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  • Writer's pictureMuhammad Sair Khan

Behavioral Health Billing Trend Report




The behavioral health industry, particularly addiction treatment, is evolving rapidly.. To keep up with the changes, it’s vital that your facility pay attention to industry trends—identifying which will have long-term consequences to both you and your patients.



As you are planning your next fiscal year and making changes to your budget, you should consider these key trends and how your facility can best take advantage of them.


Federal Funding for Medicare and Medicaid



Funding for Medicare and Medicaid have greatly expanded over the last five years, especially as more states vote to expand Medicaid services. This increased funding has led to an entirely new insured patient population who need behavioral health care.


While Medicare and Medicaid aren’t known for outstanding reimbursement rates, the right business model that meets Centers for Medicaid and Medicaid quality measures may help you increase your revenue after all. To care for this patient population and receive appropriate reimbursement, it’s important you have an efficient plan in place to meet and exceed requirements, which may lead to reimbursement bonuses.


Increased Government Regulation (Parity Act)


The Affordable Care Act changed the way insurance companies cover mental health and substance abuse treatment. It named these treatments as an Essential Health Benefit, requiring that all insurers cover these services.


The ACA also greatly expanded health parity laws to include mental health services and substance abuse treatment. These parity laws state that insurers cannot cover these services differently than other health services. These services cannot have stricter limitation or financial responsibilities than other type of specialty care.


These two major changes have helped make substance abuse treatment more accessible for patients. Your facility needs to be ready to meet the growing demand for substance abuse treatment and ready to work with many different payors in your area.


A Shift to Outpatient Care


A greater demand for treatment can also put a strain on inpatient care. You can treat many more patients through outpatient services than through residential care.


In the past, when patients paid out-of-pocket and insurance companies reimbursed at full billed charges, a luxury long-term stay model may have been best for your revenue. However, this model may now mean you are missing out on huge numbers of patients in your area. It’s important to determine how you can incorporate outpatient care into your business model in the future.


Increased Use of Medication Assisted Treatment



Since 2007, the use of medication assisted treatment (MAT) has almost doubled. This increase in MAT is partially in response to the opioid epidemic and partially in response to new research. The latest studies are providing hard data that show the success of MAT in addiction care.


This type of data is exactly what payors need to begin offering reimbursement for MAT. It’s likely that as research continues, more and more payors will cover the treatment or be willing to increase existing reimbursement rates. Your facility can take advantage of this change by tracking MAT outcomes and demonstrating quality patient care.


At Datapro Billing, our experienced team stays on top of the latest trends in behavioral health reimbursement. We are ready to help you adjust your billing practice to increase your revenue. Schedule a complimentary 15-minute consultation with Datapro experts by calling 805-579-3537 or contacting us online.

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