by Terence Blackwell Jr on May 21, 2025
Accurate and thorough documentation is essential for providers serving individuals with intellectual and developmental disabilities (IDD), as organizations must bill by service and be able to justify each charge.
While this may sound like an easy enough concept, many organizations struggle in practice.
When organizations don’t have smooth IDD billing practices in place — such as when they capture charges manually — they risk using incorrect inputs, missing required information entirely, or undercharging.
Likewise, if staff overcharge or fail to document services delivered, then the organization can be at risk of accusations of fraud, potentially triggering costly audits and fines. What’s more, insurance companies can clawback payments for services they previously agreed to cover, leaving organizations with thousands in retroactive payments.
Even when documentation and charge capture is accurate, if the associated billing process is too slow, the result can be payment delays that can significantly affect the organization’s cash flow.
Ways Technology Is Improving IDD Payment Accuracy and Speed
Electronic health records (EHRs) with integrated artificial intelligence (AI) solutions are modernizing financial management at many organizations that serve children and adults with IDD or autism
In particular, the following functions are helping these organizations improve their clean claim submission, support easier compliance and audit processes, enhance the speed and completeness of IDD billing, power other improvements in the overall revenue cycle, and better track and understand financial trends across their organization.
Documentation Assists
Many IDD service providers still operate under a fee-for-service (FFS) payment model. In this model, organizations must accurately and completely document each service to support the charge and reduce the risk of payment denials.
The FFS model requires accurate and comprehensive documentation to support charge integrity. The right EHR should prompt providers with the required documentation for each service and enable seamless linking of that documentation to claims, allowing for automatic bill generation. Such automation minimizes opportunities for incomplete or missed charges and helps ensure that documentation and the IDD billing statement are aligned.
IDD billing software should also format claims for electronic submission and tie claims to service codes while verifying against payer rules. This helps ensure faster payment and reduces the risk of claims denials and processing delays.
Easy Claims Tracking and Auditing
EHRs can help service providers track the status of claims, including denials and rejections, and quickly respond to any issues that arise. This can reduce the time it takes to resolve payment issues and increase the likelihood of timely payment and successful denials management.
Tracking and trending payment denials is integral to identifying and resolving documentation and coding errors and missed pre-authorizations. Easy claims retrieval is also essential for minimizing the time and effort needed to comply with audit requests.
Insurance Eligibility Verification
Medicaid is the largest single payer for long-term support services (LTSS) for individuals with IDD. According to KFF research, federal and state Medicaid LTSS spending totaled more than $804 billion in 2022 and is expected to grow at a 3.9% rate through 2025.
While many individuals with IDD needs are ensured through Medicaid, they may also be covered through Medicare and/or private insurance. Dual eligibility can make the IDD billing process more complex. Medicaid is the “payer of last resort” for most services, meaning it will pay for services only if no other payment sources are available.
With that in mind, service providers need to be able to verify insurance eligibility and coordinate benefits quickly and accurately. This step is critical for ensuring that individuals and caregivers know what insurance will or will not cover and any expected out-of-pocket costs.
The right AI-backed EHR can be integrated with payer systems to provide real-time eligibility verification for clients. This can help providers identify potential payment issues, such as outdated insurance information or a lack of coverage for a particular service, before delivering services.
Customizable Billing Templates
One of the benefits of an EHR is the ability to create templates that reduce the need for manual data entry. Many states require IDD service providers to work with managed care organizations and other payers, each of which may have its own rules around payments and billing. Having a staff member manually enter the different services and payers increases the likelihood of incorrect data entry or omissions of required information.
IDD billing software that includes customizable billing templates makes it easier for providers to set rules for each payer and easily adapt as rules inevitably change over time.
Revenue Cycle Management and Custom Dashboards
Paper-based systems limit an IDD service provider’s ability to track and trend financial key performance indicators (KPIs) in detail. That can make it difficult for providers to identify areas for improvement.
EHRs with embedded AI technologies empower staff and providers to quickly spot and sort clients by payer type, denial type, and service. Core Solutions’ IDD revenue cycle management tool, for example, reviews each claim using around 80 rule iterations before submitting it. By reducing human error often caused by manual entry, these AI-powered solutions minimize the chance of costly and time-consuming denials by identifying inconsistencies before they become a more substantial problem.
Also, AI-backed EHRs enable leaders to generate reports on key IDD revenue cycle management metrics, such as average payment time, denial rates, and payment trends. This information can help providers identify areas for improvement and make data-driven decisions to optimize their revenue cycle processes. Meanwhile, quick reports of billed services enable staff and providers to efficiently see what was billed based on service authorizations.
Readiness for Performance-Based Contracting
Some organizations serving children and adults with IDD are preparing to shift from the FFS model to the managed care or performance-based contracting model. In these newer models, financial incentive or risk is often tied to an organization’s ability to improve quality and contain cost.
An advanced, AI-integrated EHR can provide an organization with both granular data and a comprehensive view of their business performance and client care. Having more and better-quality data on the level of care delivery, alignment with person-centered life plans, and/or service gaps enables teams to optimize their performance and better ensure accountability for tasks related to improving and achieving positive outcomes.
Consider an agency with 15% unbilled, but authorized, services. How would that impact the organization? Top EHRs can give you that financial picture by offering custom dashboards with intuitive data visualizations that help service providers recognize trends in staff productivity, non-billable services, shifts in service utilization, cost of service delivery, revenue trends, and other areas affecting financial performance.
Technology Transforming IDD Billing Processes
Relying on paper-based or outdated systems makes managing financial operations for IDD services exceptionally difficult. As providers seek to optimize the financial management of their organizations and better prepare for the future, it will be essential to add technology that supports automated charge capture, streamlines IDD billing, and offers AI-powered solutions to reduce errors and staff workloads.
With staff constraints, increasing payer complexity, and continued pressure on the bottom line, the IDD revenue cycle management capabilities and financial dashboards of an EHR are becoming vital to organizations’ performance and ability to successfully serve its communities.
Request a demo of the Cx360 platform today to learn more about our suite of solutions and how they are helping IDD organizations nationwide strengthen and streamline their revenue cycle.
