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