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.
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 clinic, 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 Substance Abuse Billing
Continuous industry changes, new payer rules, declining reimbursements, 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.
MedicalBillersandCoders (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, payments posting, denials handling, accounts receivable follow-up, credentialing, and enrollment. To know more about our substance abuse billing services, contact us at email@example.com / 888-357-3226.