Substance abuse billing is a common problem area for many addiction recovery practices across the country. Insurance claims and self pay options are complicated and industry specific. While every provider wishes to dedicate their time and energy to offering quality patient care, they often fail to optimize and streamline their billing processes. Claim denials, billing issues, and disorganized admin teams impact your facility’s revenue stream.

A streamlined billing solution plays an extremely valuable role in helping addiction recovery practices continue offering care to those who depend on it. When administrative workflows are not properly established or maintained revenue and client care (your number one priority) ends up suffering in the end. Learn about common substance abuse billing issues that providers deal with and easy solutions that can help you succeed. 

The Evolution of Patient Insurance Coverage for Treatment

Until recently, there was a huge gap in coverage for patients seeking out substance abuse services. This made actually engaging with providers extremely difficult and discouraging. With each added cost and the bills piling up, a lack of coverage can deter clients from actually getting the help they need. 

The good news is that insurance providers are covering substance abuse services now more than in years past. Society now understands that people need help and assistance to get out of the hole that is addiction. 

An increase in coverage would be a great thing if providers knew how to optimize it. Unfortunately, many addiction recovery providers are lacking in their billing department, leaving clients and patients vulnerable to the high costs of treatment. 

Minimizing the risk that an individual will have to pay for services out-of-pocket is one of the reasons that substance abuse billing is so important and why providers should do everything they can to optimize it. Improving your substance abuse billing will increase approved claims and help the client worry less about the cost of services. Instead, they can focus entirely on their recovery. 

Common Substance Abuse Billing Problems

Many addiction recovery centers deal with some of the same billing issues. Below are some of the more common problems that providers deal with when it comes to substance abuse billing.

Coverage

Whether or not a patient has coverage plays a huge role in what they will have to pay for services. For patients who do have coverage, sometimes details fall through the cracks, causing them to have to pay more for services than they anticipated. 

These details might include a lapse in their coverage, prior authorization requirements, or other regulations within their plan that were overlooked. When a provider fails to catch these details before rendering services, problems with substance abuse billing arise. 

Denials

One of the most common reasons a patient might have to pay more for services than anticipated is that their claim was denied by their insurance company. While a claim can sometimes be denied due to a coverage issue, this is not the most common reason. 

Most claims are denied due to an error in CPT codes for substance abuse billing. When a claim is coded incorrectly, that claim will get denied by the insurance company. This problem lies on the end of the provider, who coded the claim and submitted it. Providers need to perform their due diligence to ensure their claims are always coded correctly. 

If a claim is coded accurately and a claim still gets denied, providers need to have a quality denial management system in place. This will help your team take yet another step toward optimizing substance abuse billing. 

Lost Revenue

When a claim is denied, patient payments are written off, and other details go unnoticed, this results in lost revenue. Lost revenue is any income that a provider does not collect on or slips through their fingers. While providers may think they can afford to let a few dollars slip here and there, lost revenue is actually quite dangerous to an addiction recovery center. 

A few dollars here and there can quickly transition into thousands of dollars lost each year. When this happens, providers risk their bottom-line plummeting and put their practice at risk.

Coding

As mentioned earlier, errors in CPT codes are the most common reason for a denied claim. CPT codes are notorious for being complicated and difficult to keep up with. They are constantly changing, and every provider is responsible for keeping their billing staff trained and up to date on those changes. 

Having a full and comprehensive understanding of CPT codes for substance abuse billing is essential to decreasing denials, increasing clean claims, and maximizing your revenue. 

Technology & Substance Abuse Billing

Providers everywhere are familiar with the role of technology in a number of different processes within their practice. When it comes to substance abuse billing, the role of technology is to enhance the billing process, make it easier for busy providers, and improve their revenue. If providers want to improve substance abuse billing within their organization, they need to adopt quality tools that can help them do so. The right billing solution will empower a provider to worry less about their billing and focus more of their energy on their clients/patients.

Solutions for Substance Abuse Billing

These solutions can enable a provider to optimize their substance abuse billing and streamline operational efficiency.

Billing Formats

Billing formatting tools help providers satisfy payer requirements. It enables them to generate standard and customized bills to satisfy payers and get paid on time, every time. The right vendor of substance abuse billing tools will offer special formats, rules, and revenue codes that meet specialty billing standards.

Prior Authorizations

For patients whose insurance requires prior authorization, quality substance abuse billing tools can keep track. For every patient, no matter the date, type of service, PCP, frequency of visits, state requirements, or insurance requirements, the right solution will keep track of all authorizations. This tool will also offer insight into why your claims are getting denied and the right steps to take to get them approved.

Charge Generation

A substance abuse billing tool worth using will make it easy for a provider to generate charges, code claims accurately, and move on to their next task. Providers can easily issue charges for any type of visit in a way that streamlines their workflow and simplifies each process. 

Transaction Reporting

Your billing solution should also empower your entire organization to optimize each workflow with ease. Transaction reporting is a feature designed to generate detailed and high-level reports on A/R transactions. This enables addiction recovery centers to easily make smarter business decisions and grow. 

A/R Trial Balance

When an account spends too much time in A/R, that is more time a provider risks losing valuable income. A substance abuse billing system worth using will offer detailed financial reports on A/R including aged receivables, credit balances, unbilled projects, and more.

Electronic Clearing House

A clearinghouse is a middleman between the provider and the insurance payer. This substance abuse billing tool enables a provider to automatically scrub each claim and assess it for errors. It allows you to track it through the system until it is paid. With this ability, substance abuse billers can submit more clean claims and receive more timely payments than ever before. 

Optimizing your substance abuse billing is key to helping patients get the care they need, growing as an organization, and worrying less about your bottom line. To learn more about Logik’s substance abuse billing solutions schedule a demo or call.