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Revenue Cycle Management 1 ensure accurate and efficient payment services 2 minimize denied claims Improve revenue collection

What is Revenue Cycle Management?

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According to RevenueXL, Revenue Cycle Management (RCM) is a financial process used by healthcare practices to maximize the total patient service revenue generated by the practice as quickly as possible. This is achieved by managing and optimizing all the administrative and clinical functions contained in the revenue cycle. The RCM services for your facility will ensure accuracy and a results-oriented approach. The primary goals are to ensure accurate and efficient payment for healthcare services, minimize denied claims, and improve revenue collection. When your claims are handled accurately, and the bills are paid in full and on time, we have maximized your revenue and cash flow.

Solving Your RCM Issues

Do you need help identifying missing information and confirming insurance details before patient visits? Integrity Billing addresses these variables to minimize the likelihood of claim hold-ups.

Integrity makes informed, data-driven decisions to improve documentation and coding quality. Our comprehensive suite of RCM services is customized for each client. Integrity’s experienced team of experts serves as an extension of your business office, providing a specialized approach tailored to your needs.

We will study your performance benchmarking, root cause analysis, predictive analytics, and review operational improvements in a timely manner. We provide you with the insightful data that will help you understand your revenue cycle performance more clearly. We will identify underpaid claims and work towards recovering lost revenue. You will notice that we aggressively follow-up on unpaid claims. Once your facility begins working with Integrity, you will see a decrease in claim errors and denials.

Enhanced Compliance

RCM helps medical practices like yours stay compliant with the numerous healthcare regulations. This reduces the risk of financial penalties and legal issues. Integrity understands the importance of protecting your behavioral health or mental health facility and your patients’ data. We wholeheartedly comply with every regulation to ensure compliance.

Your Reporting Package

Integrity provides you with a standard package of monthly reports that cover various aspects of your facility’s performance. These comprehensive reports include both high-level summaries and itemized details on charges, payments, and aging receivables. By analyzing these reports, you can gain a clear understanding of your revenue cycle performance and make informed decisions to improve your facility’s financial health.

From insurance verification and prior authorization to the final payment of a balance, we can help you simplify your revenue cycle management processes. Let’s set you up for success. Contact Integrity Billing today at 561-355-5640.

integrity billing logo handshake logo solutions of north texas logo

A Testimonial We Are Proud Of

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We work with substance use disorder facilities that provide drug and alcohol treatment services.  SONTX is a non-profit center, certified as a 501(c)(3) organization. Integrity Billing has a long-standing history of partnering with SUD and Mental Health (MH) facilities which proves to be an invaluable asset when working with SONTX. Chrisina Nichols of Solutions of North Texas located in Denton, TX  tells us about her experience changing to services with Integrity Billing. “In 2018 we needed to find another Third-Party Vendor for the Insurance Claims Billing/Utilization Management portion of our Substance Abuse Outpatient Clinical Services and were referred to Integrity Billing Co. After speaking with Eric and Denise and a couple of other facilities that use their services-we contracted with them.”

 

Christina feels confident she made the right decision switching the substance use treatment facility to Integrity. She states, “From the beginning Integrity Billing has worked diligently for us through effective and timely communication. Integrity Billing Co. goes out of their way to help answer questions and resolve issues we may have with insurance providers. Even being a small facility, they make us feel just as important as a large volume client.” That is our way of working; you will see our attention to detail and leaving no stone unturned.

 

She concluded her review with the following, “Everyone at Integrity Billing has been amazing to work with and we hope to continue our working relationship with them for years to come.” We are happy to work with our clients long term.

 

Our COO Denise Corbisiero says, “It is almost impossible to find someone within a 100-mile radius that hasn’t heard of Solutions of North Texas, SONTX for short, and the amazing work they do in their community.  Collaborating with SONTX feels like working with a close family friend that you’ve known for years.”

Integrity works so closely with its clients which are deeply rooted Substance Use Disorder (SUD) centers.  Speaking of SONTX, Corbisiero states, “We highly doubt anyone has ever been turned away because they couldn’t afford the services. The owners, Scott and Leslie Wisenbaker along with the Operations Manager, Christina, make sure to supplement their insurance revenue with generous grants and donations.”

