How Accurate Insurance Billing Can Improve Patient Outcomes

Thinking of outsourcing the billing and financial aspects of your program?

You may be surprised to know that patients often associate your professional services with things completely removed from obtaining treatment for their addiction or mental health issues.


Does stress or anxiety play a role in seeking help?

Patients report that stress over the cost of services is often a deterrent to seeking help.

mental health billing

When your practice revolves around substance abuse and any presenting mental health issues, adding more emotional stress is counterproductive to obtaining desirable outcomes.


Problems with coding

With the advent of the far more detailed ICD-10 and CPT4 coding, onsite or captive practice  billing departments are often caught between rapid billing to stabilize cash flow and accurate billing to reduce error returns.

That certainly has consequences at the provider level, but perhaps more importantly it creates distrust and tension between providers and patients, as the following example shows.

One woman, who found some $4,200 worth of errors on her medical line items from an drug rehab facility stay after being treated for addiction from an opiates, says that she would have considered the amount of insurance reimbursements before seeking treatment at this particular place.

Now When her primary care provider suggests in-patient testing or a procedure on anything, she first gets at least one more opinion. Seeking the second opinion means weeks could pass before accepting the initial doctor recommendation.

In the meantime, she researches what the procedure or stay at a facility should cost so she can anticipate what her bill will be when her services are provided.


Deductibles and co-pays

Given the higher deductibles many people have these days, the deductible may be all that is charged for the service(s).

In short, her concerns prevent her from getting medical care within a prompt and effective time frame.

If treatment or testing proves unavoidable, she reports feeling tense, anxious and even angry because of the cost – and in her case, high probability of triggering a relapse.

This mentality certainly doesn’t improve her recovery outcomes.

With many patients now subject to deductibles and co-pays ranging in the thousands of dollars, they are more likely than ever to scrutinize their bills.


Mental Health Parity

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) strives to assure that private insurers meet certain criteria to maximize reimbursements for mental health providers.

Comprehensive accounts receivable management starts with accurate verification of benefits (VOB). Verification of Benefits is normally completed within one to two hours, based on the accuracy of information received.


Proper insurance billing practices

Accurate billing for residential substance abuse treatment can relieve your staff of some of the more unpleasant aspects of practice management.

problems with insurance billing

Prompt but accurate substance abuse billing maximizes reimbursement rates, but there will be times when patients fail to pay their share of the costs. It is very important that your staff isn’t the source of unpaid claims that increase the burden on patients and families.  

One of the most important factors affecting inpatient mental health reimbursement is the completion of a thorough intake history.

Identifying concurrent health issues can prevent insurance billing errors. If your practice includes medical as well as behavioral health and addiction recovery services, it is important to identify and separate those secondary and even tertiary diagnoses from one another.

For instance, a patient with substance abuse issues may also suffer from underlying depression as well as physical health issues resulting from addiction.

Incorrectly lumping all of these under one code fails to maximize billable revenue from insurance providers, may result in using up billable days allotted under the mental health guidelines, and may cause insurers to incorrectly reject claims.


Charting errors can be costly within insurance billing

Working across a wide variety of payment platforms, ranging from Medicare and Medicaid through various insurance carriers might generate many potential errors at the time the claim is submitted.

Another area of concern is found with charting errors arising from electronic medical records (EMR). Some of these commonly used in the behavioral health world include BestNotes, Accumed, HIPPAcrm, and others.

The advent of EMR was meant to provide continuity in patient histories, but it has also resulted in significant charting errors.

As noted in this Chris Dimick article available on the AHIMA website, copy and paste, aka “carry forward” charting errors can significantly impact both care and reimbursement outcomes.

While drug rehab insurance billing does not take the place of regularly scheduled chart audits, it may be easier for a detached third party to catch repetitive charting errors simply because they are not intimately involved in daily patient care.


Be diligent!!

To recap, accurate insurance billing and/or practice management removes some of the stressors that affect positive patient outcomes.
It also improves employee and staff morale, creating a positive experience all around.