Virtual healthcare is here to stay, allowing many providers to deliver exceptional care beyond their four walls. We saw telehealth billing take off during the pandemic, and even though virtual visits are leveling off as vaccinations increase, it is now a core part of the services many organizations provide. The opportunity for providers to offer services in other states not only gives more individuals the support they need regardless of location, but also expands care across communities. With mergers and acquisitions remaining steady in healthcare, this also creates opportunities for organizations to extend their reach to new clients through more physical locations.
Regardless of drivers, multi-state care and billing is on the rise, giving providers the chance to become a regional player without state line limits. Embracing this opportunity allows providers to grow their business, provide more care and stay competitive. However, successful expansion into new states requires necessary preparation, especially with your billing operations.
Before you start providing services outside state lines, there are a few things you should consider. To avoid lost revenue or unnecessary billing complications for your team, providers should plan for multi-state billing before jumping into new territories.
The Netsmart Revenue Cycle Management (RCM) team frequently assists clients with this expansion process, but unfortunately, we are often brought in after revenue and collections have suffered.
To help you on your journey with multi-state billing, we’ve complied a high-level, pre-planning checklist that introduces key areas to consider before your team starts providing services in other states:
1. Centralize your billing office
A Centralized Billing Office (CBO) ensures cohesive training and consistent use of RCM best practices and technology. Trying to supervise multiple billing offices is challenging. Creating a unified operation keeps all billing functions under one roof, and more importantly, under one technology solution. In addition, universal executive reporting, including state and roll up reporting is easier with a CBO.
If your RCM department is not in a centralized location, work to do so. You will gain credentialing and billing expertise, as well as efficiencies. Overall, reporting will be easier, and it eliminates trying to hire, train and support remote locations, which is extremely challenging.
2. Contract with payers and credential providers in advance
Contract or enroll with the payers in each state prior to offering services. Leverage any lessons learned from your payer contracting experience with your active payer base to negotiate solid and mutually beneficial payer contracts. Also, do your research to understand coding, qualification and submission requirements of newly contracted payers.
Credentialing is also incredibly important. Many providers put this on their HR department, when truly it requires a partnership with your CBO or RCM team. If not, there will be a large disconnect between those working denials and those setting up credentialing information. While some denials are a given, most are avoidable. Setting up providers and managing credentialing with a highly efficient process reduces some of the most common denials.
3. Leverage technology
Once you have centralized billing, payer contracts, and credentialing is in place, make sure your technology is working for you, not vice versa. Your electronic health record (EHR) and clearinghouse solution should be configured to support state-specific nuances. Configuring your technology to its fullest capabilities reduces a majority of claim errors. Using automation to get your claims submitted correctly the first time will help guarantee the financial health of the organization.
Before you expand to other states, make sure you are taking advantage of configuration opportunities and automation within your technology platform.
Billing payers in a new state may require the set-up of new payers in the EHR, along with new contract rates and billing system configuration changes to ensure services billing to any new payer sources transmit clean and in line with the payer contract and fee schedule. Pay close attention to National Provider Identifier (NPI) numbers added as you expand to new states and locations. Make sure they are set up in your EHR and clearinghouse solution. Billing with incorrect NPIs can create denials as payers are unable to match submitted claims to a pricing contract.
Reviewing your plans with one of our multi-state billing experts is a great first step in improving your success. To learn more about multi-state billing and how we can help, please contact us.
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