BHB VALUE: Balancing Care and Capital: Leveraging Revenue Integrity in Behavioral Health Organizations

This article is sponsored by NextGen Healthcare. This article is based on a discussion with Sri Velamoor, President & COO at NextGen Healthcare and Javier Favela, VP of Integrated Care Solutions at NextGen Healthcare. This discussion took place in March 2024 during the BHB Value Conference.

Behavioral health organizations may recognize the value of a consistent electronic health record (EHR) partner, but working with an EHR can also carry challenges through the ups and downs of a health care business. When a care provider goes through an acquisition, for example, there may be multiple EHR systems to manage. All in the name of revenue integrity, it’s important for behavioral health organizations to pay attention to consistency of data, billing information and how they balance both capital and care.

Consolidating multiple clearinghouses


Being able to generate real-time key performance indicators can help providers make optimal decisions, but ideally this means having a single platform for information flow.

“The most successful groups that we work with have gone to one single practice management solution; one single clearinghouse,” says Javier Favela, VP of Integrated Care Solutions for NextGen Healthcare. “They’ve integrated their systems into one single system.”

NextGen has also found that creating Management Service Organizations (MSOs), or administrative entities to govern the complexity of practices, has also helped to organize information for behavioral health organizations.


“The centralized billing and some of the solutions take on a bigger import because they’re trying to use a single TIN for pre-negotiated rates with payers that they can then pass through into all the practices that they’re acquiring,” says Sri Velamoor, President & COO at NextGen Healthcare. “Everything from how you’re credentialing the providers to how you’re setting up the practices from a tax identification perspective to inherit the payer rates that you desire them to inherit becomes a big deal. The combination of both of those is a key part of where things are added.”

Billing, coding and financial status

NextGen, which has operated in the world of portals for many years, has found that focusing on patient engagement contributes to overall success in terms of data integrity.

“The relative sophistication of the tools as well as the amount of activation and education that you have to do for patients and their ability to consume these engagement capabilities is also relatively low [in our] experience,” says Velamoor. “A lot of the emphasis has been on simplifying what that engagement front-end looks like.”

NextGen advises activating and engaging patients by using the Quadruple aim:

  1. Reducing costs
  2. Reducing hospital readmission rates
  3. Reducing health disparities in communities
  4. Patient engagement should be the key strategy

3 ways the NextGen EHR supports clinical professionals

  1. Simplifying the use of these solutions and improving the usability for the clinicians
  2. Being able to take advantage of API access that’s now available to access different models
  3. Ambient assist: a phone records the entire visit, translates the recording and transmits it into the EHR platform

“We’re seeing clinicians save 45 minutes to an hour and a half of documentation time per day when they’re able to use these tools,” says Velamoor. “It’s early days, but we’re keeping an eye on how clinical quality is actually improving three and six months down the road.”

The importance of technology

Key performance indicators, or KPIs, are in the systems that these organizations use, allowing the clinician to focus solely on the patient and not worry about documenting what is being said. The more that is automated, the more often it results in the accuracy of financial reporting and key performance indicators.

In addition to supporting organizations through transitions, technology also makes the job of clinicians and administrators easier while increasing revenue integrity and efficiency. Users of the EHR can work with their technology partner to assess its impact across the organization:

  1. Ask: Did the encounter get captured and documented correctly?
  2. Ask: Are the diagnosis codes appropriately captured?
  3. Look at the reconciliation with the charge-master
  4. Transfer of charges from the electronic health record into the practice management system
  5. Integrate AI-assisted coding enhancement solutions that are available

Comparing two similar organizations that have different clinical processes may introduce a path to success using new technology. A few ways to overcome challenges of accessing the data you need for multiple revenue cycle solutions:

  • The path of least resistance: try to build one ring to rule them all
  • Finding good analytic solutions
  • Utilizing machine learning technology
  • Have a single point of communication for clients or a patient portal
  • Encouraging patients to show up – using simplified proactive communications via mobile, via text

“Every practice can come up with a three- or four-step process by which they can start to build trust with their consumers that they’re going to be there for them,” says Favela. “Once you hit a few of these wins, every one of these successful campaign completions creates an engaged patient who’s more willing to be there and to show up.”

NextGen Healthcare provides customized solutions to fit the exact needs of ambulatory practices. The solutions empower patients to take control of their health and enable clinicians to be more productive and engaged. To learn more, visit:

Companies featured in this article:

, ,