by Mike Lardieri, LCSW on September 24, 2024
As a newer model for high-quality, personalized, value-based care, certified community behavioral health clinics (CCBHCs) help ensure widespread access to services for people with a range of conditions, including mental health and substance use disorders (SUD).
Given that providing care to all — including underserved and underinsured communities — is a central tenet of CCBHC care, the model eschews traditional payment structures in favor of a system that offers more flexibility and financial support to truly re-envision what behavioral healthcare can look like.
The complexity of this payment structure, however, requires behavioral health billing solutions that include automated insights, fast data reporting, and revenue cycle management capabilities. With an advanced electronic health record (EHR), CCBHCs can get all these components of a billing system plus the clinical tools to better ensure every client receives the care and support they deserve.
5 Essential Features of a CCBHC Billing Solution
In the traditional healthcare billing system, fee schedules with set service category rates dictate provider payment amounts. But because each clinic has its own specific needs, the traditional system doesn’t work for everyone.
In contrast, the CCBHC prospective payment system (PPS) allows states to control cost growth more effectively and ensure provider payments better align with each clinic’s unique needs. Within this model, states certify CCBHCs and set custom rates based on an individual clinic’s cost reporting from the previous year, according to the National Council for Mental Wellbeing. As a result, each clinic has its own payment rate based on services offered and clients served.
But to meet PPS requirements, CCBHCs need behavioral health billing solutions tailored to the model. While different EHRs offer different capabilities, here are five must-have features for any CCBHC.
1. Comprehensive Data Management
To enable states to determine service rates, CCBHCs are required to provide accurate cost reports on a regular basis, the timing of which depends on their state’s requirements and the type of PPS plan they use. Each report must include several types of data, including the:- cost of services rendered within the clinic by CCBHC providers;
- cost of care associated with any designated collaborating organizations (DCOs) the CCBHC partners with to provide client care and support; and
- cost of “shadow services,” which involve underlying encounters that comprise full-service delivery, such as follow-up appointments or telehealth visits.
For most CCBHCs, manually juggling this much data from multiple sources can be incredibly taxing on the clinic — which is why having an EHR that can efficiently handle this data load is essential.
Strong EHRs enable clinic staff to set custom billing rules for their unique situation. These EHRs include dashboards that consolidate data from multiple streams in one central location. Data tracking capabilities make identifying the right data and constructing state-ready reports quick and easy.
2. Integrated Billing and Clinical Tracking
Not only do CCBHCs need to capture and report on data from diverse encounters, but they also must differentiate provider and service types falling under the behavioral health umbrella. What’s more, provider and service categories shift state by state, with each requiring specific reporting codes.
Consider this breakdown from Minnesota, as an example. In this state, CCBHCs must track and code mental health, outpatient substance use disorder, and non-CCBHC services with their own unique codes. Other states, however, may categorize services differently and require distinct coding.
In short, it’s a lot to track — especially for CCBHCs with multiple clinics extending across state lines. The best behavioral health billing solutions take the burden off clinic staff. An EHR can provide automated session time tracking per provider or service line. Custom, clinic-specific documentation helps organize this data and ensure it aligns with state reporting requirements. These tools transform clinical work into structured and accurate billing data.
3. Sophisticated Automation Capabilities
The data reporting requirements don’t stop there. According to the National Council for Mental Wellbeing, CCBHC reports must include both current and anticipated costs. This data allows states to not only set bespoke rates based on projected clinic needs, but to also benchmark costs across CCBHCs to ensure comparable services generate similar costs.
When looking for a solution to aid in this complex and forward-thinking CCBHC billing, data collection, and reporting, it’s essential to select a tool with built-in automation capabilities. Automated, real-time analytics can help clinics better and more accurately derive insights and project their anticipated costs based on past data — without the time-consuming manual math.
Find a solution that also has automated payment plan administration, self-pay facilitation, and collection protocols. These solutions require minimal manual intervention and help clinics stay on top of both billing and data collection processes. EHRs that send automated follow-ups on billing procedures and collections better ensure billing cycles run smoothly and boost a clinic’s overall operational efficiency.
4. Tailored Revenue Cycle Management
Revenue cycle management involves staying on top of several elements that impact a CCBHC clinic’s bottom line: verifying insurance eligibility in a timely manner, accurately assessing out-of-pocket costs, capturing charges without error, coordinating DCO partnerships, and more.
CCBHCs should look for behavioral health billing solutions that streamline the management of these operational elements. With custom workflows and rules-based processes, a robust EHR can help clinics render services appropriately, generate bills automatically, create seamless workflows for distributing payments, and capture charges with minimal errors. The solution ensures everyone is paid on time and clinics manage their full revenue cycles effectively.
5. Regulatory Compliance and Data Security
Data privacy is critical within a healthcare environment — and that definitely extends to the CCBHC model, in which providers across multiple clinics and DCOs regularly collaborate and share client information.
Look for a CCBHC billing solution with integrated compliance and data security features. Providers and clients alike should be able to sign forms, communicate, review progress notes, and pay bills more safely and securely.
Additionally, some advanced EHRs incorporate compliance trackers that help clinics keep pace with regulatory deadlines and set provider-specific responsibilities for completing compliance tasks.
An All-in-One CCBHC Billing Solution
Behavioral health billing solutions come in all shapes and sizes, but CCBHCs need an EHR with the features that enable them to deliver high-quality service, report costs effectively, and maintain financially strong operations.
Core Solutions’ Cx360 EHR offers all these benefits and more. Tailored specifically for behavioral health providers, the platform enables clinics to optimize their billing cycles, coordinate value-based care across the continuum, and access evidence-based practices to enhance the care they provide. It’s a robust, comprehensive solution that’s redefining what’s possible for CCBHCs.
Request a demo to see what Cx360 can do for your CCBHC.