Expert Addiction Treatment Billing 

 

The team at Integrity advocates for you with a deep understanding of the behavioral health and addiction treatment industries. Our work goes far beyond billing with on demand reports and collections. We are your partner. We support your facility with comprehensive, end-to-end billing services. How does that sound?

 

Integrity is proud to be fully immersed in the behavioral health community as our team members understand its unique billing and reimbursement complexities. Taking care of your account is done with expertise, ingenuity and integrity.

 

Expect More- You Can Count On Us

 

We want to work with your facility next. Don’t hesitate to reach out and see what it is like to have a diligent team working for you and taking care of the issues with insurance providers. We can be reached at 561-355-5640.

the importance of accuracy in urology coding

Urology Coding the Importance of Accuracy

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Coding is the process of identifying descriptive terms and codes for diagnoses and medical services. These are generated from interacting with patients and other healthcare providers.  This information is gathered and then organized in alpha and/or numeric order that can then be used for charge submission, performance measurements, and data collection for emerging technology, services, and procedures.  Under the Health Insurance Portability and Accountability Act, The Department of Health and Human Services designated the International classification of Diseases and Current Procedural Terminology as the national standard code sets for healthcare professional services and procedures.

Although daunting medical billing methods are one of the most critical functions of your Urology practice.  Urology Medical coding and Urology medical billing both are terms used to refer to a set of standards and guidelines that are used to characterize what has been treated and how it was handled.  Among the many aspects of your medical practice documentation is key.  Accurately recording then transcribing that documentation into the proper codes, modifiers, and extensions help create a seamless function of proper revenue stream for the practice by reducing claim rejections and denials.  Denials however can be one of the many issues Urology practices face and failing to take safeguards to prevent denials can be costly to your practice.

Stay on top of Urology coding updates

Yearly the American Medical Association (AMA) makes new changes to the Current Procedural Terminology (CPT) codes, and it is vital to make sure your practice stays current on the most advanced coding updates.  Coding is an integral business skill that an Urology must develop and cannot be reiterated enough.  Coding is the systematic way you transcribe what you treated and how you treated in order to be paid.

Urology documentation

Documentation is critical to your Urology practice and correctly interpreting this information and transcribing it into proper codes cannot be stressed enough.  We will begin with Evaluation and Management(E&M) services new and established patient visits and consultations.  Remember moving forward coding is rule based.  Therefore, E&M documentation has strict and specific criteria that determine the level of visit performed, including the location that the service is performed.  E&M service has three key components: history, physical examine, and medical decision making.  The guidelines for each of these areas are found in the Current Procedural Terminology (CPT) codebook.  The detail included in the note needs to match the level of E&M service reported.  The physical examination must be performed and documented by the individual recording the visit.  It is recommended at this time labs and tests are documented in the medical decision-making portion.  Lastly, the assessment and plan should be thoroughly summarized.  This area of CPT coding is most complex.

Urology Modifiers

A modifier is a 2-digit code that furthers defines a CPT code.  Modifiers are used to communicate additional information to the payer and are applied for many reasons including but not limited to a return to the operating room for a related procedure or an E&M service that includes the decision for surgery.  Modifiers are designed to be used with either an E&M or a procedure code.  Memorizing all the possible modifiers is difficult, but you should be aware of all the different reasons that a modifier may be needed to complete a code.  When put to use properly, modifiers can bring accuracy and detail to the record of the transaction.

Shining a Light on Mental Health

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Hold on. That is what I continually tell myself as I navigate through life. I have had more than my share of life-altering setbacks and have had people, including therapists, ask how I am still standing? It is not until recently that I can say it is because I tell myself to hold on. Many times, when the world feels as though it is caving in on me, I make it to bed and tell myself tomorrow is a new day, a fresh start, a new beginning. I can’t express how challenging life became holding it ALL in. I felt isolated, as though I was the only one or no one would understand. I slowly learned I am not the only one, and although you may not fully understand, it is my story and my feelings, and they matter! I began letting others in by going to therapy, al-anon, and opening up. I have learned that I definitely am not the only one. EVERYBODY has a story EVERYBODY hurts. So why? Why is it that, as a country in this day and age, we shut down/feel shame when we talk about mental health? There is a realm of mental illnesses, including depression and anxiety, yet when we say mental illness, we conjure up horrific thoughts and don’t discuss it. We go into a shame spiral. Again, why do we do that? Everyone feels sadness, grief, and even passing feelings of hopelessness or despair; they are all part of the human experience.

