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Behavioral Health Revenue Cycle Management: Triadic LLC

Meet two technologists, Cindy Day and Heather Griffin, owners of Triadic, LLC – a Behavioral Health specific revenue cycle management company. It became imperative for everythingEHR to find a billing company that understands how electronic health records software works. The Triadic team is responsible for processing millions of dollars in claims per month for some of the largest Community Mental Health agencies in the United States.

Join our host, Kristin Sunanta Walker, as she discusses the skill-set and passion required to serve our favorite sector of healthcare: Behavioral Health.


How have you seen technology change in Behavioral Health in terms of what a billing company needs in order to process claims?

Technology has allowed for more timely filing of a larger volume of billing at once by reducing the time it takes to submit claims. It has also allowed for more “edits” to be used in processing the billing. In some instances prior to the billing ever being submitted allowing for more “clean claims” and therefore a higher volume and quicker turn around on cash flow as well as a reduction in repayments. While we feel technology being incorporated into Behavioral Health billing is a positive and important step for the industry, it also created the need for people who need to be more than just “billers”.  They need to understand how EHR technology impacts what they do for their agencies and how to communicate with others, both internally and externally, about those impacts.

TriadicBalloons1What kinds of technology are you familiar with including Behavioral Health EHRs?

Some of the technology utilized the most includes Access, Crystal Reports, Microsoft SQL, Microsoft Office Suite, Multiple EHR platforms: AlphaFlex, Epitomax, Therapy Appointment, NetSmart, myEvolve, Valant, ehrYOURway, Dr Cloud EMR, and Checkpoint by Integrity Support.  There are also multiple EHR companies we consult with in order to advise them on the needed enhancements in the billing portions of their systems.

What kinds of reports have you created when EHR technology didn’t give you or your clients what is needed?

We’ve created a wide range of reports utilizing multiple tools. Some solutions are simple Excel spreadsheets with basic data while others are more complex reporting utilizing a custom database. We always try to use the EHR resources as much as possible but at times do have to house data from the EHR in a separate tool. We need in many of these instances to utilize other systems such as the portal of the payor or that of a clearinghouse.

As an example, one of our larger agencies has an EHR that does not produce an accurate aging report. It doesn’t reflect the aging buckets the agency would like to see. We created a custom database to generate the reports they need. To do this, we generate a detailed report from the EHR, download the “dumpfiles” from multiple MCOs and import all of that into our database. From there, we are able to generate an accurate aging with the aging buckets they need as well as generate numerous other reports they are unable to get from their EHR. We have also incorporated into this database the denial reason codes from documents supplied by MCOs to report more detailed and accurate denial reasons. We’ve also created SQL statements for the Microsoft SQL database we created because we needed to query and aggregate data from multiple sources.

Providers typically want a billing entity to negotiate better rates from private insurance carriers. It takes a lot of work to make this happen. There is no magic strategy and yet many billing agencies tell their providers this is an easy negotiation process. What is Triadic’s take on this process?

We’ve been successful at achieving this for some of our agencies but there is no guarantee this will be successful. Payment rates, especially for Behavioral Health, can be very difficult to negotiate. We prefer to be honest with our clients. We’ll certainly try to make this happen but managing the expectations of our clients is top priority.

everythingEHR has, unfortunately, had to refer many of our Behavioral Health clients to new billing entities because they experienced significant losses in revenue and lack of professionalism from their previous billing firm. What are some of the reasons you’ve seen billing companies quickly go down hill?

Many billing organizations are not properly staffed and mismanaged financially. You can’t be responsible for the financial well-being of your clients if you can’t manage your own revenue as a revenue cycle management organization. A common issue is lack of or zero follow up on claims, lack of communication with their clients, not posting payments or posting inaccurately. The provider should always come first. It is our job as a billing agency to ensure that the provider is able to focus on their clients. They should not have the added responsibility to deal with financial or financial related system issues. This is what they are expecting us to handle when they agree to use our services. They are committing to trusting us with their livelihood and we need to be worthy of that trust.

Many billing companies don’t understand technology and how systems work, or the importance of data input correctly.  Bad data in means bad data out. Many billing companies will blame the EHR vendor simply because they don’t understand technology and most providers don’t realize this is happening. If a billing company is constantly complaining about every EHR vendor they must work within, this is a problem with the billing staff not the technology.  This why our team is asked by multiple EHR vendors how to enhance the billing portions of their systems. The principals at Triadic are Information and Technology professionals. We don’t blame EHR vendors, we simply create our tools to work around them if needed. Providers struggle with inadequate processing and reporting which could be a detriment to their agency and keeps them in a constant state of unrest or constantly searching for a new system. It isn’t fair to the EHR vendor because their system could very well be a dream system for the provider, if it were being utilized properly. We are EHR vendor friendly. It doesn’t serve our team or our clients to blame technology vendors. Yes, some systems are pretty awful. In those cases we work with everythingEHR to help our clients find a better system.

