In Part 1 of this series, we covered how to get an addiction treatment center licensed in California, Arizona, Kentucky, Maine, North Dakota, Montana, Wisconsin, and West Virginia. Be sure to check out that post if you are looking for how to get your center’s launch off to the right start in those states.
“Playing nice” with insurance companies is one of your most important jobs as an addiction treatment provider. Organizations that master the art of interacting with insurance providers reap major rewards in terms of happy patients, strong revenue cycles, confident clinicians, and flawless documentation. Organizations that struggle with “insurance speak” grapple with angry patients, poor cash flow, unmet patient responsibility payments, and wary clinical staff.
With the opioid crisis still grinding along, now is a great time to open an addiction treatment center. But navigating the licensing requirements of each state is tricky—they are all different and each plays by its own rules. Because there are no federal guidelines for addiction treatment center licensure, every state’s regulatory body is unique.
Getting insurance companies to fairly reimburse for services rendered is one of the biggest struggles for many addiction treatment providers today. Between an initial verification of benefits, pre-authorizations, concurrent reviews, and even retrospective reviews, it’s easy to get lost in the insurance authorization labyrinth and spend a lot of your organization's time (and money!) fighting with insurance companies.
Biopsychosocials (or “BPS” for short) are often one of the first pieces of documentation addiction treatment counselors complete with their patients. Although busy clinicians might dread writing these lengthy and time consuming tomes on each client, the BPS is more than just a mandatory insurance form.
SOAP (Subjective, Objective, Assessment, and Plan) notes have been the cornerstone of medical documentation since Lawrence Reed introduced the “Problem Oriented Medical Record” in the 1950’s. Before the dawn of SOAP notes, medical practitioners of Reed’s time had no standardized method of record-keeping. Instead, each provider would scribble notes in their own fashion, making insurance reimbursement, coordinated care, and chart review difficult and time-consuming.
There’s a lot at stake when your organization decides to implement a new Electronic Health Record (EHR) system. Bringing a new EHR online is more than just an update of your record keeping process—it’s a huge cultural shift for your organization.
Patient portals—online dashboards where patients can access their EHR, view test results, review treatment plans, track referrals, and message their providers—have been around for years.
The adoption of patient portals in the addiction treatment industry was slow, but as more and more providers realize the benefits of these powerful patient engagement tools, patient portal adoption rates at addiction treatment centers and sober living homes are soaring.
We hear it from our clients all the time: treating patients for SUD is easy, but getting patients into treatment is hard.
For many of the providers we work with, filling beds and keeping them filled seems to be taking more and more staff time, slowly cutting into their businesses’ bottom line. That’s why we created BehaveHealth Bridge—a platform to help you connect with new clients.
The US government recently reported that millions of health records are breached every year. For behavioral health organizations, each breach translates into massive fines for violations of the Health Insurance Portability and Accountability Act (HIPAA) laws.
HIPAA fines, which range from $100 to $50,000 per record, can easily bankrupt an organization.
People in the behavioral health industry are usually passionate about helping others—but they’re not usually passionate about completing paperwork.
Very rarely do we hear our clients utter the words “I love medical billing!”
But the truth is, insurance billing is the lifeline of any behavioral health organization. Do it well, and your business has a chance to succeed. Do it poorly, and you definitely set yourself up for failure.
During an overdose epidemic so large that it is cutting overall life expectancy in the US, you’d think that insurance companies and the healthcare system would be bending over backwards to get people into evidence-based treatment—especially since we have two drugs that are proven to cut the death rate by at least half. In reality, they are doing the opposite. And the barriers they place in the way of treatment are killing people.
The newly enacted SUPPORT Act’s wide-ranging provisions take aim at the entire healthcare continuum, including providers, who will be on the front lines of change as the new law takes effect. The law includes amendments to Medicare and Medicaid, and changes affecting program integrity and transparency reporting of provider payments by drug and device manufacturers and the disposal of unused medication.
Accreditation is an important piece of the behavioral health industry puzzle. Treatment Centers should seek accreditation as soon as they can for many reasons. While most insurance payers don’t require Treatment Centers to be accredited, some payers have already made the shift to requiring accreditation before they will pay for the service rendered. Treatment Centers can choose accreditation at the state level through CARF. They can also opt to become accredited through JCAHO, which is accreditation at the national level.
…Last year, according to a preliminary estimate from the Centers for Disease Control and Prevention, 72,000 lives were lost to overdoses. That’s 197 people dying every day — more than enough to fill a Boeing 737 passenger jet. It’s an increase of more than 6 percent over 2016.
Let’s face it, denials may be the absolute worst thing to find in the mail, especially if you’ve just opened. It is discouraging and disheartening to find out you won’t be paid for someone’s treatment; even if it is only one date of service.
A verification of benefits is the first vital piece of admitting a patient to your facility. If they don’t have benefits for the treatment they receive, there will be no reimbursement. There are a number of things that can be found out on a verification call; information about patient responsibility, what services are covered, etc.
To be in-network or not to be? This is a question for which many behavioral healthcare facilities struggle to find an answer. There are so many things to consider before signing any contract, but it can be difficult to know what those things are. Ultimately, it comes down to the choice of the facility decision-makers, but there are a few things to consider during the process of making a decision.
PHP stands for Partial Hospitalization Program. This type of care is used most in the behavioral health industry for treatment of substance abuse issues. It is also utilized for patients with mental health disorders.
The term “Outpatient” in the behavioral health industry is frequently used. But, what exactly does it mean? Outpatient is sometimes used as a broad term to describe a specific license type. There are two types of licenses which are typically referred to in this industry; inpatient and outpatient.