Billing medical insurance for drug rebab services can be tricky, especially when the Affordable Care Act is under attack and has already been repealed in the US House, which is why insurance companies are looking more and more to accredited rehab facilities to ensure that their reimbursements are only going to highly effective programs. The process of going through accreditation by companies such as Joint Commission, clinicians can become informed not only about how to effectively chart for medical necessity, but also about the proper way to prepare for insurance billing and reimbursement. As a behavioral health service provider, you give clients the ability to get back to living life without drug and new shot at life; as a businessperson, you should reap the benefits of quick reimbursement.
Accreditation shows high functionality of a company through standardizing:
Patient care and services
Quality and assurance programs
The number of clients that need drug rehab services is phenomenal. As millions of clients still suffer under the opioid epidemic, millions have insurance and qualify for services. With this many clients needing care and the ACA's mental health and rehab benefits on the chopping block by the Trump administration, any practitioner or rehab who interacts with insurance companies needs to be best prepared for the future.
Currently, the trend has been that more insurance providers are requiring accreditation before they reimburse because of how unregulated the drug rehab industry has historically been before the ACA, and recently at time of writing this, has been intensifying presumably because of the unsure future of mental health benefits. For instance, talking with a detox center client of mine just last week, they told me they turned down four detox clients with good plans (low deductible, co-pay, and total out-of-pocket) because the detox center did not have an accreditation. What's more, if a rehab wants to take any type of Federal, State, or Military insurance plan, those plans specifically will want accreditation.
Accreditation is also an integral part of many Blue Cross Blue Shield, State, Federal, and smaller commercial insurance plans. Rehabs, especially those working with detox and IOP clients, this accreditation becomes more pertinent as there is more competition out their for them. Unless the staff or program director staff has much educational training on this, it is almost impossible to know the standards or the ramifications of the accreditation processes.
Another benefit of accreditation, is that billing may become less opaque. What may seem complex, but when you comply with the accreditation rules, the process can be quite smooth because your clinicians know what to chart for. What's more, being accredited will allow you to advertise and use that logo on your website.
Conclusion: Accreditation can be a difficult process. However, this is not an arduous process if you find professionals who know what to do and when to do it. Accreditation is one way to alleviate some of the hassles of insurance reimbursement for you and your clients. Give your company the best shot at success.
About the Author: Rishi Khatri is both an healthcare attorney and doctor and has worked in healthcare clinical practice and law since 2008. He advices and consults for a vast variety of healthcare companies for compliance, mergers and acquisitions, clinical practices, accreditation, including drug rehabs.
Please contact him at Info@KhatriMedLaw.com or (310) 896-5183 for questions or free consultation. www.KhatriMedLaw.com