The advancements in technology that are transforming behavioral health care come with heightened expectations from payers and patients. One of the country’s historical leaders in substance use treatment is successfully navigating the transition from human conversations around documentation to the nuances of online portals that will determine the fate of a claim.
Caron Treatment Centers has had to manage an increasingly complex payment landscape as its share of revenue from insurance contracting has steadily grown. Its senior director of patient financial services, Kelly Current, traces her experience in the field to a time when utilization review involved passing handwritten notes in paper charts. Technology has brought progress to every role in financial operations, albeit with increased demands for efficiency.
Every task now has a time frame attached, Current says, from initial authorization for treatment to review to claim submission to an appeal if a claim is denied. Ultimately, “The goal is a clean claim, and that is where AI helps us,” she says.
In the pre-AI environment, the process of dictating clinical notes, entering them into the record and checking for accuracy could take up to 72 hours, Current recalled. Often there would be gaps in the information that payers required, delaying authorization and worrying patients and their families. “Families would be calling staff,” Current recalls. “This was already an anxiety-riddled environment for them.”
Use of the AI-powered tools in Sigmund Software’s Aura solution has allowed Caron to complete the needed documentation with same-day results. An early-morning history and physical for a patient arriving the night before can now lead to an authorization for treatment by noon, Current says.
“Payers now are giving us 24 hours; they know we have AI,” Current says.
The AI-enabled features of the EHR create greater consistency of language in clinical documentation, an important factor in overcoming potential barriers to authorization and timely payment. AI is closely aligned with the language of the ASAM Criteria, the standard used by most insurers for level-of-care determinations.
Before the use of AI to extract key information from the patient record, “We’d have to read every single note and assessment,” Current says. “It would take about an hour per case.”
She suggests that in the new environment, all parties can breathe a bit easier. Payers are no longer routinely reconnecting with the provider, in search of missing or delayed information about the patient. Clinicians no longer are dealing with backlogged work that required them to catch up after hours or on the weekend.
“It allows clinicians to have more time with the patient,” Current says. “They’re not bogged down. It allows the therapist to be more present.”
Current oversees financial activities across the continuum, from pre-admission verification to utilization review, also offering assistance to families as they seek to clear financial hurdles. She says use of AI not only has facilitated cleaner claims and timelier payment, the consistency that it allows proves to be a major help on the back end, whether in arguing an appeal or meeting the requirements of insurer audits.
Current says the training of Caron staff in use of the system progressed smoothly. She also appreciates the ongoing support from a Sigmund team that assists in implementation of the behavioral health-focused software solution.
It is rare to see an advancement that arugably offers equal benefit to all involved stakeholders. We at Sigmund believe that sound use of AI to improve documentation can achieve impactful results for providers, payers and, most importantly, patients.
