The Unsung Hero of Recovery: Unveiling Cassandra Bangaru’s Role at LESC

Many heroes work behind the scenes at LESC, ensuring our clients can focus on their recovery journey. One such person is Cassandra Bangaru, our Director of Revenue Cycle. While Cassandra might not directly interact with clients, her work is vital to maximizing revenue that goes towards providing services for the clients.

As the Director of Revenue Cycle, Cassandra oversees the complex world of medical billing, particularly for Medicaid, Managed Care, and Medicare. Her team handles everything from insurance verification, medical coding, claim submission, and revenue collection. This ensures a smooth billing process and allows LESC to maximize revenue, ultimately supporting our mission to provide quality treatment.

Building a Successful Billing Process

Cassandra emphasizes several key factors for a successful billing process that ensures maximum revenue collection and operational efficiency:

• Verification and Eligibility: LESC’s stringent verification processes guarantee that each patient has active insurance coverage. 
• Precise Medical Coding: The team’s expertise in assigning accurate medical codes for diagnoses, procedures, and modifiers is paramount. These codes not only facilitate smooth billing but also provide insurance companies with clear information about the services rendered, reducing claim rejection rates.
• Charge Entry: Accurately entering charges for services provided into the system eliminates billing discrepancies and supports transparent financial transactions between LESC and insurance providers.
• Clean Claims Submission: Leveraging electronic claims submission, LESC ensures that claims sent to insurance companies are error-free and comply with regulatory standards, expediting reimbursement processes and reducing payment delays.
• Collections and Reporting: With a dedicated team monitoring open claims and engaging with insurance companies when necessary, Cassandra oversees a seamless collections process. Regular reports enable her to track the entire revenue cycle, identify trends, and implement strategies for continuous improvement in billing practices and revenue optimization.

The Challenge of Managed Care

While the billing process might seem straightforward, working with Managed Care companies adds another layer of complexity. She explains, “We always hear managed care is in the business of not paying. So the challenge that we have is submitting a claim that will be sometimes denied for no reason. The solution is staying on top of the claim submission process and follow-up because our job is to maximize revenue and constantly optimize our collection.” Cassandra highlights some key challenges:

• Reaching the Right People: It can be difficult to contact someone who can answer and resolve issues quickly with Managed Care companies. Phone calls can last over 30 minutes without resolution.
• Restricted Plans: Even when clients are limited to receiving care at LESC through a Managed Care plan, getting reimbursed can be challenging.
• Integration Issues: Insurance company systems may not be well-integrated, leading to outdated eligibility information and incorrect claim denials.

Despite these obstacles, Cassandra and her team maintain a diligent approach to ensure claims are submitted accurately, and payments are received using:

• Pre-billing Checks: Before submitting claims, the team runs reports to identify any missing information or errors, like missing diagnoses, incorrect insurance details, or invalid codes.
• Constant Monitoring: The billing team actively monitors all open claims and ensures they are assigned to the correct insurance plan for processing.
• Customizable Reports: LESC utilizes various reports generated by our Electronic Health Record (EHR) system to assess staff productivity, utilization, and revenue collection. These reports allow for continuous improvement and efficient claim processing.

Payment Options at LESC to Help Cover the Cost of Recovery Treatment

Starting a journey toward addiction recovery can be daunting, especially when concerns about paying for treatment arise. Cassandra emphasizes, “To be able to sustain what we’ve been able to do for over 60 years at LESC, it is more than being the bread and butter in the community; it’s the sense of warmth, the sense of a home away from home. And the biggest part of it is the service that we provide as an agency to our community and the clients that we serve. We need to continue making recovery treatment accessible to everyone.” 

Cassandra shares valuable insights into the various options available to cover treatment costs at LESC. 

• Insurance Coverage: LESC accepts Medicaid, Medicaid managed care, and Medicare plans. We work with seven major Medicaid managed care plans, including Fidelis, Healthfirst, MetroPlus, Emblem, Health Plus Amerigroup, Wellcare VNS, and Medicaid.
• Managed Care Company Arrangements: LESC works with Managed Care Companies to facilitate payment arrangements for services provided. This involves navigating reimbursement processes, negotiating favorable terms, and ensuring services align with coverage guidelines.
• Out-of-Pocket Payments: For clients who may not have insurance coverage or access to financial assistance programs, LESC accommodates out-of-pocket payments. They work with clients to establish transparent billing practices and offer options for managing payment responsibilities.
• Third-Party Payer Assistance: Sometimes, clients may access third-party payer assistance programs or employer-sponsored benefits that can contribute to recovery treatment costs. LESC assists clients in exploring these options and coordinating payments accordingly.

Beyond initial payment arrangements, LESC provides ongoing support and advocacy to ensure clients can sustain their treatment without financial burdens hindering their progress. 

The Secret Ingredient to Success: A Dedicated Team

Cassandra emphasizes that LESC’s impressive 95% collection rate for the last fiscal year wouldn’t have been possible without her dedicated billing and Accounts Receivable (AR) staff. Their hard work and commitment ensure smooth billing operations and allow LESC to focus on providing the best possible care for our clients.

By working diligently behind the scenes, Cassandra and her team play a crucial role in making recovery accessible at LESC. They are the unsung heroes who ensure financial barriers don’t stand in the way of healing.