 

Here are just a few facts from the National Alliance on Mental Illness (NAMI)

Statistics show that one in four adults experiences an episode of mental illness per year.

Mental illness can affect persons of any age, race, religion, or socioeconomic status.

Individuals diagnosed and undiagnosed with mental illness are those around us- our neighbors, our friends, family, and co-workers.

In the United States, four million children and adolescents suffer from a severe mental disorder that causes significant functional impairments at home, school, and with peers.

Mental health disorders account for more disability than any other illness, including cancer and heart disease, reports the Centers for Disease Control and Prevention (CDC)

NAMI, the National Alliance on Mental Illness, is the nation’s largest grassroots mental health organization dedicated to building better lives for millions of Americans affected by mental illness.

What started as a small group of families gathered around a kitchen table in 1979 has blossomed into the nation’s leading voice on mental health. Today, NAMI is an association of hundreds of local affiliates, state organizations, and volunteers who work in our community to raise awareness and provide support and education to those in need. All of the services and programs that they provide are FREE! One voice at a time! We as a society need to start talking to remove the stigma of mental health. We help one another when we begin chatting.

Integrity C.A.R.E.S.

At Integrity billing, we believe mental health awareness lies within every community, which is why we are a Silver Sponsor. Integrity Billing is a top donor/team participating in the NAMI Walks 5k Walk/Run yearly. Team Integrity C.A.R.E.S. was created by Lorinda Yorlano.  Lorinda was our team’s driving force, and NAMI was a program she loved, supported, and believed in. Lorinda had a dual diagnosis of depression and substance abuse and passed in 2019, and we walk in memory of her. Help us end the stigma of mental illness. Help us today by sharing, opening up, and starting to talk.

All donations are appreciated and make a difference! You can help us reach our goal. Again, NAMI’s programs are all free. Your donation helps raise awareness of mental illness and also helps support our local organization to empower persons with mental illness and their families so they can continue to receive all programs at no cost. Visit our team page at https://www.namiwalks.org/team/integritybillingcompany. Help us support NAMI in the hope that we can replace ignorance, stigma, and hopelessness with knowledge, empathy, and understanding.

Loss profit and break even

RCM Optimization

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Today’s blog is shared from the President of MCAnalyTX’s, Eric Depew, an expert and leader in consulting on outsourced Revenue Cycle Management Services, Healthcare Claim Management & Contract Modeling Solutions. To learn more about MCAnalyTX’s Inc., visit their website at  https://mcatx.com, or reach Eric Depew at (281)920-0300 ext 101

 

Healthcare revenue cycle management is the process of managing billing, coding, and collections basically every aspect of the healthcare organization. RCM is a process that directly impacts your organization’s financial performance.

Revenue cycle management services can help improve your organization in terms of revenue, while also reducing denials, appeals, and follow-up work. Within this article, we will discuss the benefits of outsourcing your organization’s RCM. We will also outline some of the common questions about outsourcing and the process.

First, and foremost in order to be successful, a healthcare organization must process claims in a timely manner, while ensuring that patients are aware of what they owe, and what they pay. The goal of outsourcing RCM is to increase patient collections, and reduce bad debt, all while improving patient satisfaction and care. One of the most important parts of revenue cycle management is reimbursement. In fact, it makes up about half of a hospital’s operating revenue.

What does reimbursement mean?

Simply put, it means getting paid for your healthcare services. It is the process by which a hospital, practice, or clinic receives payment from a third-party payer for services provided to patients. The payer – either a private insurer or a government program like Medicare or Medicaid then reimburses the organization for the services rendered on a negotiated reimbursement basis.

