Substance Abuse Medical Billing

Creating a Process for Accurate Records and Reimbursements

As a rehab owner or senior staffer, you may already know that substance abuse medical billing can be a complex and challenging task for treatment centers. Ensuring that your substance abuse treatment centers receive appropriate reimbursement is vital for their continued success.

Unfortunately, even the simplest mistakes can be a detriment to your substance abuse billing process, resulting in the loss of countless amounts of revenue.

In the following article, we cover the specifics of the substance abuse billing procedure, steps you can take to optimize your workflow, and how the right service can help avoid major revenue losses. Keep reading to get all the details with our latest support resource for rehab ownership from Ads Up Marketing!

Understanding Substance Abuse Billing & the Cost of Errors

For your staff, it can be easy to dismiss an error or two when it comes to substance abuse billing. This might be the case – but the problem is – compounding multiple “simple errors” can and does lead to jaw-dropping losses in the addiction treatment space and medical industry as a whole.

Just how much do billing errors cost healthcare providers each year?

Consider the following statistics:

• The United States healthcare system loses a whopping $935 million per week because of medical billing discrepancies.
• Over 65% of adults have encountered some form of medical billing error at some point in their lives.
• 25% of billing errors are due to simple typos.
• Averaging the total cost of losses and errors, each mistake during the medical billing process costs around $100.
• It’s estimated that nearly 80% of medical bills from all industries combined have errors.

To be fair, these statistics are compiled from the United States healthcare industry as a whole. Granted, a large majority of this data comes from hospitals and other major facilities. However, the substance abuse treatment industry is a significant niche when it comes to health services.

Rest assured, the impact of medical billing errors in the rehab industry is enormous. Just how much is your organization losing on errors that take place during your medical billing process?

And that’s just the tip of the iceberg – we’re also talking about the reputation of your organization. Errors in medical billing not only impact the well-being of your clients and bottom line but can affect the overall perception of trustworthiness around a rehab brand itself.

The True Cost to Your Clients and Your Reputation

Data can’t measure the true cost of billing errors to your clients and the reputation of your behavioral health facility. It’s easy to underestimate the impact of a simple billing error – until it costs someone life-saving treatment.

Let’s say – for example – a client that has a severe alcohol addiction requires inpatient detox and certain medication to help them avoid life-threatening withdrawals. Because of an error during the authorization process, they’re denied. They don’t have the money to pay out of pocket.

What happens if they’re sent home and have a potentially fatal episode as a result of an error or oversight? Even more – the family pursues this issue and you’re either found liable in a worst-case scenario or receive negative press exposure at the very least. At the minimum, this costs you and your facility money and reputation.

Understanding the intricacies of the billing workflow for substance abuse centers is critical for owners and program directors. We created an example workflow in the next section as a general reference to the billing process.

The Medical Billing Workflow In the Rehab Industry

The medical billing process in the substance abuse treatment industry consists of several critical steps. The workflow looks something like this:

1. Client Registration
2. Establishing financial responsibility for the insurance company
3. Client rehab check-in
4. Client rehab check-out
5. Scanning for coding and billing compliance
6. Preparing and sending the claim
7. Monitor payer adjudication
8. Generate the bill for the client
9. Follow up on client payment
10. Handle any potential collections

Now, consider the fact that each of these steps is broken down by another set of designated steps, coupled with the fact that adherence to compliance is of the utmost importance – and it leaves a lot of room for error.

There are several major areas of concern when it comes to drug and alcohol addiction treatment centers and the billing process. Understanding these areas and how to approach them is key to receiving compensation.

Areas of Importance for Rehab Treatment Facility Medical Billing

Medical Billing Services and Coding

Coding claims properly as a rehab facility is one of the most intricate portions of medical billing in the substance abuse industry. All services rendered have a code attached to them that allows the payer to identify the exact procedure or services the client received.

Everything must be itemized and listed correctly to ensure the insurance provider receives accurate information with regard to each client’s stint at your facility.

Some of the codes attached to the substance abuse treatment industry include:

• 90853: Code for group psychotherapy or talk session involving a number of different clients during addiction treatment.
• 90846: Family therapy that takes place without the client involved.
• 90847: Family therapy that takes place with the client involved.
• 99408: Alcohol or drug use screening and intervention services.
• 99409: Alcohol or drug use screening and intervention services in the primary care setting.

The list goes on and on. Think about the number of services a client may potentially receive at any given number of treatment centers – and there’s an equal amount of codes that go with them.

Verification of Benefits and Preauthorization

Before initiating treatment, verifying your client’s benefits is a crucial step. This entails confirming the specific level of coverage allotted by their insurance company.

Obtaining preauthorization from the insurance company ensures that the treatment will be covered, minimizing the risk of denied claims.

Changing Regulations

The landscape of healthcare laws and insurance regulations is constantly evolving, especially in the field of substance abuse. Billing staff must stay informed about new coding, insurance credentialing and billing practices to accurately navigate this volatile environment.

In the following section, we outline actionable steps you can take to optimize the billing process for your treatment facility. When combined with the right billing service, using these tips can lead to a significant decrease in errors and lost revenue.

How Can I Optimize My Medical Billing Process? 3 Proven Strategies

Incorporating a uniform standard for your billing process is vital to minimize errors, ensure compliance, and optimize revenue. Consider the following practices:

1) Understand Your Costs

Optimizing your billing process also entails deploying an effective strategy for pricing your services. This requires intricate knowledge of unit of care costs and profit margins during certain operating times. For example – when you’re operating at 50% capacity, it doesn’t cost nearly the same as it does when you’re running at maximum capacity.

Learning how to take these things into account can help you develop an efficient strategy for billing – which starts with setting your prices. Many drug rehabilitation centers fail to take this into account.

2) Perform Regular Audits

You fail to correct 100% of the mistakes you don’t catch. This is what makes auditing so important. It’s impossible to catch and correct EVERY error made – that’s just the cost of doing business.

However – you can avoid substantial losses by conducting audits throughout the year and at each phase of the billing cycle. This is also an invaluable service that billing specialists provide for treatment centers.

3) Clear and Effective Communication

Maintaining clear and constant communication with insurance payers is vital. By understanding policies, staying updated on any changes, and addressing recurring issues with claims, providers can develop a more efficient billing process.

Effective communication helps in resolving claim denials and preventing future discrepancies. Remember – every payer is different, so keep track of each company individually.

Get Rehab Consultant Support for Substance Abuse Billing

At Ads Up Marketing, we have decades of experience in the substance abuse recovery industry, including the administrative side of things, and as rehab consultants at every level of operations. We offer a comprehensive medical billing service that provides a range of different offerings based on the needs and size of your facility. This is just a small example of the services we provide:

• Verification of client benefits
• Collections
• Reimbursement notifications
• Billing and coding
• and more

Our client list includes facilities of all sizes, from the smallest of private rehabs to the largest, multi-location industry giants. We’re confident we can put together a tailor-made strategy plan that satisfies all of your medical billing needs, helping you avoid denials and other hang-ups. For more information, contact us today!