Substance abuse billing, private pay collections, correct and streamlined coding were done no favors under the new Affordable Care Act passed into law recently by President Obama.

The ACA has established 10 essential benefits that must be included in every plan.  Millions of more people will have access to health Insurance that did not previously and this is a good thing.  However nothing was done to address the complex problem of streamlining the billing process.  Here are some Roadblocks that will continue to exist:

Roadblock 1: Getting out of pocket payment – deductible/co-pay/co-insurance.

Although many more people will have access to quality health insurance, they still may not be able to afford their large deductibles or co-pays.  This may seem as simple as a conversation with your potential client’s family on assistance.  The problem is, even if they have insurance, they may not have the financial ability to afford the upfront costs in order for the benefits to kick in.  We all want to help whenever we can, but because just covering the upfront costs is not an option, you have to help find another way of payment.

If possible, you want to collect as much as you think is needed in order for the health insurance benefit to be used.  You and your team are going to want to explain to Families very clearly what additional fees or ancillary costs may come up during their stay.  Many of our treatment facilities have systems in place to set up payment plans if up front payment is not possible.  This is one way to help collect on all charges that are not covered by insurance.

Roadblock 2: You are at the mercy of the benefits of the insurance policy – how to deal with limitations.

You know that not all insurance plans are created equally – especially in the very grey area of mental health and substance abuse coverage.  The first step in addressing this issue is to fully understand how your clients insurance coverage works – knowing what exactly is covered and what isn’t.  This will allow you to see opportunities in the benefits for billing, as well as areas to avoid.  Because so much of the financial health your treatment facility depends on the ability to maximize the benefits of your clients insurance plans, its important to be as diligent and detailed as possible when fighting for their cause.

Bottom line: have a well rounded understanding of each clients benefits, work with your billing company in order to maximize every last benefit.

Roadblock 3: The ever dreaded pre-authorization – it doesn’t have to be!

“Pre-authorization” and “pre-certification” refer to the process by which a patient is pre-approved for coverage of a specific medical procedure, service/program, or prescription drug. In order to pre-approve such a drug or service, the insurance company will generally require that the patient’s doctor or therapist submit notes and/or lab results documenting the patient’s condition and treatment history.

This pre-auth required used to be a bit scary because a treatment facility needed to do the assessment on-site before knowing whether or not the insurance carrier would pay for treatment.  This would cause many heartaches and denial of services if not done correctly and communicated quickly.

By understanding the pre-authorization process and spending the amount of time necessary to do them correctly and up to the insurance carriers standards, you can avoid this roadblock.

Roadblock 4: Keeping up with the changes within the insurance billing industry – coding, billing, and collections.

It is hard enough to keep up with the most current changes in your own behavioral health industry, trying to do the same for insurance billing is just impossible.  Having an open line of communication with your substance abuse billing company and asking questions is a great way to get around this roadblock.  Allow the research and education to be done on your behalf by a team of people that are trained in this area.  By outsourcing your insurance billing and collections you can keep your focus on what matters – the care and recovery success of your patients.

Roadblock 5: Keeping your staff on top of the ball.

An overwhelmed staff is a normal occurrence in any industry, but can be especially detrimental to a treatment facility in the healthcare arena.  You know your team is solid and does its best to stay in tune with their patients, stay on top of their reporting and note taking, and be mindful of the program as a whole.  With increased case loads across the board, it easy to understand your staff getting overwhelmed and missing key details that are needed to get the most out of your insurance billing revenue.

There is not an easy fix to entire staffs being over loaded with work.  At any treatment facility there are ebbs and flows of both patient census and employee moral.  Keeping ahead of this issue requires open communication between all staff and executive management, a healthy and experienced team, and a solid understanding from each member to know when they are approaching a dangerous level of stress.