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Importance of Quality Substance Abuse Treatment Billing


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Revenue cycle management is more complex when it comes to billing for substance abuse treatment, which causes many centers to lose money and even close down over the loss of payments. In fact, medical billing for behavioral health treatment has proven to be more complex than ever. Insurance companies have changed their requirements for billing these services, making it difficult to monitor normal revenue cycle processes. Substance abuse billing companies who are familiar with the changing requirements to be in-network with insurance companies can help maintain an even flow on the revenue cycle. Thus, keeping treatment centers from losing money. 

Problems With Most Substance Abuse Billing Companies

Substance abuse treatment is much less expensive than other alternatives, such as jail. With methadone treatment averaging $6,552 compared to $24,000 per year to be incarcerated, insurance companies are continually making processing claims more difficult. The problem with most substance abuse billing companies, however, includes stringent credentialing processes that allow providers to be in-network and allow for more responsibility on the insurance companies instead of the patients.

With doctors losing $125 billion of revenue a year, problems with most substance abuse billing companies are submitting claims that meet the ever-changing requirements from insurance companies. Insurance companies make it difficult to find correct eligibility for these services and if the providers are in-network and properly credentialed so that claim submission can flow smoothly. Additionally, electronic health record systems for behavioral health billing have difficulty keeping up with upgrade services to meet the changing requirements. Denial rates are also much higher because of coding changes and the changes in credentialing systems. Utilizing a billing company that specializes in substance abuse and mental health billing can increase your revenue as they are well aware of the changing guidelines. 

Why Choosing the Right Substance Abuse Billing Company is Important

Choosing the right substance abuse billing company is important because experience with the changing guidelines is of utmost importance in keeping the revenue cycle moving consistently and with a timely flow. A behavioral health billing company with strong credentialing skills and an understanding of the revenue cycle can thwart the normal problems billing departments have. Insurance companies have a timely guideline allowing only for a certain number of days, usually 90-120, for claims to be processed before they will not pay the claims due to timely filing. 

Important Factors

The following are important factors when it comes to revenue cycle protocols:

  • Registration: having knowledge of insurance effective dates, subscriber info, coverage details for treatment, and if the providers are in-network for reimbursement from the insurance companies.
  • Correct Coding: charge capture and knowledge of CPT and ICD10 guidelines for charging substance abuse treatment is a must.
  • Timely filing of claims: getting claims out the door as quickly as possible to keep processing time at a minimum and no chance of denials for timely filing.
  • Denial and Appeal Management: having a team who has experience and knowledge in keeping the AR low by knowing the rules for billing allows for quick action on correction of coding errors, specific insurance company guidelines, and what forms or notes are required for denials and appeals.
  • Communication with patients: finding help for patients who may qualify for Medicaid or Medicare and working out payment plans ahead of time can reduce $0 reimbursement.

At the end of treatment for the patient, it should be known what the patient responsibility is, and plans for payment of that balance need to be made while the patient is at hand. Maintaining the correct demographics to be able to bill the patient and communicate with them is crucial. This is why choosing the right billing company is imperative. Experience in facing the billing requirements and knowing what to expect from insurance companies can increase revenue by making the revenue cycle work for them. 

What to Look For in a Billing Company

What to look for in deciding on a substance abuse billing company is a simple determinant, referrals. Asking for referrals can give a glimpse into how much revenue is being captured by the billing company and how they are managing the revenue cycle for other providers and treatment centers. Contacting a billing consultant who has successful substance abuse billing companies in their contacts is a great way to find reputable companies. 

Coding certifications and experience in medical billing can prove that the billers involved have been effectively trained. Most electronic health records have reports that can be utilized in proving denial rates and what issues have been addressed with their previous billing activities. Strong credentialing departments are especially needed for billing to be sure providers and centers are credentialed with all insurances that may possibly be used by patients. Authorizations may be required if providers are out of network so finding a billing company with an authorization specialist is also important. 

Substance Abuse Billing Companies in South Florida

If you are looking for a substance abuse billing company or a company with substance abuse billing experience, our consultants can help you find a perfect fit for your needs. Billing companies with excellent experience and reputations can be difficult to find. Contact us and speak with our professional consultants, so your facility can find the billing assistance you need.