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Lightning Step Features August 31, 2022

Streamlined Utilization Review Means Streamlined Business


Working with insurance companies is part of the reality of working in the behavioral healthcare industry. Insurance has many benefits for patients, such as allowing individuals to access life-saving services they might not have otherwise been able to afford. Low deductibles and co-pays can eliminate some of the barriers these individuals would have to face in their pursuit of mental health treatment, especially in the case of long-term treatment. 

For those seeking services for mental health disorders and substance abuse, treatment looks like months rather than days, and this can quickly add up. With insurance, many patients can benefit from consistent care that is not interrupted because their wallet has run dry.

As a treatment center, choosing to accept various insurances can make your services accessible to a broader range of potential patients and open doors to your organization. Growing your organization to treat more patients with various needs can help you develop into a trusted voice in the community, a beacon of hope for those who are struggling.

What Is Utilization Review?

Accepting insurance does add extra layers to the payment process. One of these areas that needs extra attention is utilization review. Utilization review refers to the evaluation of a patient’s treatment by the insurance company to determine whether it is medically necessary and, therefore, something that the insurance will choose to cover. 

At the end of this process, the insurance company can choose to approve or deny the treatment. If they approve it, your treatment facility can go forward and offer the services to your patient that you initially planned on with the knowledge that it will be paid for, and you will ultimately be reimbursed. However, if it is denied, the insurance company may offer alternative courses of action that would be approved, or your facility can submit an appeal.

The Importance of Utilization Review

Utilization review is at the crux of patient care. While you may follow the accepted standard of care and implement the newest, most updated evidence-based care, a patient’s insurance company may not accept it. Additionally, if you accept multiple types of insurance, there is no guarantee that a treatment that is accepted by one company will be accepted by another. 

Even if you have been doing something one way for years, you may find that insurance no longer covers it because they now prefer something different. It is a significant amount of information to keep track of, and errors can lead to unexpected out-of-pocket costs for patients, disruption to their care, and delayed reimbursement for your organization. 

A System That Does It All

Behavioral health treatment centers need to be knowledgeable and proactive about utilization review to expedite the process and ensure treatment is not slowed down. Lightning Step Technologies understands this, which is why our product is designed to provide a solution. 

Our All-In-One system encompasses an EMR (Electronic Medical Records), CRM (Customer Relation Management), and RCM (Revenue Cycle Management) that are fully integrated behind a single login and covered by a single price. Our system was designed by experts in the behavioral health treatment industry who have many combined years of experience and knowledge about the specific needs of the patients and staff in the industry. 

Lightning Billing

Our Lightning Billing service can help you navigate the murky waters of utilization review to generate the best outcomes for your patients and your organization. Our billing team has been doing this for many years, and we have learned many of the best tactics to maximize approvals and limit denials. 

We understand the criteria that lead to an approval versus a denial, and we can help you meet these criteria the first time. When denials do occur, we can help your organization make effective appeals. We have maintained relationships with many of the largest payers in the industry. We will leverage these relationships to ensure you are paid what you are due in a timely manner.

Helping You Focus on Patient Care

At the end of the day, insurance is not your job – people are. You are designing treatment plans not to make the most profit but to provide the highest quality of care to the patients who trust you to lead them to wellness and recovery. Lightning Step Technologies can take that burden off your shoulders and free you up to provide exemplary care while ensuring you are paid appropriately.

The nature of our All-In-One system means that data entered anywhere in the system is automatically generated in other relevant places within the system. This means that treatment information contained within the EMR or preliminary insurance information collected in the CRM is automatically threaded into the RCM. 

Our system is designed to optimize convenience at every opportunity while ensuring accuracy in the process. In addition to the utilization review services provided by our Lightning Billing experts, our integrated RCM gives you the tools to manage the rest of your organization’s finances. You can enable automatic charges based on patient attendance in treatment, allowing for information in the EMR to automatically translate into charges sent to the patient portal. Billing audits are easy to perform, and you have your organization’s full financial overview and outlook at your fingers. 

Accepting insurance opens up opportunities to both your patients and your organization, but it can also slow down the process. Between verification of benefits and utilization review, you might find yourself spending more time appealing denials and rewriting treatment plans than you do carrying out those treatment plans. Every setback can hinder your patients’ progress and render them ineligible for services. It also delays the payment your treatment center needs to continue serving your community. Lightning Step Technologies is here to help you focus on what you’re best at while we take care of the tedious yet crucial task of utilization review. We have years of industry experience and leverage that we will use to help you avoid many of the pitfalls of insurance review and continue to provide uninterrupted care to your patients that need it most. To learn more about our All-In-One system, schedule a demo today.

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