Behavioral Health

AAFCPAs performs internal control reviews of the revenue cycle operation to help clients capture more revenue. This involves assessing the controls and procedures from the front end through the back, and all the various layers in between in the collection of accounts receivable. We perform analysis of your insurance verification process, authorization & re-authorization process, timing of billing, and collection follow-up. We take an objective and subjective look at your people, process, and technology and make pragmatic and best practice recommendations in areas where behavioral health organizations may increase reimbursement and improve revenue cycle management efficiency.

We review current fee structures to determine adequacy of rates charged and make rate setting recommendations to ensure optimal reimbursement.

AAFCPAs works with behavioral health and CCBHCs to develop tracking and monitoring systems for risk-based contracts. This involves determining the costs for providing the services to be covered under the contract. In addition, we also help to develop a system to monitor the services being provided and costs involved. The profit/loss on these contracts needs to be determined as well as how much is attributable to the organization. We consult on the level of reserves that are necessary for these contracts, and the accounting and financial reporting requirements.

AAFCPAs has extensive cost reporting and reimbursement experience with both cost-based and Prospective Payment System (PPS) providers. We understand the importance cost reports hold for behavioral health organizations. We provide guidance to ensure accurate completion, insight into the key objectives of the report, and critical areas of scrutiny of your disclosures. We frequently present training sessions on best practices for minimizing the effort necessary to prepare, while maximizing reporting to properly reflect your true cost of care and maximize reimbursements.

Most denials are caused by inefficient processes and can be prevented. Denials can be caused by internal issues, technology issues, or billing complications from third party payors. Interpreting the billing and coding requirements of a variety of payors can be challenging. AAFCPAs identifies opportunities to minimize denials and increase reimbursement. This includes identifying the causes for the denials and common themes. If the denials are caused by internal factors, we can provide training to prevent the denials from reoccurring. If the denials are caused by external payor issues, we work with clients to develop an action plan to address these with the insurance companies. We utilize our Data Analytics team as well as advanced, data mining software as appropriate to enhance our abilities to evaluate vast amounts of data found within complex, disparate information systems.

AAFCPAs is familiar with the Key Business Questions central to growth and profitability strategies, as well as the correlating Key Performance Indicators (KPIs) that help inform decision making.

We help behavioral health organizations and CCBHCs monitor the health of their revenue cycle with data analysis and visualization. This includes guidance on the appropriate metrics, or key performance indicators (KPIs), that inform your decision making. Our in-house data analysts work with your team to extract, inspect, cleanse, and model data to monitor real time the health of your revenue cycle operations.

AAFCPAs has guided healthcare organizations through significant industry change, including consolidation activity and the integration of behavioral health into primary care delivery systems. Our specialists help clients evaluate partnerships, affiliations, and integrations designed to improve clinical outcomes, strengthen operations, and manage costs. This includes comparative analysis of cost structures, reimbursement models, practice patterns, quality of care, and clinical outcomes, as well as guidance related to evolving reimbursement methodologies, regulatory frameworks, and high-deductible health plan trends.

We also advise clients on accounts receivable and third-party reimbursement performance, optimizing ROI on technology investments, and aligning operational controls with organizational objectives. Our team helps organizations streamline reporting and compliance processes, while developing tracking, monitoring, and financial reporting frameworks for risk-based contracts and value-based care arrangements.