There was a time in years past when substance abuse billing was relatively easy.
In those days:
Claims usually went smoothly
VOBs felt straight-forward
Net days in A/R were decent
Denials and appeals were manageable
Then, Obamacare opened the doors to easier access to lifesaving addiction treatment for the average citizen. Great! If you’re anything like the rest of the addiction treatment community, you were overjoyed.
What happened next was, shall we say, not so great.
Insurance companies saw these new requirements to provide treatment as a threat to their bottom line. They responded to this threat by clamping down on substance abuse reimbursements, moderating their losses by making your addiction treatment center’s substance abuse billing issues as irritating, time-consuming, confusing and emotionally draining as possible.
That’s where we are now.
Here’s how to fix it.
Step #1: Realize That Substance Abuse Billing is Rigged
Sure, your addiction treatment billing team can always brush up on avoiding coding errors, improving billing efficiency, and shaving down net days in A/R. (And if you need to start at the beginning, that’s OK —check out our medical billing glossary for substance abuse.)
Regardless of training or background, no team—no matter how experienced—submits 100% clean claims 100% of the time. Mistakes are inevitable, especially as individual insurance requirements, government regulations and industry conditions continue to change.
Still, it’s important to recognize that the playing field for substance abuse billing is not a neutral arena.
To put it bluntly, the game is rigged.
Insurance companies have a lot to gain by limiting access to addiction treatment for the average consumer, maximizing patient responsibility and/or sticking your addiction treatment center with bad debt as you provide lifesaving services to patients who unexpectedly find that their treatment isn’t covered as adequately as they initially imagined.
In short, everyone loses—everyone except insurance companies, of course.
Step #2: Accept That Not Every Third Party Substance Abuse Billing Company is Trustworthy
If you’ve already abandoned in-house billing and are currently unhappy with your substance abuse billing company, you’re in good company.
If you’re thinking about outsourcing your substance abuse billing to a third party and you’re wondering who in this crowded space you can trust, you’re also in good company.
You’ll see a lot of firms offering substance abuse billing online. They claim to understand the business. They claim to understand billing. They claim that they can improve your bottom line and get you more reimbursements in less time, etc, etc, etc.
The truth is, too many of these “substance abuse billing companies” provide subpar service.
They’re either:
Healthcare billing generalists without specific expertise in the behavioral health space
Or
Addiction treatment marketing companies who also do billing services for some reason
If you’re looking at companies that fit into either of these categories, run.
Generalists will not understand the ins and outs of substance abuse billing and they will waste your time with errors, misunderstandings and ignorance surrounding the complexities of the job.
Addiction treatment marketers will talk a great game about their services, but think about it: Why are they offering this service? Is it because they know anything about medical billing? Is it because they know anything about substance abuse CPT codes or how to submit clean claims?
The answer to both of these questions is likely no.
They are offering this service because they saw an opportunity to make more money from the marketing clients they already have. That’s it.
Keep moving.
Step #3: Build Rock Solid Substance Abuse Billing Relationships With Insurers or Outsource to a Third Party Who Can
Substance abuse billing can feel incredibly impersonal.
You submit lifeless forms, filled with numbers and symbols, to a no-name recipient and wait for a robotic non-response in the form of VOBs, utilization reviews, denials or reimbursements. Maybe you put in a call to an insurance representative, but the call is all business, no-nonsense and usually completely unhelpful.
That’s the formula for 99% of the substance abuse billing interactions that go on today.
But what if there were a different way?
What if you were dealing with a human being, not a bureaucracy? What if you had an advocate at the insurance company that was dropping you little hints about how to play the game well so that you could win more of the time?
That’s the power of relationships. They can transform even the worst substance abuse billing experiences from nightmare to smooth sailing, quickly and easily.
The downside? Building relationships with folks at insurance companies is not only an art form, but it takes time. A lot of time.
Sure, your in-house team can accomplish this task if they have the tenancy, the fortitude and the right skillset. But do you want to take that gamble and put in the time and money to see if it works?
Or do you want to plug into a pre-existing substance abuse billing team filled with clinicians and utilization review specialists who have already put in the time and effort to cultivate those smooth sailing relationships for you?
At BehaveHealth, we work with clients who are ready to stop wasting time and start working with their dream substance abuse billing team NOW.
Ready to Learn More About BehaveHealth’s Substance Abuse Billing Service?
When you turn your billing over to us, you can rest easy knowing that you’ve chosen the best.
We get addiction treatment billing because it’s the only kind of billing we handle.
It’s what we do.
Ready to take a closer look at what we can do for your business?
Get your free trial started today and see why more addiction treatment centers prefer Behave Health.