Client: Cedar Ridge Post-Acute (name changed due to privacy concerns)
Industry: Post-Acute & Skilled Nursing Facility with a Dedicated Psychiatric Wing
Location: Southwest USA
Date: July 2024
Overview
Cedar Ridge Post-Acute helps older adults dealing with complicated mental and physical health issues. They have a special unit just for behavioral health, offering things like therapy and addiction counseling.
By early 2024, Cedar Ridge saw a huge jump in demand for these services—therapy and addiction counseling sessions rose by 35%! The trouble was, their billing system couldn’t keep pace. It all came down to messy paperwork, confused insurance companies, and a disconnect between the care teams and the billing folks. Cedar Ridge realized they needed more than just someone to send out bills; they needed a partner who truly understood the ins and outs of behavioral health billing in their kind of facility.
Challenges on the Ground
- High denial rates—especially for long-term psych care flagged as “not medically necessary.”
- Prepayment reviews from a major commercial payer tied up cash flow for weeks.
- Dual-provider confusion, like when psychiatrists and therapists treated the same patient on the same day.
- Separate Records: Patient notes from psychiatry, billing, and nursing weren’t connected, creating isolated records.
- Patchy Training: Not everyone on the team knew the best way to document behavioral sessions to meet all the rules.
Rapid RCM’s Custom Strategy
Behavioral Health Revenue Cycle Overhaul
- Integrated EHR Connection: Connected clinical documentation from psychiatry, social work, and nursing into a single billing-ready workflow.
- Real-Time Denial Risk Alerts: Claims were flagged automatically if documentation was missing or clinical notes do not support medical necessity.
- Easy Co-Treatment Billing: They automated the tricky parts of billing for multiple services on the same day, making sure things were coded right and avoiding double charges.
- Pre-Approvals Handled: A special team took care of all psychiatric admission approvals and reviews ahead of time.
- Working with Insurers: Rapid RCM directly teamed up with major insurance companies to clarify rules for long-term mental health care, preventing unfair denials.
Staff Empowerment at Every Level
- Biweekly “Behavioral Billing” Huddles: Led by RCM experts to walk staff through real-life scenarios and documentation best practices.
- Custom Simulations: On-demand training videos for social workers and psychiatrists on how to code, document, and appeal correctly.
Family-Facing Financial Clarity
- Simple Billing Tools: Families received straightforward information about what behavioral services their insurance covered, what needed approval beforehand, and what they’d owe.
- No More Surprise Bills: This newfound transparency meant smoother talks with families and a lot fewer arguments over unexpected charges.
The Results
| Metrics | Before Rapid RCM | After Rapid RCM |
| Behavioral Denial Rate (Overall) | 24% | 8% |
| Denials for “Medical Necessity” | 11% | 2% |
| Claims in Prepayment Review | 18% | 4% |
| Avg. Days to Behavioral Payment | 57 | 21 |
| Patient/Family Billing Inquiry Resolved | 63% | 95% |
Why This Approach Worked
- Checks were in place to stop common billing mistakes before they even happened.
- Everyone on the team, from doctors to nurses, got the right tools and training to document things correctly.
- Direct talks with insurance companies cut down on confusion about what behavioral health care was covered.
A Smarter Way to Handle Behavioral Billing
Behavioral health billing is different. It requires more coordination, more precision, and more understanding of both care delivery and payer policy.
Cedar Ridge didn’t just need better billing software—they needed a smarter system, more support for their team, and a partner who could help them keep up with fast-changing behavioral reimbursement rules.
Rapid RCM Solutions delivered all three. And the results speak for themselves.
Want to See What’s Possible?
If your skilled nursing or post-acute facility is struggling with behavioral health billing, Rapid RCM can help you take control before denials and delays become the norm.
Get in touch with a billing expert today.
