Substance abuse billing companies are playing a pivotal role in the addiction treatment industry helping those seeking drug and alcohol addiction treatment. Substance abuse billing companies are also helping drug rehab owners increase revenue with specialized knowledge in the drug and alcohol addiction treatment billing industry.
Substance Abuse Billing Companies Understand How the Insurance Companies Operate
An experienced Substance Abuse Billing company is an essential weapon in your arsenal when seeking reimbursement for claims for addiction treatment services. Are you submitting claims with incorrect modifiers, incorrect CPT codes or outdated HCPCS codes? Are you being reimbursed the maximum allowable amount on every claim? These are important questions you can confidently answer “yes” to when you’re working with an experienced Substance Abuse Billing company.
The prevalence of improper billing and inconsistent collection practices are increasingly common throughout the Substance Abuse Billing industry. Too often we see lost revenue because of unwillingness to investigate denials and/or rectify improper pricing because of a third-party administrator or insurance company error. Knowing exactly who to call and how to fix these errors is the difference between and experienced and inexperienced Substance Abuse Biller.
What the guarantor can expect financially when a loved one is receiving treatment for a Substance Abuse Disorder or Mental Illness
As a guarantor responsible for the financial end of Substance Abuse or Mental Health treatment, there can sometimes be a cash bill left over after insurance pays their portion. This is commonly referred to as the “Patient Responsibility”. The worst-case scenario would be assuming the liability for unpaid claims resulting from Substance Abuse Billing and/or Collections errors. While the practice of balance billing patients may be unlawful under the No Surprises Act in states like Texas, other states may not offer these protections to patients seeking Substance Abuse Disorder or Mental Health Treatment. As a patient, it is very important for you to know your rights when receiving treatment to avoid unnecessary financial liability.
The Application of Experienced Substance Abuse Treatment Billing and Collections
The struggle to find a Substance Abuse Disorder or Mental Health Treatment facility can be exhausting for patients and their families. Both the clinical and medical capacity of the facility to properly treat the patient’s Substance Abuse and/or Mental Health should always be the paramount concern. Unfortunately, limitations dictated by the insurance plan’s coverage can play a role in finding a Substance Abuse Disorder or Mental Health Treatment facility if private funds are unavailable for treatment.
The Verification of Benefits performed at the request a Substance Abuse Disorder or Mental Health Treatment facility is the key indicator of insurance coverage limitations as well as a patient’s financial responsibility. Typically, Insurance Companies will recommend an In-Network Provider to ease both the financial burden for the patient as well as the Insurance Company. Inexperienced Substance Abuse Billing companies can fall victim to a misquote of benefits, potentially leaving a patient with a large financial responsibility if the patient’s plan lacks proper coverage.
Finding the Right Solution for the Patient
Once a patient finds the appropriate provider or facility to render Substance Abuse Disorder or Mental Health Treatment, an Intake Assessment is performed to address the underlying reasons for coming to treatment. This information is provided to a Utilization Review team that is responsible for advocating the patient’s medical necessity for treatment to the insurance company. This process, also known as Prior Authorization, is essential for the services to be pre-approved for reimbursement by the insurance company. This process also determines the length of stay, which is also affected based on the patient’s progress in treatment. In some cases, daily assessments can even be required to authorize further coverage.
An experienced Substance Abuse Billing company thoroughly understands this process and, in most cases, develops a professional relationship with Utilization Review teams at most major Insurance Companies. Advocating for a patient’s treatment services requires a strong understanding of each insurance company’s criteria for Medical Necessity, which in some cases can be more onerous than even state regulations for Substance Abuse and/or Mental Health treatment! While the patient’s treatment plan is dictated by the attending provider at the Substance Abuse Disorder or Mental Health Treatment facility, a claim denial may arise if claims lacking Prior Authorization are denied by the insurance company. When this happens, it is essential that an experienced Substance Abuse Billing company understands the intricate process of appealing a denied claim. Understanding the appeals process can be the difference between a patient assuming financial liability for unpaid claims or being covered by their insurance carrier.