Payor Trends in Addiction Treatment

Reimbursement for addiction treatment is changing across the country—and unfortunately, it's not changing for the better. Between 2017 and 2018, insurance payments on amounts billed decreased by approximately 6 percent across the industry, with the sharpest dip occurring at the end of last year. These changes in payment are having widespread, negative effects on facilities.

The number of new treatment centers has continued to increase over the past 18 months. However, there has been a steep decline in the census among centers. This has caused many facilities to close down, even as demand for addiction treatment increases.

To help your facility meet its financial goals, it is more important than ever to build close relationships with payors and understand their reimbursement policies. By following the trends in reimbursement, you can ensure you are receiving the payment you’ve earned.

A Move Toward Value-Based Care

All commercial payors are demanding more data on patient outcomes to ensure they are paying for quality care. Though this transition to value-based care has been slow so far, it’s unlikely to stop.

You can prove you are providing value-based care by collecting data on your patient outcomes and sharing it with the insurer. You may want to collect information such as readmission rates, incarceration rates among your alumni, employment rates among your alumni, and other information that shows your patients are successfully in recovery.

You may also choose to implement programs that insurers themselves are investing in, such as medication-assisted treatment programs or peer support groups. These programs show your dedication to patient outcomes while giving you another opportunity to charge for services.

A Preference for In-Network Providers

While in the past, going in-network was not financially feasible for addiction treatment centers, negotiating an in-network contract may now actually be to your benefit. Being in-network helps make revenue forecasting easier because you have more reliable reimbursements for payors.

Payors also prefer to refer patients to their own in-network providers. Moving in-network may give you wider access to patients in your area.

Many payors are also testing out pilot programs in partnership with healthcare professionals across the country. By being in-network, you position yourself to take advantage of these partnerships and make it easier to keep in close communication with the payor.

More Reimbursement for Outpatient Care

Across the board, payors are looking to spend less on expensive inpatient care. It may benefit your facility to design intensive outpatient programs, alumni groups, medication-assisted treatment, and other outpatient services that cost insurers less while still delivering quality care.

To encourage outpatient care, payors are reimbursing more often for telemedicine services. These services may allow you more extensive follow-up, even with patients who live far from your treatment center. They can also help you continue to monitor patients after they have left your facility.

Staying on top of the latest trends, from telemedicine to medication-assisted treatment, benefits your facility financially and can help your patient outcomes. At Datapro, our experienced team has been identifying trends in behavioral health care reimbursement for decades. We can help you take advantage of these trends while staying on top of billing collections and claims. Find out how we can help you; schedule a complimentary 15-minute consultation with Datapro experts by calling 805-579-3537 or contacting us online.