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.  

Some denials are unavoidable.  Denying claims is one tactic payers use to delay payment.  Sometimes they process claims incorrectly by mistake and other times, they randomly deny claims or request additional information to delay the process.  Insurance company’s claim denial tactics have been all over the news. 60 Minutes even did a segment called Denied.  It is a nationwide problem.

The cold, hard truth, though, is that most denials can be avoided on the front end.  Yes, I said avoided. Most denials can be avoided by billing properly on the front end.  Behavioral Health billing can be a complex maze of CPT codes, revenue codes and different claim forms.  It can be difficult to establish billing practices that are correct according to the insurance company, which is why it is important to have a billing company who is experienced in this specific field.

Another thing to remember is that what works for some payers, doesn’t necessarily work for all payers.  There is really no “industry standard” when it comes to behavioral billing and, oftentimes, facilities and providers find themselves stuck in a purgatory of denied claims and medical records requests.

Some requests are random and are to be expected.  If you are receiving multiple requests from the same payer for the same type of service, it’s advisable to take a look at front-end billing practices.  If they are valid records requests, simply follow the instructions on the request to submit the records and the waiting game begins.

Receiving a valid denial isn’t always the end of the road.  While there are some denial types that can’t be appealed, most of them can be appealed and overturned.  The process of appealing a denied claim can be time-consuming and tedious. Having an experienced billing company to advocate on your behalf will save you time and time is money, as they say.

Get your free trial started today and see why more addiction treatment centers prefer Behave Health.