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Medical Billing for Drug Treatment Centers

Posted on Nov 20, 2018 by Jim Peake


Insurance providers have been changing and evolving their claim distributions and the way they look at addiction treatment claim payouts since the beginning.  Part of the reason is to limit fraud of course but the other reason is that it is a complicated process of checks and balances and mistakes can be costly and when providers can deny a claim for any reason they will, they do and they want to for sure, as most insurance companies are Wall Street funded.

Why do drug rehab claims have such low reimbursements?

Drug and alcohol addiction treatment centers are constantly battling insurance companies for reimbursements, good billing practices spend sometimes 2 hours three times a week for just one claim that is pending most billing practices abandon pending claims and that is what hurts the medical practice, abandoned claims 9 times out of 10 get denials due to the insurance provider needing more info and never receiving that info.  Accounts receivables if left unattended for even the shortest periods of time can get out of control fast and even a couple hundred thousand dollars that sits in collections status can put a well-established practice out of business.  For example, most practices rely on workflow to stay consistent and efficient, if one person is put on leave of absence or let go without proper replacement the workflow capacity changes and the stress from that is felt organization wide even though the executives do not feel it right away does not mean it is not happening.  For instance, some providers pay to the patient directly, without having a few experts on the phone with these folks on a regular basis can cost the practice thousands if not hundreds of thousands per year. Usually the call handlers or outreach departments are the first to be replaced by budgeting practices.

The industry as a whole is a bit archaic when compared to thriving practices that have to constantly gauge workflow performance and budgeting. Finance directives are constantly instituted by larger medical practices, why? Well for one reason most hospitals operate primarily based on Medicare and Medicaid clientele. Without lean and mean system management, those hospitals would be out of business long ago so they have adopted best practices in organizational awareness and delivery.

How about revenue cycles and revenue cycle management?

Does your practice see usual and customer payouts on claims in regards to time of entry to time of received? This is also why practices feel they are getting low payouts, because they are always behind the curve of the operating cash pendulum. Once a sophisticated billing group gets behind the practice a few immediate things should happen:

  1. The practice should be informed of any and all automation inefficiencies and any and all automation software that can be implemented to help assist workflow and remove bottlenecks.
  2. Appropriate and apply best practices to all the treatment facilities current utilization review and verification of benefits departments if they currently do that in house.
  3. Schedule checks and balances documentation to avoid error and remove as much of the human elements as possible
  4. Schedule a call to go over current A/R and EOB data to get Rev Cycle up to date
  5. Review integration for EMR and Physician input procedure guidelines
  6. Set up EFT with all carriers

If this is not being done, never has been done, and sounds scary this is great news for us however bad news unfortunately for your practice yesterday, but also good news for you today! Schedule a free no commitment workflow discovery call with us to find out how mistakes can cost millions and documentation can get it all back and some.

If you are tired of getting the short end of the stick from the insurance companies call us and let us show you how you can compete with the larger operators in the billing addiction treatment space.


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