Aligning Mental Health RCM With Quality and Outcomes Goals

In behavioral health, financial performance and clinical outcomes are tightly linked. Effective reimbursement and revenue cycle management (RCM), for example, depend on clinical best practices, such as accurate documentation, timely treatment, and individualized care that ultimately leads to positive outcomes.

Likewise, organizations with strong mental health RCM often have the resources and systems in place to deliver high-quality client care.

As organizations increasingly shift to value-based care models that prioritize outcomes over volumes, the connection between RCM and clinical performance will become even more critical.

In a mental health care landscape where reimbursement and compliance drive organization success, collaboration between financial and clinical teams is key to improving performance on both fronts.

The Importance of Staff Collaboration in Mental Health Reimbursement

Value-based care (VBC) is a rapidly growing payment and reimbursement model in the United States: McKinsey projects that by 2027, about 90 million people will be covered under the model, which would represent a 109% increase over 2022 levels. Measurement-based care (MBC) is becoming the clinical foundation of VBC in behavioral health.

In this model, behavioral health providers are reimbursed based on measurable improvements in client outcomes. Unlike fee-for-service, the value-based care approach forges a tight connection between an organization's quality of care delivery and revenue.

Research has shown that these two elements of healthcare are already inextricably linked. A 2023 study, for example, found that as care quality increases, so too does a hospital’s profitability. And vice versa: Decreased care quality can negatively impact an organization’s revenue stability.

If behavioral health care organizations fail to establish coordination mechanisms between their clinical and RCM teams, they can miss opportunities for improving both areas. Strengthening the alliance between clinical and RCM teams requires organizations to:

• Set up regular joint meetings to ensure alignment. In these meetings, teams can discuss topics like documentation best practices, billing procedures, and clinical gaps that could be impacting the organization’s RCM capabilities.

• Educate staff to boost communication. Educating each team on the other’s roles, responsibilities, and objectives can help improve mutual understanding and support better cross-functional communication.

• Establish shared performance goals. Ensuring clinical and RCM teams are working toward the same goals helps everyone understand the relationship between clinical and financial outcomes.

How to Align RCM Activities With Quality Metrics

Driving financial sustainability and better client outcomes starts by establishing strong collaboration between clinical and RCM teams, but it doesn’t end there. For providers and RCM professionals to truly accomplish shared goals, they need the right systems and practices in place for collaborative work.

Here are five steps organizations can take to align their RCM and clinical quality metrics, particularly within a value-based approach.

1. Integrate EHR and RCM Systems

Many behavioral health organizations struggle with interoperability across systems, especially if they contract with multiple payers or community partners. However, siloed systems only breed isolation. With an electronic health record (EHR) that includes integrated mental health RCM capabilities, teams can better understand and simultaneously manage:

• Clinical data and its relationship to medical billing timeliness and accuracy

• Reimbursement and payment tracking, as related to service delivery dates, locations, and types

• Claim denial rates and their connection to delivered services and medical coding

By streamlining clinical and RCM data in a single central system, teams can more easily understand and see how one element impacts the other. An integrated system saves staff time, cuts down on the need for manual data entry, and enables collaborative teams to pinpoint and address gaps faster for better care delivery and RCM.

2. Establish Aligned KPIs

Defining the right key performance indicators (KPIs) that reflect both financial health and quality of care empowers organizations to assess how well they’re integrating these two critical areas. Consider KPIs such as:

• Session attendance rates

• Treatment adherence rates

• Mental health coding accuracy rates

• Hospital/facility readmission rates

• Insurance claim approval and denial rates

Each of these KPIs measures both the care delivered and the financial impact of that care, enabling teams to clearly see how client outcomes relate to RCM. That knowledge improves both areas: A 2021 study found that when surgeons understand their KPIs, for example, they’re more likely to see how their performance in the operating room impacts the organization’s revenue.

The same goes for the behavioral health space: When mental health providers have a solid grasp on their KPIs, they can connect the dots between their work and their organization’s bottom line. This enables them to work more effectively with mental health RCM teams to support the organization overall.

3. Standardize Workflows

To improve collaboration and connection between clinical and RCM teams within a value-based care model, organizations need to automate and standardize workflows. The best behavioral health EHRs have integrated workflow templates generated from evidence-based best practices. The system notifies staff members when a task is due, then automatically routes the task to the next person in the workflow upon completion.

This level of integration and workflow automation holds clinical and RCM staff accountable to their roles in collaborative decision-making, client management, and revenue generation.

4. Ensure Accurate Documentation and Coding

For clinical teams, inaccurate billing codes can cause a headache and some repeated work. For RCM teams, however, incorrect mental health coding translates to delayed payments, a higher likelihood of claim denials, and even the potential for revenue loss. And in a value-based care model, accurate qualitative notes and billing codes reflect both the organization’s quality of care delivery and its ability to sustain cash flow.

Organizations with manual documentation and coding practices tend to experience delays that can impact client outcomes and mental health RCM alike. According to one study, manual coding processes led to an average three-month backlog and an incredible 50–98% range in accuracy.

Top EHRs with artificial intelligence (AI)-powered solutions enable teams to better ensure the accuracy of their documentation and coding processes. These systems can record spoken notes (i.e., ambient documentation), then provide summaries for quick, accurate documentation of diagnoses, care plans, and outcomes. Teams can also create bespoke coding checklists and rely on the EHR to flag any billing codes that don’t align with the organization’s set rules.

5. Foster a Culture of Continuous Improvement

A culture of continuous improvement not only ensures organizations are continually improving their RCM and clinical practices but can also lead to innovative revenue-generating ideas, according to a 2024 study.

When that continuous improvement is based on clear, accurate data, the benefits are even greater. A top-tier EHR offers an intuitive dashboard for accessing the right data and comparing clinical and RCM metrics. The system can enable teams to monitor quality-linked financial outcomes in near real time, giving them a more informed understanding of client care and RCM processes.

RCM and Clinical Outcomes: Keys to Proper Mental Health Reimbursement

The value-based care model inherently shifts behavioral health organizations’ focus — and for the better. Teams need to accurately assess the quality of care they deliver and the outcomes that care drives because doing so directly impacts not only their clients but also their organizational revenue.

Core Solutions’ Cx360 Enterprise EHR offers all the tools organizations need to support clinical and RCM operations. These include AI-powered documentation capabilities, customizable workflows, an easy-to-access data dashboard, and embedded RCM tools. Cx360 Enterprise is a central resource for organizations looking to lead the way in a value-based care environment by delivering the best care possible and enhancing their revenue management simultaneously.

Reach out for a demo today to see the Cx360 Enterprise platform's intuitive data dashboards in action.