In the evolving landscape of healthcare, providers face numerous challenges, from navigating complex patient needs to addressing the social determinants of health that impact patient outcomes. However, with the right strategies in place, healthcare organizations can optimize revenue streams and improve the return on investment (ROI) of their programs. One solution is leveraging Rely Health care navigation programs to capture patients that “fall through the cracks” which provides increased billing opportunities and optimized health outcomes.
Rely Health Care Navigation programs offer comprehensive support to healthcare providers and payers alike by delivering personalized care and addressing the diverse needs of their patients. These programs encompass a range of services, including preventive illness navigation, social determinants of health assessments, and chronic pain and chronic disease management. By leveraging these programs, providers can enhance patient engagement, improve health outcomes, and ultimately drive revenue growth.
One of the key benefits of Rely Health Care Navigation programs is our ability to capture billing opportunities that might otherwise be overlooked. With the recent revisions by the Centers for Medicare & Medicaid Services (CMS) to billing codes related to preventive illness navigation, social determinants of health assessments, and chronic pain and chronic disease management, providers have the opportunity to bill for additional services as supervisory to navigation.
Rely Health has worked diligently in 2023 to capture the Community Health Worker (CHW) billing capabilities utilizing care navigators across the country. Particularly in California, Rely Health employs over 50 Substance Use and Behavioral Health Navigators in emergency departments and cross-covering inpatient settings. In collaborating with billing departments and Revenue Cycle Management teams across these hospitals, 15% of our programs have fully adopted the CHW billing opportunities. Rely Health care navigators have successfully supported billing efforts to capture over $7,500 during the months of October through December 2023 alone. These rates continue to rise as programs are refined and standardized to capture all eligibility and supportive documentation requirements, while enhancing our navigation reach.
The offset of reimbursements from billing capture are projected to bring ROI for up to a quarter of the cost of a navigation program in 2024. Although fractional, these ROI figures add to the impact that care navigation programs make on health systems and communities and are not inclusive of the return gained in downstream revenue acquisition, reduction in costs of high utilization and avoidable revisits, and reduction in readmissions.
The new preventive illness navigation billing codes introduced by CMS enable providers to bill for services aimed at preventing the onset or progression of chronic illnesses.
Rely Health care navigation programs can play a crucial role in delivering these services:
With Rely Health navigators documenting and coding these activities appropriately, providers can capture billing for preventive care services, thereby improving revenue and promoting population health even after their patients leave the facility.
Addressing social determinants of health is essential for delivering holistic and patient-centered care and it’s all the recent buzz in the healthcare landscape. The CMS revisions have expanded billing codes related to social determinants of health assessments, allowing providers to bill for the time spent assessing and addressing patients’ social needs.
Rely Health navigation programs excel in identifying and addressing social determinants of health, such as:
By integrating these assessments into the navigation workflow and documenting the associated activities, providers can capture billing for these critical services.
Chronic pain and chronic disease management are areas of significant focus in healthcare, given their impact on patient well-being and healthcare costs. The revised billing codes from CMS offer providers the opportunity to bill for comprehensive care coordination and management services for patients with chronic conditions.
Rely Health care navigation programs can enhance these efforts by providing patients with:
By documenting the time and resources dedicated to chronic pain and chronic disease management, providers can maximize billing opportunities and improve patient outcomes.
Rely Health’s approach to maximizing revenue and improving ROI hinges on our proprietary HIPAA-compliant Patient Relationship Manager (PRM) tech suite. Our innovative platform is custom-built for navigation and care coordination, offering a seamless solution to capture billing opportunities and successful navigation outcomes effectively.
By leveraging Rely Health Care Navigation programs to capture billing opportunities effectively, healthcare providers can improve the ROI of their programs in several ways:
In conclusion, Rely Health Care Navigation programs offer healthcare providers a powerful tool for maximizing revenue and improving the ROI of their programs. By strategically leveraging these programs to capture billing opportunities related to preventive care, social determinants of health assessments, and chronic disease management, providers can enhance patient care, drive revenue growth, and achieve long-term success in a value-based healthcare environment.
