Medical billing is a complicated procedure, one that will typically require expert assistance. When we get into substance abuse billing, though, you get into even more specific challenges, even for people who are experts in medical coding and billing. Substance abuse billing is an area in which facilities are prone to having payments delayed and revenue lost. Because of how many challenges there are in this domain, a lot of facilities are shutting their doors. So what challenges are giving facilities so much trouble. These are the substance abuse billing challenges that medical facilities need to handle.
Increased Claim Denials
When treating patients with histories of substance abuse, every solution is going to be different. Because of this, substance abuse billing cannot be done in the same manner for every patient, and billing can sometimes be done incorrectly as a result. Improper billing leads to an increased rate of claim denials, so it’s important for facilities to be careful and use the correct billing procedures for every client they have.
Increased Patient Responsibility
A lot of payers will have policies in place that state that substance abuse is not a condition, but instead a choice because the patient is not born with the condition like in other cases, such as with mental health disorders. This means patients getting treatment for substance abuse won’t get the same quality of reimbursement as other patients. The patients are the ones who are burdened with carrying financial responsibility for any treatment they may need.
No Billing Expert
Like we said before, medical billing is complicated enough, but when it comes to substance abuse billing, that complexity is taken to a whole other level. There’s a good chance that facilities that perform substance abuse billing in-house aren’t bringing in as much revenue as they could be getting. Even facilities with highly experienced billing staff could find difficulties improving their reimbursements.
There are many codes for ICD-10 that have to do with substance abuse treatment. If you’re going to be a pro on substance abuse billing, you first have to understand all of the ICD-10 billing codes. The problem is that there are many of these codes, and understandably, this can be quite overwhelming for pretty much any medical facility. Without the necessary information on all of the codes involved in substance abuse billing, a medical billing coder won’t be able to help too much in this domain.
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