What is a VOB? 

A VOB, or a Verification of Benefits is a process by which the insurance benefits are checked for a potential incoming client at a substance abuse or mental health facility. This process entails making sure their health insurance is active, the payments are up to date, finding out the deductible and out of pocket max, as well as a variety of other questions.

This process can either be done by someone in-house at a facility or it is often times done by the outside billing company.

Why are VOBs so important? 

Verifying benefits for an incoming patient is crucial. By checking all of the information needed a facility will do its best at limiting any surprises when it comes to a patient’s insurance coverage, or more importantly what it won’t cover. In addition, because the billing cycle is typically a week behind, if a VOB is not done properly there is a chance a patient will be in your care without valid benefits and as a facility you won’t receive any financial compensation. VOBs are also often times used when it comes to payment appeals. If an insurance company comes back and says something isn’t covered, the biller can refer back to the VOB and use that as proof that payment should be given.

Most important factors of doing a VOB: 

1. The right form asking the right questions 

You can’t do a proper VOB without having the right questions to ask. Often times insurance companies aren’t always the most forthcoming with information so it’s imperative to make sure you’re armed with the right questions.This is important because often times different insurance companies have different stipulations, variations, and needs for each policy.  That means each VOB form should have the correct questions for each of insurance company. Asking all the right questions will also help identify any red flag policies that could potentially slip through the cracks. For example, every VOB form needs to include the insurance representative’s name and reference number for the call – if that isn’t noted it will be near impossible to appeal a claim later on. Ideally, the VOB call is recorded to refer to if necessary during claim follow up or the appeal process.

2. Accuracy

 Once you have the right questions to ask, the next step is to make sure everything is collected carefully and accurately. The information collected through a VOB is used by each facility to determine if a patient is going to be a good fit for their program. If the information collected is inaccurate, it doesn’t equip the facility to make the correct decision. In addition, as mentioned earlier in this post, VOBs are often referred back to and if the information is inaccurate this can affect every stage of the billing cycle.

3. Timeliness 

The behavioral health space can often times deals with immediate crises. Calls come in at all hours from patients needing help. This makes it all the more important that a VOB be done in a timely manner as to not miss the window of opportunity to have a patient come in. There is always going to be variation depending on hold times but most VOBs can be done within 60 minutes during a normal business day.

4. Having the right data set to refer to 

Once all of the information has been collected accurately and in a timely manner the final factor in determining whether or not an insurance policy is a good fit for a facility is the right data to compare it to. Even with all the right questions asked and information obtained, it can still be hard to determine how well a policy will pay. However, if you have a comprehensive data set  to see how the same policy has already performed within a facility you’ll be able to make a much more informed decision. The bigger the data set you have to refer to, the less likely you are to run into a policy you’ve never seen that could end up not paying well. This is one of the benefits of using an outside billing company, they typically have a much broader scope when it comes to policy data.

By this time, the COVID-19 pandemic has affected almost every industry in this country, the behavioral health space included – however, this industry is rightly still considered essential and so as a behavioral health billing company, we are still operating full steam ahead for our facilities while practicing safe social distancing with our employees. We wanted to take some time to share some of our observations, insights and updates from CA Billing and the industry at large. 

• Moving into Q2: We’ve hit April so the first quarter is over! Historically this means insurance reimbursements should begin picking up as deductibles and out of pocket maxes have been hit. 
• Admissions still coming in: People are still seeking help for substance abuse and mental health. At CA Billing we are still running a lot of Verification of Benefits and seeing admissions come through, so even in the face of this pandemic behavioral health facilities are still providing care and services to clients.  
• Telehealth for social distancing: Insurance companies are encouraging facilities to utilize telehealth to help stop spread this virus. The good news is that once this is set up, the reimbursements and claim processing timeframe are the same for traditional services. If you need assistance setting up telehealth, please reach out to us we’re happy to help. 
• Strategic In-Network Contracts: As a facility have you thought about going in-network with any providers? We wanted to go through some of the benefits of being in-network: 

• • Consistency:  As an in-network facility you are guaranteed reimbursement rates for each level of care. This means as a business you are better able to project your income coming in and make more definite plans for your business.
  • Easier Claims Process: As an in-network facility your claims will be processed faster with less processing issues. Also a smaller number of claims will get denied so there will be less claim follow up.

CA Billing helps our facilities strategize which insurance carriers make sense to develop an in-network contract with. Based on your location, services you provide, and your marketing we can help you determine what makes the most sense for your business. 

If you have any questions about your billing, whether you are one of our facilities or not please feel free to reach out. Also, we have some exciting new data tools coming out in the next several months for the facilities we work with and we can’t wait to share. 

There comes a time for every behavioral health facility to decide whether it makes sense to build an in-house billing team or hire an outside company. There’s no one size fits all answer for every company but there are some advantages of hiring an outside billing company to keep in mind when making your decision.

• Specialized in the behavioral health industry: Hiring an outside billing company can ensure that the people doing your billing will be more specialized in your industry. There are huge differences between different kinds of medical specialties and especially in something as intricate and specialized as behavioral health, there are a lot of benefits in going with an outside company. In addition when it comes to audits from insurance companies, outside billing companies typically have the resources and experience to effectively deal with the carriers to rectify the audit. Here at CA Billing we’ve been able to identify a client is in an audit when they weren’t even aware of it. If payments drop significantly or stop altogether, many in-house biller’s are not able to diagnose the root cause and we’re able to pinpoint the issue and get reimbursements back on track in a timely manner.
• Bigger data set to see trends: One of the biggest advantages going with an outside billing company is their unique capabilities to see trends across different insurance providers. When you have an in-house billing department, you’re only really able to see what’s going on with the patients/clients you have currently in your care. While a lot of behavioral health facilities are feeling or experiencing decreases in reimbursement, our clients are seeing increases due to the extensive data we’re able to leverage benefiting all clients we work with. Combining this data set with our expertise and experience in the industry allows us to stay ahead of trends.
• Better ability to provide information on verification of benefits based on our data: As an independent billing company we see a very broad range of policies every month,  not just a couple dozen from one facility. This along with our data-driven approach gives us the pulse on what policies are doing and what they are paying. While most facilities and billing departments are able to give a somewhat educated guess on whether or not to take a certain policy, we are able to provide detailed estimated reimbursements on what the policy will pay, giving our clients the best information to make well-informed decisions for their business.

So, do the benefits of hiring an outside billing company outweigh the cost?

• You will have to hire someone anyway to do your in-house billing
• With the expertise of an outside billing you will typically far more than make up for the billing fee through higher reimbursement, audit management, expert appeal response- ensuring all avenues for reimbursement are pursued.
• Have a pro handling your billing will free up your time to focus on providing the highest quality level of care and building your brand.

While there are reasons to invest in building an in-house billing department, there are many advantages of hiring an outside company with expertise, experience, and a breadth of knowledge and data.