Healthcare organizations can save millions of dollars by utilizing RCM services.

RCM outsourcing saves you money by:

  • Reducing administrative costs
  • Increasing cash flow through faster reimbursement
  • Increasing revenue by ensuring all claims are processed accurately
  • Reducing bad debt and bad debts recovery costs
  • Reducing the number of claims denials and appeals
  • Increasing revenue by identifying errors
  • Improving cash flow

RCM provides a framework for optimizing your revenue cycle performance. The goal is to reduce organizational costs, and improve cash flow, and patient satisfaction.

Get pid the importance of medical documentation

The Importance of Medical Documentation

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Medical documentation is necessary to claims being paid quickly

In today’s healthcare world you need to develop the necessary organizational controls to develop successful processes and procedures in order to stay compliant and financially healthy.  The key to excellent documentation is knowing what is required and what is not. Medical reimbursement comes only from what you have documented if something is not written down it did not happen.  This documentation is also a crucial form of communication. The importance of writing complete, concise, dated and timed documentation cannot be stressed enough. It is not only how you are reimbursed, but legal protection and critical communication.  In the event of a medical malpractice lawsuit the only tools you will have to work with is what has been recorded.

Insurance checklist complete concise date time

Accurate documentation begins with gathering patient information from the very first point of contact, and continually updating as the patient moves through the healthcare process.  Using verification tools will enable you the insight to see how you will be paid for services, and which services and procedures will require further approval from their healthcare provider.  Medical documentation is telling the patient story and applying the correct billable codes. Once services have been rendered it is the facilities responsibility to transcribe said services into billable charges. With clear and concise documentation, you can assign medical billing codes to the claim. These billable codes are the vehicle to revenue.  They are inflexible and must be followed to maintain a healthy bottom line.

Understanding the importance of good documentation is crucial to all aspects of the medical record.   Documentation is more than legal protection.  Medical records are a vital form of communication, and the importance of accurate and dated communication cannot be reiterated enough.

Communicate the treatment plan

Good documentation promotes continuity of care through clear communication with all that are involved in patient care.  This is a way to communicate your treatment plan to other providers for the patient.  This level of communication ensures the highest quality of care.

It’s a legal document from the medical provider

A medical record is a legal record of services rendered by the medical provider. Once written it is permanent.  In case of legal proceedings written documentation is called upon and reviewed to help support an argument either way.  So again clear, concise documentation is crucial to every step of the process.

It’s a document of medical services for the insurer

Medical documentation tells insurance providers what they are paying you for.  Each case is coded and translated into a cost for your practice.  Thorough documentation of all medical issues and treatments is therefore critical to your bottom line.

How do I get paid by insurance?

Your documentation is a process of taking all that is written and identifying it as a diagnosis’s, medical tests, treatments, and procedures for medical insurance. This information is then transcribed into standardized codes. These codes are what are then used to bill government and commercial payers for reimbursement of services rendered.

Information you need to get paid verification of benefits, assessment, date and time, treatment plan, procedure, diagnosis, billing codes

Medical billers are the professionals in charge of processing patient data, which would include treatment records, medical plans, and all related insurance information. Medical billers work to ensure that you, the healthcare provider is accurately and efficiently paid for the services performed.

A full understanding of medical insurance, the claims process, the appeals process, and the impact on your revenue cycle gives the medical billing professional the necessary knowledge to maximize revenue performance.  The financial health of your practice depends on the effectiveness and overall performance of the billing office.

Let’s take  look at your revenue cycle.  Revenue cycle management is an invaluable part of a successful healthcare organization.  Without a trustworthy and efficient billing company, you would be losing out on thousands of dollars in payer reimbursements, patient payments, that your practice depends on.

Understanding and executing an outstanding revenue cycle is an integral component of success.  We have all heard of location, location, location for successful real estate endeavors well for successful revenue cycle management it comes down to documentation, documentation, documentation.

