Medical billing on its own can be a complex process, requiring specific expertise. However, substance abuse billing comes with unique challenges even for certified billing and coding experts. Substance abuse billing is one of the major areas with which drug and alcohol addiction treatment centers struggle resulting in lost revenue and delayed payments.
Many drug rehabilitation centers and behavioral health organizations are closing their doors due to rapidly changing industry laws, regulations, and payer reimbursement policies.
Substance abuse services are provided by: Physicians (medical doctors or doctors of osteopathy); Clinical psychologists; Clinical social workers; Nurse practitioners; Clinical nurse specialists; Physician assistants; and, Certified nurse-midwives.
These substance abuse treatment providers are finding it increasingly difficult to get reimbursements from payers. Let us look at some unique Challenges of Substance Abuse Billing.
Unique Challenges of Substance Abuse Billing
- More claim denials: Drug rehabilitation treatment centers across the United States are struggling with reimbursement issues as more claims are getting denied. Rehabilitation centers are dealing with cash flow issues as there is an increase in the denial rate of reimbursements. Treatments for patients with only substance abuse issues and those with substance abuse and mental health problems can never be alike. Hence, their billing cannot be done in the same manner either. It is critically important for healthcare service providers to bill their patients appropriately.
- More patient responsibility: Most payers have policies that consider substance abuse as a choice rather than a condition. Whereas mental disorder is something, the patient develops or is born with i.e., they are not at fault. So naturally, mental health patients get better reimbursements than patients of substance abuse. Substance abuse patients have to bear the burden of financial responsibility for the treatment.
- Lack of billing expert: As mentioned earlier, medical billing is a complex process and substance abuse billing takes it to next level. Treatment centers and behavioral health organizations that handle billing and collections in-house are almost assuredly leaving money on the table. Even if you have a person with years of substance abuse treatment center billing experience, you could struggle to improve reimbursements. Drug and alcohol addiction treatment centers are typically leaving 20-30% of their earned revenue unearned.
- ICD-10 codes: ICD-10 has thousands of billing codes pertaining to substance abuse and behavioral health treatment. Having great command over ICD-10 billing codes is a prerequisite to being successful. substance abuse billing ICD-10 has hundreds of billing codes concerning behavioral healthcare, including substance abuse treatment, and, at times, they can be overwhelming. From medically supervised outpatient withdrawal to chemical dependency for youth outpatient clinics, the list can seem endless at times Absent a thorough knowledge of the detailed substance abuse billing codes and procedures, a medical billing coder is, at best, ineffective and at worst, of little value. Costly errors can and will occur, all at your expense.
Outsource your Medical Billing
With continuous industry changes, new payer rules, declining reimbursements, and tighter margins; the stakes are high, making oversight and accountability crucial. Stop looking back at the end of the month and wondering what happened to your cash flow. Your team of substance abuse billing and coding professionals has a lot on their plates.
By outsourcing your substance abuse billing, you can reduce your practice’s overhead costs, increase reimbursements, and decrease claim denials and rejections. This can enable a practice like yours to be more proactive, to focus more on your patients’ receiving the proper quality care, rather than spending hours on constructing and interpreting the billing reports.
Medical Billers and Coders (MBC) is a leading billing company providing substance abuse billing services. We can help you to guide through the various processes to lower your denials, improve cash flow and help you meet all your financial goals.
Our substance abuse billing services include coding, charge entry, payment posting, denials handling, accounts receivable follow-up, credentialing, and enrollment. To know more about our substance abuse billing services, contact us at info@medicalbillersandcoders.com / 888-357-3226.
FAQs:
1. What unique challenges do treatment centers face with substance abuse billing?
Substance abuse billing often encounters high claim denial rates, more patient financial responsibility, and the complexity of using specific ICD-10 codes, making it difficult to secure reimbursements.
2. Why are claim denials more common in substance abuse treatment?
Many payers view substance abuse as a choice, leading to stricter reimbursement policies compared to mental health disorders, which can result in higher denial rates for treatment claims.
3. How does patient financial responsibility differ for substance abuse services?
Patients seeking substance abuse treatment often face greater financial burdens because insurers typically cover mental health disorders more comprehensively, leaving substance abuse patients with higher out-of-pocket costs.
4. What role does ICD-10 play in substance abuse billing?
ICD-10 includes numerous codes specific to substance abuse and behavioral health, requiring thorough knowledge to avoid costly errors and ensure proper billing practices.
5. How can outsourcing billing help my substance abuse treatment center?
Outsourcing billing can reduce overhead costs, increase reimbursements, and minimize claim denials, allowing your practice to focus more on patient care rather than administrative tasks.
