What to Bill On – The Showdown of UB04 VS CMS1500
When you start billing insurance for the Services at your Substance Abuse facility, whether you do it in house or outsource it, you want to make sure your I’s are dotted and T’s crossed. Remember, health insurance companies like Blue Cross Blue Shield want to deny your claims as much as possible. They look for the smallest errors like a misspelling or wrong date, because less claims equals more dollars stay with the Insurance company.
One of the biggest problems I see new facilities making is that they don’t know what they can or can’t bill for as a facility. Mistakes or unethical practices like Double Billing or billing for services your doctor’s taxonomy doesn’t approve him for will raise red flags to an Insurance company. Worst case scenario you end up getting audited, your pending payments frozen, and you’re stuck in insurance purgatory for months.
So how do you prevent this from happening to you and your treatment facility? The main way is to make sure you bill your services on the proper forms, as the right kind of entity. Also to make sure you only bill for whatever the patient does, even if authorized for more.
In terms of facility, a Substance Abuse Treatment Facility can only bill for Detox, Residential, PHP, IOP, outpatient individual and outpatient group therapies. You file their charges on a UB04 that insurance goes by in order to pay the facility.
If you’re looking to bill ancillary services, a Doctor’s Group is the way to go. Doctor’s group allows you to bill things like Acupuncture, personal training and more; and it’s completely legal. This enables you to create a second stream of income within your facility. All Dr.’s group services must be billed On a CMS1500 form, not doing so will cause problems.
It is critically important these cohesive services are billed separately. Not doing so will throw back tons of denials on your claims for wrong forms. If you need assistance getting your credentialing done and signing up with insurances, these are all services we provide to our new clients. We will also double check your services and taxonomy to make sure your doctors are licensed to provide any service. If you’re a current client, then you know we’ve got your back on this and we make sure all your services are billed properly for maximum payout.
If the world of insurance billing is still causing you a headache, then reach out to us here at MedPro so we can partner together and take your business to the next level. Let us handle the billing, collections calls, and the headaches while you focus on expanding your facilities and curing people who really need your help.