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Centralize billing and consolidate multiple clearinghouses  

Behavioral health organizations, especially for-profit or private equity-backed organizations experiencing acquisitions, face challenges when consolidating multiple electronic health record (EHR) systems. Critical problems can manifest on the revenue cycle side in regard to maintaining integrity, i.e., ensuring a patient is accurately billed and the organization is reimbursed appropriately. In the substance use disorder sector, where state-specific rules complicate processes like methadone dispensing and billing, the most effective organizations consolidate their operations. Organizations that make moves to adopt a single, robust practice management system and clearinghouse, integrating all claims and financial rules into one cohesive system, can experience successful financial, operational, and clinical outcomes.

Manage your business and bottom line with KPIs

Effective revenue cycle management requires real-time tracking of key performance indicators (KPIs), which is difficult without automated systems. Automating billing processes, such as waterfall billing and service code selection, ensure efficiency and compliance, and allow for better visibility. Removing the burden of manual code selection and memorizing complex codes from clinicians with technology can streamline the billing process.

AI-assisted coding enhancements and automated charge transfers from EHRs to practice management systems prevent errors and optimize revenue. Moreover, advanced algorithms can analyze historical data to predict and prevent claim denials, supporting administrators in maintaining revenue integrity from the start. Look for tools that can predict the likelihood of a denial happening before the claim ever goes out the door, assisting administrators right from the get-go, greatly improving the accuracy of financial reporting.

Enhance patient engagement with a robust practice management platform

The pivot towards digital front doors is crucial for enhancing patient engagement. Federally qualified health centers and community behavioral health organizations need to simplify their engagement tools to better meet patient needs, especially in communities with lower digital literacy. The goal is to provide a user-friendly, text-based interface that allows patients to access care services with a single click, without the need for smartphones or complex logins. This approach aims to provide a seamless platform that supports patients in their communities.

The ideal solution is a comprehensive, mobile-first platform that streamlines authentication and provides easy access to scheduling, registration, and payments. Simplified communication between physicians and ongoing support from care providers are essential for maintaining care regimens post-discharge.

Activate and engage patients to show up
High-acuity behavioral health patients—often with co-morbid conditions—SMI patients, and those with co-occurring substance use disorders, require targeted engagement strategies. Effective patient engagement involves education, care coordination, and support through the healthcare ecosystem. For organizations balancing value-based care and fee-for-service models, a robust patient engagement and risk management strategy is vital for success.

Simplified, proactive communication via mobile or text is a great starting point. Additionally, doing what you say, and saying what you do, is essential, i.e., increasing the accuracy of your scheduling process and streamlining operations to deliver on that promise. Just those two initiatives start to create enough trust in the patient to engage with you and participate in the clinic.


Meet NextGen Ambient Assist, your new AI ally that generates a structured SOAP note in seconds from listening to the natural patient/provider conversation.

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Javier Favela
Vice President of Integrated Care Solutions
Javier Favela is Vice President of Integrated Care Solutions at NextGen Healthcare. He is an industry leader that provides integrated healthcare technology solutions to meet the needs of the behavioral and integrated healthcare community. Javier brings over 20 years of accounting and executive leadership specializing in the healthcare and healthcare information technology field. He offers extensiv...