in behavioral health right now. Certainly there's a revolution going on in the industry, yet for every positive development, there seems to be an equally important caution.

As you know, coverage for mental health and addiction treatment services under all types of benefit plans is increasing, driven largely by the Affordable Care Act and parity laws. However, the caution here is that much of the opportunity lies in commercial insurance-including managed care Medicaid- which means there are more administrative hassles. You have more patients, and that's great. But now you also have more paperwork, and that's not so great.

Managed care often plays hardball when it comes to reimbursement. For example, health plans might stop paying claims if they suspect your organization or the providers in your area are submitting fraudulent charges. An administrative misstep might be considered fraud. Or actual fraud by the provider down the street might be identified, and you might suffer an undeserved audit because of it.

Sure, it goes without saying that the large majority of providers are honest and just want to earn their fair, agreed-upon payment. However, many of these good guys still lack the necessary technology backbone to leverage data and keep the pace with payers.

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