How to Ensure Compliance and Privacy in Behavioral Health RCM Outsourcing

Why do most behavioral health practices rely on RCM outsourcing? The answer lies in its potential for the entire RCM operation from start to finish while letting providers focus on client care.

A study shows that outsourced RCM can generate up to 15% additional revenue for the behavioral health provider. Coming to the billing, regulatory, and even privacy issues seen in behavioral health, outsourcing RCM turns out to be a convenience and strategic advantage.

In this blog, we discuss the compliance challenges in RCM outsourcing and best practices to guide your way to effective data protection for patients.

Why Behavioral Health Providers Choose to Outsource RCM

Revenue Cycle Management is the most complex operation which includes from initial patient registration to final payment.

Managing it alongside caring for behavioral health clients can be frustrating for providers. However, RCM is crucial as it ensures the practice’s financial stability. This is where outsourcing comes in.

Behavioral health providers often rely on RCM outsourcing services to reduce the burdens and focus on client care. Moreover, RCM outsourcing partners are professionals and have specialized expertise in handling complex behavioral health-specific billing for instance:

• Non-standardized billing codes
• Frequent insurance verification issues

According to a study, 75% of medical providers realize financial benefits within the first year after outsourcing their RCM. This is the main reason why most behavioral health practices usually choose to outsource RCM.

Related: How Does RCM Outsourcing Improve Patient Care in Behavioral Health?

Benefits of Outsourcing RCM for Behavioral Health

• The company will enjoy better productivity, higher accuracy, fewer errors and denied claims, and better collection rates, among other advantages, by outsourcing to seasoned RCM service vendors.
• It would be expensive to have an in-house RCM team. 
• Cost savings on staffing, training, and compliance open the way for cash allocation to patient care through outsourcing.
• When behavioral health professionals outsource RCM, they can focus on providing high-quality care, which improves patient outcomes and satisfaction.
• RCM providers employ the most advanced technology and software that may be quite pricey to acquire individually for behavioral health companies.

Related: 3 Ways to Transform Your Behavioral Health RCM Strategy to Value-Based Payment

Key Compliance and Privacy Challenges in Outsourcing

In behavioral health, compliance and privacy are at the top of the list because patient data is extremely sensitive.

Providers face distinct risks concerning outsourced RCM, including:

• Data breaches 
• Unauthorized data access 
• Failure to comply with the Health Insurance Portability and Accountability Act.

HIPPA rules must be followed by the service providers so that all relevant information related to personal health is secured and handled appropriately. Moreover, there are certain rules placed by states for behavioral health as well.

HIPAA and Its Relevance to RCM Outsourcing

HIPAA compliance is critical in behavioral health RCM, as it highlights the protections of PHI throughout the billing and claims process. It dictates that any outsourced RCM partner must operate through strict data security standards to avoid breaches. 

This sort of HIPAA violation in RCM can bring as much as $50,000 in fines per violation and harm the reputation of any provider. In this respect, ensuring the compliance of the RCM vendor with HIPAA will reduce risk and create better relationships with patients.

Best Practices for Compliance and Privacy in RCM Outsourcing

Behavioral health practices must adopt best practices to maintain compliance and privacy.

1. Comprehensive Vendor Assessment for Compliance Assurance

Initially, practices must conduct a thorough vendor assessment. 

Because it helps to evaluate the potential RCM partners. While evaluating RCM vendors, make sure to evaluate under these criteria:

• Compliance with HIPAA 
• Certifications such as HITRUST CSF 
• Adherence to National Institute of Standards and Technology guidelines

Also, ensure the vendor does its internal audits and reviews on a regular basis so that they become in line with the industry’s compliance.

2. Customizing Business Associate Agreements for Robust Protection

A BAA legally binds the RCM vendor to particular standards of compliance and defines the responsibility of the vendor in protecting patient information. And this agreement has to be rich in detail.

These include breach notification, audit rights, and privacy protocols. A comprehensive BAA ensures that the provider is relieved of breach liabilities and HIPAA violations brought about by the RCM vendor.

3. Employee Training on Privacy and Compliance Standards

Outsourcing does not absolve providers of the obligation to protect patient information but rather encourages internal training on privacy compliance. 

The relevance of internal training encompasses policies like 

• Compliance
• PHI treatment 
• Data sharing restrictions 
• Cybersecurity practices. 

Comprehensive training equips employees with complete acquaintance with changes in regulation that surface with potential security threats early, which may prevent accidental breaching of data.

4. Leveraging Technology to Strengthen Security Measures

High technologically driven solutions in the region embrace advanced encryption for secure data transfer and protocols for safe secure data transfers. 

Anomaly detection in patient data, too, should be based on artificial intelligence. If using cloud-based, HIPAA-compliant software, RCMs would ensure that the provider is prepared to prevent unauthorized access and contain a potential breach quickly. Automation in claim processing, billing, and reporting may also decrease the rate of errors and enhance overall efficiency.

Related: How RCM Integrated EHR Solution Can Help to Improve Your Practice Revenue

5. Establishing Continuous Monitoring and Improvement Protocols

Regular security practice reviews and updates keep the outsourced RCM process in line with regularly changing regulations. Monthly or quarterly reviews of RCM vendor performance, combined with periodic audits, assist in identifying vulnerabilities and strengthening defenses. 

With such performance metrics and compliance indicators, behavioral health providers can maintain: 

• High level of standards that have been achieved 
• Minimize data breach risks 
• Ensure that their RCMs are changed over time according to industry standards.

Vozo Revenue Management Cycle Service

At Vozo, we understand your struggle in navigating through all the revenue cycle processes such as regulations, medical coding, and reimbursements. 

That’s why we bring the best cutting-edge service to optimize your revenue cycle management from start to finish. Here’s how Vozo can help you to transform your practice’s financial performance.

• Automated tools for error-free coding and faster reimbursements
• User-friendly billing to keep patients satisfied and payments flowing
• Robust data security and compliance protocols to protect your practice
• Detailed reporting and analytics for smarter business decisions
• Solutions that grow alongside your evolving needs

With Vozo RCM service, you can reduce the headaches associated with revenue cycle management and focus on what matters the most – quality patient healthcare delivery.

“Partner with Vozo RCM Service and unlock the full potential of your healthcare practice and maximize its revenue”.