About The Client:
A fast-growing multi-state behavioral health provider contacted us not to resolve a billing issue, but with a growth problem that had taken root in the area of patient financial services.
Following a major merger and subsequent rapid expansion to cover five states, including Iowa, Minnesota, Missouri, North Dakota, and Wisconsin, their in-house PFS team was completely overwhelmed beyond its design capacity. Daily, around 150 patient billing calls arrived after business hours, each one going to voicemail, and all waiting until the following morning to be returned. They use Veradigm EHR to manage their clinical and administrative operations.
For a behavioral health patient contacting their provider with a balance query, a question about payment options, or a misunderstood statement, that overnight delay was more than an inconvenience; it was a failure to provide the stable, encouraging environment they require to continue with treatment. And the call volume continued to rise.
The Need for a Different Kind of Patient Financial Services Partner
Their leadership made one thing crystal clear up front: "We're not looking for another collection agency with a dialer and a standard response. Our patients are often in the middle of treatment, strained by expenses, and can easily lose months of trust if their financial inquiry is mishandled."
The legal framework was also unique to behavioral health services. Outstanding balances were never to impede medically necessary care. Each contact had to be dignified, supportive, and carefully documented. And that’s precisely where we were brought in.
Challenges:
Multiple Systemic Pressures Were Driving Patient Experience Risks
1. Limited Patient Access to Financial Support
Though patient need for support was primarily evening-based, support through the PFS closed at 4:00 PM. The call volume coming into the call center as the result of billing inquiries during evening hours was approximately 150 calls/day, all of which went into the voicemail.
Callbacks from missed calls also generated calls back, created queues and contributed to a negative patient experience at an institution where the continuity of care is a primary tenet.
2. Technology Transition Led to a Rise in Patient Confusion
As part of an attempt to improve upon issues identified with previous digital payment solutions the organization transitioned to Collectly.
Patient difficulties in acclimating to their new statement forms, payment processing, and the necessary logins were all factors that contributed to increased patient confusion regarding their bills. Evening closure always yielded the highest call volume related to payment status, questions on statement items and methods of payment.
3. Lack of EHR Specificity
The organization uses Veradigm EHR. In this system, patient account information, billing information and clinical information are so closely related that the successful patient support system could not consist of general CSR training.
The representative must be able to rapidly find and access current patient account information. Customer service roles have traditionally not been equipped to handle this functionality.
4. Complexity Deterred Internal Expansion
More staff were not enough to support operations in the evenings in five separate states and remain compliant with state specific care continuity standards.
It also required training for consistent communication guidelines, and in particular, specific guidelines for behavior health as well as a management team with the capacity to oversee all of this additional volume. The level of complexity associated with bringing these operations in-house and training employees was likely a barrier.
Solution:
We Built A Behavioral Health-Specific Patient Financial Services Operating Model
We didn’t propose a prepackaged solution. We looked at the specific pain points they were currently experiencing, and based on the four areas directly related to what breaks down regarding mental health and behavioral health PFS at scale, we began to build the framework from there.
After Hours PFS Support
We placed a team of US-based Patient Financial Representatives in after hours, the same time window that 150 calls daily were vanishing into the void. Training those agents with working knowledge of Veradigm EMR was essential-representatives could access patient accounts, pull balance information, check billing history, and give accurate answers without placing the patient on hold or arranging a callback.
These staff are not standard call center employees simply assigned to the healthcare sector. They are dedicated experts assigned based on the requirements of behavioral health and mental health PFS. They understand that a $150 balance on a statement could also hold substantial emotional weight for the caller.
Billing Inquiry Handling
We redesigned financial conversation execution for the behavioral and mental health patient population.
Before the first patient interaction, we developed a set of communication guidelines uniquely designed for behavioral health and mental health patients, not generalized from the general RCM playbook.
- How a payment option is offered without triggering patient anxiety.
- How a Collectly statement is explained to a patient who isn't familiar with it, or doesn't know what's changed from the last system.
- How a hardship situation is identified and correctly categorized.
- How to close a call, rather than pursue, leaving the patient with respect.
These aren't suggestions given to agents day one and forgotten about; they were practiced, reinforced, and evaluated in each patient interaction.
Early Stage Collections
We engaged with patient balances before they were able to age; since the balances, averaging $150, were relatively small, the core problem was the lack of timely communication.
BillingParadise implemented proactive patient outreach from the early stage of the payment cycle, engaging patients with a recent balance that was still fresh, simple, and easy to discuss.
Within Veradigm, we were tracking patient accounts and our communication efforts with a coordinated system that would not allow the patient to receive conflicting or duplicated communication; this is unlike what happens when a statement is ignored for 60 days. We were more successful in collections in the early stage because we engaged the patient before they had time to mentally check out of the process.
Patient Engagement
We ingrained compliance into each patient interaction: The continuity of care required for mental and behavioral health meant that financial conversations must be meticulously documented including hardship status, resolution and next steps, and any potential care access issues needing clinical involvement.
BillingParadise built documentation and tracking requirements directly into the Veradigm platform, instead of as an audit mechanism on top of daily operations. This ensured alignment with state compliance rules while maintaining a natural patient interaction.
The model was also built to grow and accommodate more call volume through defined escalation paths, standard operating procedures, and a staff model capable of expanding along with increased demand.
The Impact of a Smarter Patient Financial Services Strategy
Each patient-facing touch point was operated under communications standards specifically built for behavioral/mental health. No generic collections language; no pressure-framed messaging; no process that treated a mental health patient balance as equivalent to a commercial overage.
Because they operate natively within Veradigm, all responses are precise, all account data is current, and patients leave with no follow-up questions a PFS rep cannot answer at the very first interaction.
This model is holding and scaling. They aren’t reconstructing themselves. They are scaling within a framework we build to perform precisely this.
Key Outcomes
- 60% reduction in after-hours voicemail backlogs
- 40% faster response times for billing inquiries
- 25% increase in early-stage patient collections
- 100% alignment with behavioral-health communication standards
- Scalable multi-state PFS framework built for continued volume growth
What A Behavioral Health Practice Actually Requires from an PFS Partner
Over the years, we understood that Patient Financial Services (PFS) in behavioral health is different from that in other health areas and shouldn't be treated as a traditional revenue cycle function at all. It takes a specialized approach that, on one side, aims at financial performance and however empathizes with the patient, adheres to regulatory compliance, builds patient trust, etc.
To be successful, one must know the behavioral health patient very well, understand healthcare continuity, and have a well-thought integration with existing technology among other things. Besides this, every financial interaction should be as compassionate as the clinical experience.
Our whole approach was based on that strategy. We did not only extend call coverage to give patients the chance to reach a person. We touched their financial support deeply, which is why we created a patient financial services model that puts the patients first using prompt communication, courteous involvement, operational consistency, and sound financial results.
Because in behavioral health, every patient conversation matters, and financial services should reinforce the trust built inside the clinic, not undermine it.