A couple of examples from experience that these concerns have created:

  • A client’s insurance information changes, instead of adding an additional insurance record and making the previous one inactive, which should be the proper way in most systems, the billing agency just changes the information that is already there. Now there is no record of what was originally billed so it makes tracking difficult, which makes working denials a nightmare and delays cash flow. If an older claim needs to be rebilled to the previous insurance, there is no simple way to do that, again delaying the cash flow.
  • Payments not being posted or posted incorrectly makes it impossible for an agency to run financial reporting and truly know where they stand. You can not project your cash flow, prepare budgets or even supply accurate financial data to executives, the board, or financial institutions with inaccurate data.

An agency needs accurate data reporting and analysis not only for themselves but for other agencies involved in their practice. This could be anyone from supporters, governing identities, financial institutions down to the client themselves. If you have a client that has generated a balance they are responsible for, you can’t bill them for that balance unless you know it is correct.

We have worked with several agencies that, because they did not have someone who understood the technology, constantly felt they had the wrong system. When we were first introduced to them, they had operated in 3 different systems over a period of 4 years. Think of how much revenue they lost as well as staff turnover and hostile work environment. One of the systems they had used would have been terrific for them if someone understood how to properly use it.

What is your experience in behavioral health?

The principals have over 20 years experience each in Behavioral Health, on both the LME (previous to becoming MCOs) and provider sides. We work not only on the billing side but also the IT, Finance (as a whole) and Clinical sides. We are familiar with most aspects of an agency and are not restricted to simply billing. Our team has experience working with staff from the service level up to the executive/board level and with a wide range of skill sets.

We feel it is important to know how each department of an agency works. We can’t help meet a mental health organizations needs if we don’t fully understand each spoke in the wheel. Often providers have an idea of how things should be handled which can actually be in conflict with what it takes to properly process their billing. We do a lot of educating with an organization before we take over their billing so everyone is on the same page. Understanding the different aspects of the agency as well as the solutions they use allows us to help them determine if there is something that may be beneficial that wasn’t on their radar.

What are the sizes of the agencies Triadic will work with?

Our staff supports agencies off all sizes. We have some individual providers just starting their own business and working part time to agencies that bill millions of dollars a month. The services provided by our clients are just as varied including support for all aspects under the Behavioral Health umbrella.

What are some problems your team has experienced on the financial side of EHR vendors?

The biggest struggle on the financial side is that some EHR vendors do not utilize staff with a financial background, specifically in Behavioral Health billing, in constructing their programs.  Many seem to start developing their system based on providers with a particular structure. When providers/agencies with a different structure try to utilize the system, it doesn’t work for them because it was’t really developed for the way they do business.

Another concern with some systems is the process it takes to handle adjustments and secondary billing. They are often cumbersome and sometimes too “techie” for someone doing billing to maneuver or for some systems, not in place at all and require action outside of the system.

What are the “gotchas” about providers when they pick their EHR systems and their billing companies?

Not understanding the technology and not including staff from each department in their review. Also, not expecting access to someone from the vendor’s staff from various departments. If you’re listening to a sales person tell you about the system, they are showing you the “bells & whistles”. They are often not a developer, financial person,  or even a clinical person so in most cases, they are not going to truly understand an agencies concerns and if the system can address them properly.

The other side of that is most providers don’t know what they need to even ask for. If you don’t know from a technical standpoint what is possible or don’t handle the day-to-day of a particular department, there may be abilities you need but aren’t even aware you’re missing.

We’ve onboarded multiple agencies that are coming to us with a horrible experience with their previous billing company. They have concerns, as they should, about changing billing companies because they worry about loss of revenue due to the switch. The reality is they are already losing revenue by staying with their current billing company.  If the right EHR and billing team are selected, there should be no lapse in your revenue and in fact, you should see it increasing rather quickly. Just as with the services your agency provides, you need the right team to make the agency efficient and successful.

triadicllcCindy Day – CEO

My professional career spans 20 years in positions that incorporate both my Finance and IT backgrounds. Having supported most departments in various organizations, as well as having an end user and programmer/analyst background, I am able to work with both internal and external customers of all levels and with various technical backgrounds.

Utilizing my knowledge in project management, staff management, analysis, training and revenue cycle management, I have assisted agencies in increasing efficiency and productivity while also reducing expenses. I have also used my skills to research, test, implement and train on multiple software packages, including EHRs/EMRs.

The goal of my team is to advise those we work with in a professional manner and provide them with the most productive working environment. We strive to not only assist with current operations within an organization, but to also help to improve them.

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