Getting Paid and Treating Substance Use

Darrin Hanna, Ph.D.

January 24, 2014

Insurance

• Private Insurance – Accepted by 85% of facilities with a primary focus on

MH services– Accepted by 82% of facilities offering general health

care– Accepted by 78% of facilities offering a mix of mental

health and substance abuse treatment services– Accepted by only 56% of facilities primarily focused

on substance abuse treatment services

Acceptance of Private Health Insurance in Substance Abuse Treatment Facilities

Insurance

• Effect on Adolescents– Facilities that accepted private health

insurance are more likely than those that did not to accept adolescents into treatment (58 vs. 33 percent)

– Ability to get paid for services has been a hurdle for early intervention for treating adolescents

Acceptance of Private Health Insurance in Substance Abuse Treatment Facilities

Affordable Care Act

• Substance abuse treatment will also become part of primary care– focused more on prevention– considered an “essential service”

• health plans are required to provide it

• coverage of substance use disorders is likely to be similar to that of other chronic illnesses

Billing Best Practices

Billing Best Practices - Eligibility

• Transitional time– Eligibility

• Increase claims paid• Ensure sending claims to correct insurer

• Clearing house services and software– Check eligibility for specific service and

timeframe– Check census eligibility

NextStep Solutions, Inc. – Headquarters in Rochester, MI

Billing Best Practices – Claims Scrubbing

• Automatic, smart billing software– Generates claims from services with correct

modifiers – Scrubs claims and “red flags” claims that are

likely to be rejected• Eligibility• Authorizations• Service provider issues• Diagnosis inconsistencies

ACA - EHR

• Comply with billing requirements– Service notes– Service limits/caps

• Submit claims quickly and get paid faster and on more claims

Hand-write on the form

Info is sent digitally

Costs

• Inexpensive solutions

• Convenient – Web-based

• High Value– Consider the cost of not using tools for

streamlining, automating, and eligibility checking

Thank you