Staying Organized and Up-to-Date: The Key to Independent Behavioral Health Practice Success
Running a behavioral health practice that takes insurance is no small feat. It will take an ongoing effort to maintain what you built.
The Evolving Landscape of Behavioral Health Practices
Gone are the days when starting a practice meant simply obtaining a license, filling out some contract applications, billing a few claims, and hanging your shingle. Today, regulatory changes, insurance complexities, and operational demands require a more sophisticated approach and consideration of your practice as a part of the entire system under which you operate. This shift can be seen in the enforcement of the 21st Century Cures Act, which underscores the importance of accurate, timely, and well-maintained provider information.
The 21st Century Cures Act, enacted to promote better healthcare access and efficiency, now mandates that all providers contracted with Managed Care Organizations (MCOs) enroll with their state Medicaid program. Additionally, the information on file with these entities must match precisely (sometimes down to the comma). For example, in Minnesota, discrepancies in enrollment data with the Minnesota Health Care Programs (MHCP) have already led to payment denials and contract application denials, as enforcement ramped up in July 2024.
What This Means for You
Regardless of where your practice is based, these trends highlight a growing emphasis on compliance and organization. To ensure your practice thrives:
Keep your Business Information Up-to-Date
If you’re operating under a different name, file a DBA. If you change your business address, update it with the Secretary of State and IRS. Know your business structure. It matters if you’re a sole proprietor, Single Member LLC, S-Corp, Partnership or other, and what you choose can affect what type of insurance contracts you can get.Keep Your Banking Information Up-to-Date
Always verify that your banking details match what payers and insurance companies have on file. A mismatch can delay reimbursements and strain your cash flow. Anything you change at your business needs to be updated at your bank.Audit Your Insurance Contracts Regularly
Ensure that all the information in your insurance contracts—addresses, Tax ID numbers, and other critical details—is accurate. Misalignment between payer and Medicaid databases can lead to claim rejections or even non-payment. This is perhaps the most important part of managing your contracts. Sending claims with mismatched information whether Name, Address, Rendering Provider, or anything else are starting to get denied with more frequency.Understand Medicaid Enrollment Requirements
Whether you’re contracting with local MCOs or participating in a national network, check your state’s Medicaid program requirements. Enrollment errors can result in halted payments or terminated contracts, or restrict the ability to get new contracts.Stay Informed on Regulatory Changes
Laws like the 21st Century Cures Act are being enforced with increasing rigor. By staying ahead of these changes, you can avoid surprises that disrupt your operations and income. We at Breezy share with our customers all pertinent news we find. It may be a dry read, but your ability to pay the bills depends on it.
Why It’s Worth It
While running your practice as a healthcare business might sound intimidating, it’s absolutely doable with the right mindset and tools. The effort you put into staying organized today will prevent headaches tomorrow, ensuring you can focus on what matters most: providing excellent care.
At BreezyBilling, we’re here to help independent providers navigate the complexities of billing and operations. Whether it’s keeping your accounts in order, assisting with insurance enrollments, or simplifying compliance, we make your success our responsibility.
The key takeaway? Organization and accuracy are no longer optional—they’re essential for building a sustainable practice. But with the right approach, your independent practice can thrive in today’s evolving healthcare environment.
We created BreezyNotes and BreezyBilling, and now our sister company Phoenix Credentialing, to help providers deal with these complexities. Feel free to reach out if you have any questions or would like to discuss anything from what it takes to start a new practice or our unique, hand-on approach to helping solo providers to large group practices handle this administrative burden. Click here to Contact Breezy Today!
