Clinicians and healthcare practices often struggle to follow regulatory requirements. This creates additional challenges for health providers, patients, and payers already trying to manage costs.
According to MGMA’s 2022 Annual Regulatory Burden Report, 89 percent of survey respondents (which included group practice executives) saw their practice’s overall regulatory burden grow in the past 12 months.
Here are some of the biggest regulatory hurdles that behavioral health providers are trying to overcome.
Prior authorizations, the process that some U.S. health insurance companies use to determine if they will cover a particular treatment, may be the top regulatory burden for group practices. According to the MGMA report, nearly 82 percent of survey respondents said that prior authorizations were “very or extremely burdensome.”
These types of administrative requirements, according to some of the group practices surveyed for the report, delay patient care and raise costs. Practices also had related clerical issues, such as submitting documentation through fax or a health plan’s proprietary web portal, or following a different set of rules for each health plan. One practice noted that nearly 100 percent of its prior authorizations were approved, yet the practice needed three additional full time employees just to manage them.
Keeping documentation up-to-date, well organized, and accurate is a challenge all by itself. Federal and state regulations, plus the standards of payers and accrediting bodies such as The Joint Commission and CARF can further complicate things. Therapists and other behavioral health professionals may also face different types of audits, creating additional stress.
Lack of Interoperability
Behavioral health clinicians often need to communicate with other providers, such as emergency departments and primary care providers. The ability of different healthcare systems and software to exchange, interpret, and store information is known as interoperability.
Many health-related federal laws in recent decades have sought to address interoperability. Unfortunately, interoperability remains a challenge for behavioral health providers. Different providers with different IT software may struggle to share important patient information. Adapting new software can also be disruptive for health organizations.
Following Changing Regulations
Following current standards and requirements is already challenging. When those regulations change, however, behavioral health organizations have even more work to do. Providers have to track the progress of looming changes, understand how they will affect the practice, and know when they will take effect. Then, providers have to make the necessary changes to their operations, staff, or facility to stay compliant.
For example, the 21st Century Cures Act includes provisions to reduce information blocking, or anything that limits the sharing of electronic health information (EHI) between clinicians and patients. The Cures Act’s Final Rule applies to anyone with access to this EHI, including practitioners, clinical social workers, and clinical psychologists. Now, as of October 6, 2022, that EHI includes all electronic information in a provider’s designated record set.
Regulations and the accompanying paperwork can add stress, expense, and time to the work day for many behavioral health providers and their teams. Using the right tools can help alleviate part of this burden.
BestNotes EHR solutions are designed for behavioral health providers, helping reduce stress and costs while saving you time. Our documentation feature helps eliminate redundancies and double-data entry, and automatically maintains and updates to federal and state standards.
BestNotes EHR also meets current interoperability standards, helping your practice communicate with other providers. Reach out to us today to ask questions and learn more!