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Medical Billing Services and Insurance Claims for Drug Rehabs 2020-06-23T20:46:51+00:00

Medical Billing Services and Insurance Claims for Drug Rehabs

The medical claims in relation to drug rehabilitation services differ, in most cases, to other types of medical claims. Great improvements to widen the coverage available for members in need of substance abuse and addiction treatment were implemented as a component of the Affordable Care Act, in 2010. The specific coverage a health insurance company must provide to its members remain ununiformed, as it depends on type of health insurance as well as plan selected by the member. The insurance provider and precise plan will specify what explicitly will be covered in relation to substance abuse and addiction treatment. 

Types of Drug Rehab and Cost

There are several different types of substance abuse and addiction treatment programs available in the US. The most common types available include residential rehab programs, outpatient rehab programs, partial hospitalization, and detox programs (including both inpatient and outpatient options). According to the National Institute on Drug Abuse, there are over fourteen thousand, five hundred specialized treatment facilities for drug addiction in the US. It is important to bear in mind that although there are a plethora of addiction programs available, not all health plans provide coverage for every facility and/ or program. 

Substance abuse and addiction treatment programs can be quite costly. There is, however, a significant range regarding potential costs and fees, and is specific to each program. Some programs work with insurance companies and accept insurance as a form of payment (provided the plan allows), while others do not accept any type of insurance. For medical billing and insurance purposes, addiction treatment typically falls under the mental health treatment category. Understanding the nuances that exist in the mental health and addiction treatment category is vital. 

Insurance Claims

Having proper and efficient medical billing practices in place is essential when it comes to obtaining prompt payments from insurance companies with regard to filing substance abuse, addiction, and drug rehab medical claims. Insurance providers vary when it comes to the precise types of rehab treatment they will cover, the monetary allotment for rehab program coverage, as well as the length of time/ duration of treatment they are willing to cover. Hence, it is crucial for a medical billing specialist to ensure proper verification of benefits as well as file claims with proper coding. 

Additionally, it is important to inform a potential patient, prior to commencing his or her admissions process, of his or her out of pocket financial responsibility in regards to the substance abuse and addiction treatment services that may be rendered. Verifying one’s insurance status and needed documentation to assure coverage can be helpful in properly providing a potential client with this information. If there is any confusion regarding coverage, it is important to advise the patient to contact his or her insurance provider for clarification. Regardless of how a patient pays for his or her treatment, it is imperative for a drug rehab program to obtain payment for services rendered. In order to sustain proper financial health of any substance abuse and/ or addiction treatment program, timely, accurate, and correct payment must be received. This is most effectively done with the help of a medical billing specialist.  

Further Information

As insurance regulations change, it is imperative that companies understand how each change can affect their practice, in all aspects. Insurance companies are notorious for offering excuses and utilizing loopholes to avoid paying providers what they owe. Accreditations such as CARF and JCAHO are now a common requirement for insurance companies to render payment. These certifications alert the public that a company has been adequately inspected and is considered reputable, meeting the accreditations high standards. The accreditation process can be arduous, requiring a significant amount of time and energy. Our staff offers diverse skills that enable Oracle Billing and Services, Inc. to assist in areas ranging from CARF-Accreditation, Verification of Insurance benefits, Insurance Collection Calls, Drug/Alcohol state licensing, JCAHO-Certification and more. Oracle Billing and Services has extensive experience in assisting companies in the health industry, in understanding the ever-changing regulations as well as providing expert consultation for all areas of operations.

Further Reading

Help Resolving Claim Disputes for Medical Billing

Finding a Medical Billing Company For Your Practice

Medical Billing for Rehabs

Ensuring Privacy in Medical Billing

The Cost of In-House Medical Billing vs. an Outside Agency

Starting a Treatment Center