 

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5 Ways That Software Can Help You Grow Your Practice

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You know that growth is essential to your success if you’re a business owner. You need to expand and improve to stay ahead of the competition constantly. One way to achieve this growth is by using helpful software. Good software can help you automate tasks, improve communication, and increase efficiency. We will discuss five ways that software can help you grow your practice. 

1. Prescription Software 

One type of software that can help you grow your practice is prescription software. This tool helps doctors electronically prescribe their patient’s medications. It also allows them to renew and cancel prescriptions. This is a great tool that benefits patients because they don’t have to worry about filling their medication at their pharmacy. All aspects are taken care of by the medical practice’s staff, and the patient just needs to pick up the medication. 

2. Patient Portal 

Implementing a patient portal is another way software can help you increase business. A patient portal allows your current patients access to their medical records and test results, so they don’t have to call your office every time they need an update on their condition. Some portals even allow your patients to schedule an appointment.  

3. Outsource Medical Billing 

While outsourcing your medical billing may not be necessary, it can save you a lot of time and hassle. If your staff spends 40 hours per week on medical billing, you could spend more time on office procedures. If office procedures aren’t yielding enough business, though, then missing out on potential revenue is also an issue. You can outsource medical billing services to a reliable medical billing company regardless of if you need help full-time or just occasional assistance. 

4. Electronic Health Records 

Implementing an electronic health records system can save time and improve your patients’ quality of care. An automated system will keep track of patient information, so it doesn’t have to be updated repeatedly. This also alleviates the risk of human error. Electronic health records can make it easier to schedule follow-up appointments, which will lead to more revenue. 

5. Scheduling 

Scheduling is another area where software can help you save time, improve efficiency, and increase revenue. While many practices still utilize paper to schedule patients, scheduling software can automate this process, ensuring there are no missed appointments. The scheduling system will send reminders to the patient by email or text message that their appointment is coming up. You may also find that utilizing an online appointment scheduling system will help you book more appointments because it is available 24/7. 

Conclusion 

Above are just five ways software can help you grow your medical practice. The software can be customized to meet the specific needs of your business, so if you think about what issues your practice faces and what could be improved upon, you can come up with additional ideas for how software can help you grow your practice. 

5 Benefits of Outsourcing Your Medical Billing

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As a result of the COVID outbreak that shook the world in 2019, new technologies have drastically reshaped the medical field. Electronic health records have replaced the manual administration and manner of operation, which include everything from networking portals to test findings to effective medical billing systems. Technological advancements have profoundly altered the method in which billing services are provided. 

There are strict billing processes for both the payer and the user of healthcare services. It can streamline the medical billing process and enhance income and efficiency by employing the correct medical billing service or healthcare billing strategies. 

In this article, experts of Integrity Billing will help you learn how a medical billing service will benefit your facility the most. So, let’s begin! 

5 Benefits of Outsourcing Your Healthcare Billing Service 

1. Help You Adhere to HIPAA Rules 

First and foremost, be sure that the Medical Billing Service you choose complies with all applicable HIPAA regulations. Legal software products are governed by HIPAA, the Health Insurance Portability and Accountability Act (HIPAA). HIPAA safeguards patients’ privacy, ensuring that healthcare practitioners remain anonymous. One of the most important advantages of allowing patients to see their hospital documents is improving data systems. 

You may avoid dealing with compliance issues, rejections, and other office hassles by outsourcing your medical billing to a reputable supplier. This frees up your time for other important daily responsibilities. 

2. Free You From the Worries Of The Analytics Reports 

Back in the day, when businesses would outsource medical billing, they would lose control over the financial data required to manage your business. The information provided by your biller was all you needed to determine the financial viability of your practice after outsourcing. This means you can’t utilize the reports for immediate changes or proactive decisions because the data will be out-of-date by the time you receive them. 

A good medical billing service will free you from all the aforementioned worries. They will understand and portray the notion that if you’re spending money on medical expenses, you should be able to see all of your company’s financial information. Your medical billing company should make it easy for you to get immediate access to this data from any device or location at any time. If you’re looking to grow your practice or change your marketing approach, this kind of information might be quite helpful. 

