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  • Writer's pictureMuhammad Sair Khan

How Treatment Centers Can Increase Revenue with Medicare and Medicaid




Before the Affordable Care Act, most uninsured adults did not have access to Medicaid coverage. Even those who did have Medicaid, likely did not have coverage for substance abuse treatment. However, beginning in 2014, substance abuse treatment services were required to be covered by all insurance plans, including Medicaid.


With the recent expansion of Medicaid, millions of adults now have access to health insurance, including substance abuse treatment.


Nearly 12 percent of adult Medicaid beneficiaries have a substance use disorder, according to the Centers for Medicare and Medicaid Services. By some estimates, this equals roughly a million people who have gained access to treatment they need.


This also means that your facility can serve an entirely new patient population. With the right financial strategy, you can help these patients while increasing your revenue.


To capitalize on the increased coverage of substance abuse treatment, you should:

Check Your State’s Medicaid Coverage


Unfortunately, not all states cover substance abuse treatment equally. Some states have expanded coverage of less costly outpatient services to help providers care for more patients. Others only cover inpatient care. If you are in a state that did not expand Medicaid, it is unlikely that there are many adults who can use Medicaid for your services.

Understanding your state’s laws, reimbursement rates, and coverage can help you determine if accepting Medicaid and Medicare makes sense for your facility.

Have Paperwork in Order


To receive reimbursement from Medicare and Medicaid, you must have a written treatment plan for each patient using that coverage. For instance, you must submit a Patient Assessment Instrument for inpatient services covered under Medicare Part A. This document includes standard screenings and assessments that help determine what you’ll be paid for your services. Filling out this form as completely and accurately as possible is vital to receiving maximum reimbursement.

Meet Quality Measures


Meeting CMS quality measures can help you avoid penalties and even earn incentives. Through the Physician Quality Reporting System (PQRS), you must report data related to covered physician fee schedule services that were delivered to Medicare Part B beneficiaries. If you fail to report data, you will be penalized. If you report strong data, you may receive physician bonuses for quality care.


Other quality measures can also increase your reimbursement from CMS. For instance, meeting Meaningful Use guidelines with your electronic health record can improve reimbursement rates. Or, if you fail to meet Meaningful Use guidelines, the result is a reduction in rates.


Some states have addiction treatment specific quality measures. The American Society for Addiction Medicine is working to create more quality measures for addiction treatment to help improve care. Staying up-to-date on these measures can help both your facility and your patients.


As the government struggles with the opioid crisis, more substance abuse treatment is becoming eligible for Medicaid reimbursement. Accepting Medicaid and Medicare patients now may help you take advantage of future developments in reimbursement and make it easier for you to meet quality measures.


Datapro can help you navigate Medicaid and Medicare billing requirements, ensuring you receive payment faster. Contact us today to learn how we can help your addiction treatment center or behavioral health facility.

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