Comprehensive care and therapy are necessary for substance abuse, alcoholism, and opiate addiction. Inpatient therapy, drug and alcohol detox, and effective residential treatment programs are provided by most drug and alcohol treatment centers based on an evaluation of the patient’s physical health and well-being. Medication, therapy, meditation, and other practices are examples of other alternatives to therapy. Teamwork and the incorporation of life skills are supported in most residential substance abuse programs.
Most standard health insurance policies will pay for addiction treatment in one form or another. Billing for behavioral medicine requires knowledge of benefits and eligibility verification, collections, and billing. Medical billing is more complicated in behavioral and mental health than in other fields, especially when it comes to substance misuse.
The kind of treatment that patients receive, the available coverage, and the rapidly changing laws and regulations in the industry are the main causes of this. Some plans cover medical detoxification, dual-diagnosis treatment, inpatient hospital detoxification, outpatient detoxification, inpatient rehabilitation, long-term residential treatment care, and aftercare counseling or therapy, while others do not. Substance use disorders are partially covered by both Medicare and Medicaid. Medicare B offers assistance with outpatient care, Medicare D covers prescription medications, and Medicare A covers inpatient treatments during a hospital stay.
According to Advanced Data Systems Corporation (ADSC), drug rehabilitation treatment centers in the United States are experiencing cash flow issues as denial rates increase, putting patients under growing financial strain. Typically, 20–30% of the revenue generated by addiction treatment centers is wasted. ADSC specifies the key performance indicators (KPIs) that treatment facilities should monitor in order to ensure consistency in collections:
Clean Claim Rates and Bill Charge Lag Times
Accounts Receivable-Aging (A/R) and Days Revenue Outstanding (DRO)·
A/R for 60/90 Days·
Tracking Denials
Remittance Metrics for Waterfall
Trending Revenue Actualization Percentage of Referrals
The duration of the therapy is one of the most significant factors that insurance companies consider. While some plans may cover the entire course of therapy, others will just cover a few days. Addiction therapy must be listed as a covered benefit in the patient’s health plan and covered by the patient’s specific insurance, according to the provider. In this case, insurance verification is required. In the past, mental health and general health care services did not include treatments for the prevention and treatment of substance use disorders.
Most claims are denied because the patient is either disqualified for the services or their information does not match that of the insurance.
Other common grounds for denials of mental health claims include:
Not filling out the prior authorization form before receiving treatment
Errors in the documentation, such as missing encounter notes or timesheets.
Inaccurate coding or inappropriate use of medical codes
Common policy infractions when paying for mental and behavioral health services
Common policy violations when paying for mental and behavioral health services
Not taking timely progress notes
Reputable companies provide medical billing services for behavioral medicine, including insurance authorizations and verification, which help medical practices avoid late payments and claim denials. In actuality, businesses listed among the top home care In Delaware, billing services frequently set the bar for effective, dependable, and legal billing procedures, particularly when it comes to mental health and drug addiction treatment. Their knowledge lowers the financial risks for healthcare providers by guaranteeing that all eligibility verification and invoicing is completed accurately and on time.
ICD-10 contains thousands of billing codes pertaining to mental health therapy and substance abuse.
Best Practices for Billing in Behavioral and Mental Health
Whether you are billing yourself or hiring a medical billing and coding company, be sure the medical billers and coders are adequately trained on the latest standards to ensure clean claims. Coders should be familiar with the most recent ICD, CPT, and HCPCS codes for behavioral and mental health conditions. To get payment for all levels of care delivered, behavior and mental health facilities need to have a reliable insurance verification system in place.
The following are some recommended practices to consider:
Obtain as much information as you can from the patient, such as addresses, social security numbers, insurance type, and alternate phone numbers, before contacting an insurance provider.
On the Date of Service (DOS), always verify eligibility and benefits for new patients, hospital admissions and follow-ups.
Regularly check filed claims to identify and address any issues with denials before the deadline.
Make sure you fully understand how to apply the new Health Behavior Assessment and Intervention (HBAI) Current Procedural Terminology (CPT) Codes when invoicing for mental health treatments.
Have a strong prior authorization team to ensure that all benefit verification is finished well before the patient’s appointment visit.
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Experienced medical billing firms provide trained coders, insurance verification specialists and behavior and mental health billers. Also, many providers are investing in medical eligibility verification software, which allows their staff to verify medical eligibility swiftly and avoid payment issues.
