Insurance hasn’t always covered rehab and substance abuse treatments, but patients are benefiting greatly today since this is now not the case. However, just because treatments such as these are capable of being billed, they won’t necessarily get paid. If you’re going to receive payment, you first must file a claim like with any other type of medical procedure. If the claim form has any mistakes, your payment will be denied. These kinds of mistakes can happen any time in the field of medical billing, but there are also aspects of billing and coding that pertain exclusively to substance abuse. Here are some of the mistakes that can happen in substance abuse billing.
Authorizations
Medication-Assisted Treatment (MAT) is when providers use of medications, along with counseling and behavioral therapies, to provide treatment of substance use disorders. In order to be paid by most insurance companies for these services, prior authorizations must be completed and approved.
Pay to Patient Checks May be a Problem
In certain situations, rather than sending reimbursement to providers directly, insurers may issue payments to patients for services. What will typically occur in this situation is that the provider doesn’t get their reimbursement.
You’ll want to communicate effectively with patients when this problem arises. Your patients have to sign an agreement before they get treatment, and this agreement will make them promise to use whatever money they get from the insurer for paying whatever charges the facility makes to them.
The billing staff for the provider must understand which insurance companies will make their payments to the client directly. This way, the billing staff will know to get agreements from those patients, stating that reimbursement payments have to be sent to the facility.
Not Billing the Right Insurer
It’s important that you bill the correct insurance company, and while this may seem simple enough, it can sometimes be a little more challenging to decipher the identity of whichever company requires billing. In some instances, such as the state Medicaid, behavioral health is billed to a different Administrator.
Procedure Codes Have to Match the Diagnosis Codes
All diagnoses have approved procedures that go with them, and claims can be denied whenever treatments are distributed without providing the right diagnosis code. This is because insurers won’t think that it will be “medically necessary”.
Coders must understand that all diagnoses have at least one accepted treatment, and they should understand which treatments are acceptable in each situation. If no sufficient match is available, providers are better off receiving clarification before any claim gets submitted.
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