3. Efficient With Software Management 

If you outsource a proficient medical billing company, they will help you with the correct RCM software, which means that your firm’s operations and RCM processes will be streamlined and error-free. In this way, before meeting a patient, coders and billing staff have direct access to the patient’s data, insurance details, and clinical information; disputes are received and handled right away rather than accumulating in a pile. You’ll be in complete compliance with all HIPAA data storage standards if you store your data on the cloud. 

We believe that the cost of the software should be taken into consideration. One medical insurance billing company might charge for these services differently than others. You and your practice must make the best financial choice possible. When searching around, compare the various providers’ offers, costs, and payment terms. 

4. Quick at Insurance Verification 

You must be able to review and verify the insurance status of every patient from the software provided by the medical billing company. As a result, regular insurance status verification might save you time and speed up the procedure. Consequently, doctors can better assist their patients because the confirmation procedure has been shortened. 

5. Expert at Their Job 

With revenue cycle management’s ever-changing requirements, even the most skilled, qualified, and devoted medical billing personnel may have difficulty keeping up. You’ll need a medical team with the knowledge and experience to advocate for your best interests. The best medical billing company should answer all of your questions quickly and easily. 

It is essential to outsource medical billing duties to the appropriate healthcare billing agency to build and sustain a successful medical practice. Regardless of your expertise or unique needs, having the right medical billing services may assist bridge the gap between a seamless billing procedure and improved revenue cycle management. 

Integrity Billing is one of the top medical billing service providers with proven results of less loss and more revenue. Thanks to our custom-made solutions, improved revenue management procedures and faster reimbursements are available. Find out how we can enhance your medical billing by contacting us right away! 

Medical Billing

The Most Frequent Medical Billing Errors That Companies Make

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Medical billing errors are prevalent and can happen to any company. They often stem from a lack of understanding of the medical industry or insufficient staff who know how to code properly, especially in the medical billing companies. There are many ways to reduce these errors, but it is important to be proactive before your customers start complaining. At Integrity Billing, we specialize in billing and other healthcare management services. This blog post will discuss the most frequent medical billing errors companies make – some you might be making yourself without even realizing it.

1. Not understanding the medical industry.
This is one of the most common medical billing errors companies make. They may not understand what services are covered by insurance, how to code procedures properly, or what is considered a reimbursable expense. All of this can lead to mistakes when submitting claims and result in lost revenue for your company. However, outsourced medical billing services can help solve this problem.

2. Failure of verification of benefits for insurance.
Another common mistake companies make is failing to verify insurance coverage. Before submitting a claim, it is important to make sure that the patient’s insurance plan covers the service you are providing. If it’s not, you could be on the hook for the full cost of the procedure.

3. Not submitting claims on time.
This medical billing error can often be attributed to a lack of staffing or understanding of how the system works. When claims are not submitted on time, you run the risk of them being denied due to insufficient documentation. And if they are denied, you will have to resubmit them. However, an outsourced medical billing service provider can help solve this mistake.

4. Incorrect coding.
This is one of the most common medical billing errors and can lead to significant financial losses for your company. Incorrect coding can result from not having enough staff familiar with medical coding guidelines, or it could be due to human error. Either way, it is important to have a system to check coded claims before submitting them to ensure accuracy.

5. Not following up on denied claims.
If an insurance company denies a claim, it is important to follow up on it as soon as possible. Often, all you need to do is provide additional documentation, and the claim will be approved. However, if you don’t follow up on denied claims, you could end up losing money.

6. Filing duplicate claims.
This medical billing error often occurs when companies submit duplicate claims for already billed procedures. This can be a costly mistake, leading to claims being denied and additional administrative work.

7. Not verifying patient insurance eligibility.
It is important to verify that the patient is eligible for coverage before providing services. If you provide services to someone who is not covered by their insurance plan, you will be responsible for the full cost of the procedure. Therefore, verification of benefits is essential to ensure the eligibility of patients.

8. Failing to follow up on unpaid bills.
Often, bills go unpaid because patients forget or don’t have the money to pay them. Therefore, it is important to follow up on unpaid bills on time to get paid what you are owed.

