Case Study: How Pathways Recovery Centers Improved Financials and the Impact on Patient Care

For Drew LaBoon, Director of Operations for Pathways Recovery Centers, financial sustainability is personal. As someone who is in recovery, he knows the importance of timely care in addiction treatment.  

“We were working with a third-party billing provider unable to immediately run verification of benefits (VOB), often telling us we’d get the information by the end of the day,” said LaBoon. “We don’t have until the end of the day for our patients – it’s a matter of life and death. We need real-time benefits verification so we can treat the patient ASAP.”

With this lag in VOBs, combined with claims delays and a need to better align with strategic growth initiatives, Pathways Recovery Centers made the decision to bring its billing in-house. 

“We’re always going to prioritize lives over dollars but when I saw how much we were losing due to simple mistakes, I took that personally,” continued LaBoon. “Lack of revenue negatively affects our ability to provide care for patients. We needed help in preventing these gaps in reimbursement so we started looking for a solution that provides better alignment between our financials and patient care.”

Finding the right billing partner

After uncovering that one facility lost $270,000 over 90 days due to claims and billing mistakes, LaBoon took swift action in September of 2023 and enlisted Kipu Health’s help.

A Kipu EMR customer since 2017, it was a natural fit for LaBoon to turn to Kipu’s revenue cycle solutions. With Kipu’s support, Pathways Recovery Centers were able to take billing in-house with a model that combined hiring Utilization Review (UR) and claims experts with Kipu’s software including a comprehensive Management Center that handles all aspects of eligibility and benefit verification, UR management tools, claims management automation and patient payment collection capabilities, among other services.  

Transitioning to an in-house utilization review process at Pathways Recovery Centers has been a positive strategic move. It’s allowed for customization that aligns with the center’s unique approach to care, enhanced collaboration, improved administrative efficiency, strengthened payer relationships, led to improved client outcomes and satisfaction. Specifically, by centralizing billing with Kipu’s solutions, Pathways Recovery Centers experienced:

• Saved $10,000 per month, while increasing monthly revenue by $65,000 at just one facility
• Time consuming insurance peer reviews went from 3 days to 7 days, allowing for more time spent caring for clients, and less time spent talking to insurance.
• “We’re early in this billing transition so I look forward to even more positive results down the road,” said LaBoon. “However, I can’t quantify or put a price on the benefits we’ve experienced by peace of mind. That’s worth everything.”

A positive outlook ahead

According to LaBoon, it’s not only patients who win with improved financials, employees benefit as well. “This transition not only positively impacts patient care and our bottom line; advancing our billing processes also improves the daily lives of our employees,” concluded LaBoon. “Our people come first and if we want our staff to provide patient-centric treatment, we need to provide them with the tools and resources they need to succeed. We’re doing that with our new billing processes and our business results speak for themselves.”

About Pathways Recovery Centers

Pathways Recovery Centers offer welcoming campus environments and comprehensive clinical care. Our intensive, trauma-informed treatment can support the needs of individuals at every stage of their recovery, including:

• 24/7 Medically Monitored Inpatient Detox, Partial Hospitalization Program
• Alcohol & Drug Rehab, Intensive Outpatient
• Mental Health Rehab, Outpatient Treatment
• Dual Diagnosis Rehab, MAT (Medication-Assisted Treatment)
• Residential Inpatient Treatment
• Private Sobriety Coaching
• Cutting Edge AI/Technology enhanced biometrics feedback systems

About Kipu Health

Kipu is the leading enterprise software provider delivering Electronic Medical Records (EMR), Customer Relationship Management (CRM) and Revenue Cycle Management (RCM) solutions that serve the behavioral health industry. The KipuEMR, a HITRUST certified platform, is a fully configurable electronic health record and integrated billing platform that is the largest and most widely implemented EMR purpose-built for the addiction treatment industry. Used by more than 80,000 users at more than 1,600 facilities, globally, Kipu’s cloud-based platform manages the entire patient life cycle from the very first call through admission, treatment, follow-up and billing. To read the latest news on Kipu, please visit https://www.kipuhealth.com/kipu-news/ and connect with us on: Facebook | Twitter | LinkedIn.

About the Authors

Dean Fitch serves as the Principal at Kipu Health and is the Co-Founder of Avea by Kipu.