Avoid Common Substance Abuse & Rehab Billing Mistakes You Should Avoid
Substance abuse and rehab billing treatment are now covered by insurers. It was not always the same. This addition brought benefits to patients and their communities. Yet the fact remains the same that is the treatment can be billed but this doesn’t mean they will get a payout.
No matter a rehab facility is incorporated with a private insurance company or a government payer, to get paid filing a claim is a must like it does for any medical procedure. Any error that pops up in claims, even the tiniest piece of misinformation will bring claim denials.
Misinformation and errors include entering an incorrect date or transposed digits, these small errors occur in all kinds of medical billing. Claims require maximum attention and require careful review at the end of the process to ensure no careless mistakes occur that can result in claim rejection or denial. Billers and coders need to have proper knowledge and experience in this field as there are aspects unique to substance and rehab.
Pay to Patient Checks Issue
In a number of cases where insurers send the payment for the medical treatment to the patient and not to the provider. In such scenarios, the provider often doesn’t get their reimbursement.
One of the solutions to manage these issues is by communicating with the patient upfront. There is an agreement signed before the treatment that the patient will pay the facility in the case when the payment is sent to the patient by the insurer. To avoid these in the first place, the billing staff must be aware of such insurance companies that make payments directly to the clients, this way the staff can make a point of speaking to the patient and sign an agreement that payment must be given to the facility.
The good news is that these cases are decreasing where insurers send payment to the clients. These cases showed that the sum that was allocated to the patients ends badly as they mostly are freshly treated and end up buying drugs and gets addicted again.
Rejection of Claims When the Wrong Insurer is billed
This is obvious that you should bill the right insurance company in order to get reimbursement, but identifying the right company isn’t as distinct as it seems. Sometimes a firm acquires another company while handling different operations in it and the name seems similar (slightly different).
Insurance companies have also created subsidiary companies that are meant to meet the requirements of several states that are under the Affordable Care Act. So the billers must have to insert the exact name of the insurer to the right contact information to submit claims and avoid rejection.
Procedure Codes & Diagnosis Codes
Every treatment has its procedures. Claims get denied in these cases when the claim is coded without using the correct diagnosis code, resulting in claim rejection. The main reason behind denials is that the insurers don’t consider the diagnosis as a medical necessity. Therefore, the coders must be aware of each diagnosis and its accepted treatments and have knowledge about what they are.
Loss of Revenue
Substance abuse and rehab facilities almost lost 25% of revenue because these facilities didn’t have any effective processes to collect their bills. Most of them are avoidable easily but the medical billing and coding is complex and can be challenging.
When a claim is rejected and comes back unpaid, the insurer is bound to provide a reason but these reasons are often vague. The biller in charge will need to review the claim, find errors and problems that occurred in denial and correct it, or provide necessary documentation or explanation in order to get the claim paid. This becomes daunting for in-house medical billers as they already are dealing with current bills and also have to manage unpaid claims which are very difficult causing the loss of millions of dollars every year.
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