These are just some of the most common errors that medical billing companies make. By being aware of these mistakes and taking the necessary steps to avoid them, you can ensure that your medical billing process is as accurate and efficient as possible. If you are looking for more tips on how to improve your medical billing process, contact Integrity Billing.

Why Substance Abuse Billing is Important

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Substance addiction is very common throughout the world. But it is not something that should be taken lightly. When people regularly consume “substances” in excessive quantities, they’re called addicts. But substance abuse and addiction are two different things. 

Substance abuse refers to the use of alcohol or any other drug, be it legal or illegal, in large quantities. Substance abuse can be cured with proper rehab facilities. On the other hand, addiction is harder to get rid of. 

Rehab centers and other healthcare facilities help individuals with substance abuse and addiction problems. But these rehab centers also need an income to run properly. To get stable revenue, they need to make proper billing. Even the slightest bit of mistake in billing can cost rehab centers a lot of money. Hiring a substance abuse billing consultant can help. 

Rehab Centers vs. Insurance Companies

There is always an ongoing battle between rehab centers and insurance companies. Generally, rehab centers are paid via insurance money for the patients. A patient rarely pays out of their own pocket. 

But getting the money from insurance companies is no less than a headache. Reimbursement is often very difficult for rehab centers and other similar healthcare services. Moreover, some insurance companies send the reimbursement directly to the patients rather than to the healthcare facility. 

Even when they send the money to the healthcare company, there are many hurdles along the way of receiving money. To start with, insurance companies delay payments without specifying a reason. Furthermore, the billing process is complex. Mistakes in billing can cost rehab centers a lot more than they can earn. Some rehab facilities even ran out of business because of this particular reason. But if you hire a third party for billing, you can get the payments in time. 

Rather than opting for in-house or incompetent third-party billing companies, rehab centers must hire a reliable billing company with in-depth knowledge about billing procedures. Simply knowing the codes isn’t enough to create bills. 

Reasons for Rejected Claims and Delayed Reimbursement

Here are some of the main reasons why insurance companies reject claims or delay reimbursement to rehab facilities: 

False Claims and Caution Against Fraudulent Acts

Many healthcare facilities made false claims to get insurance money in the past. That’s why a lot of insurance providers are cautious of fraudulent claims. This is one of the biggest reasons insurance claims are either rejected, or the reimbursement is delayed. 

But effective billing can help get detox centers and rehab facilities their rightful money in time. 

Lack of In-Depth Knowledge

Another reason for delayed reimbursement is that billers don’t have enough knowledge. This can happen more commonly with in-house billing systems. It’s important to address the receivables of the last 90 days if you want to get your money quickly. 

Lack of knowledge on how to get past money can make it lost forever. But if your third-party billing company knows how to tackle lost money, they might be able to get you your money very easily. 

Reevaluation of Service Providers

Another reason rehab facilities and detox centers fail to get their money is that they don’t bother reevaluating their service providers. Reevaluation will help you understand whether or not a service provider is beneficial to your business. If it’s not, you should seek a new service provider. This is important for regaining your money. But this is one of the most overlooked factors. 

Payments Made to Patients

Many healthcare workers fail to realize that the money would be paid to the client directly. Before you take on a client, it’s important to understand how and who the insurance company will pay the reimbursement. When a rehab facility finds out, there is no way to get the lost money back. Often, many rehab facilities are left with millions of unclaimed dollars. For one reason, these unclaimed dollars remain lost, and rehab facilities fail to recoup the lost money. 

The Bottom Line

The bottom line is to have in-depth knowledge about substance abuse billing. A competent substance abuse billing consultant can guide you and even save your rehab facility from shutting down permanently. 

Some laws have mandated sending the payments to healthcare facilities rather than paying the patients in some states. If you’re not aware of all the codes, regulations, and tactics for getting the payment yourself, you should forget about in-house billing. Instead, you should hire a third-party substance abuse billing company that can do the job for you. 

Get in touch with Integrity Billing by calling (800) 683-5640 or visit Congress Professional II 1630 South Congress Ave., Suite 102, Palm Springs, FL 33461 for further details. 

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