The Perfect Storm: Prior Authorization, Denials, and Behavioral Health Survival
From The Behavioral Health Underground · 37:00
Show by Sonda Kunzi and Gary Humble
CLICK HERE TO SEND US QUESTIONS OR COMMENTS!Behavioral health organizations are facing a perfect storm: expanding prior authorization requirements, increased prepayment and post-payment reviews, more clinical denials, and growing pressure on already-thin cash reserves.In the first episode of Behavioral Health Underground, Sonda Kunzi and Gary Humble examine what these changes mean for mental health and substance use disorder providers. They discuss the operational burden of utilization management, the importance of peer-to-peer reviews and appeals, the risks of billing a lower level of care when a higher level was delivered, and why strong documentation must reflect more than clinical need alone.The rules have changed, and delivering excellent care is no longer enough to keep an organization financially stable. Behavioral health leaders must understand payer expectations, build stronger relationships with managed care organizations, and run the business side of their mission with the same intention they bring to patient care.Gary's Links For You:LinkedInWebsiteXSonda's Links For You:WebsiteInstagramFacebookLinkedIn
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