Category Archives: drug rehabs

California Drug Rehabs Vs Patient Brokering

California drug rehabs are starting to feel the pain of new patient brokering laws and it’s only going to get worse. Learning from history is one of the most valuable tools in life. What California is now experiencing in drug rehab marketing legislation, Florida has been through. Florida with it’s “new Florida model” has set the pace for patient brokering laws in the drug and alcohol addiction treatment industry.

California Drug Rehabs New Laws Affecting Marketing

California drug rehabs and drug rehabilitation centers across the US have been operating unethically for many years. The heroin epidemic has exposed many fraudulent practices in this 40 billion dollar a year industry. Lawmakers are making their way across the nation with patient brokering laws to save lives and protect the vulnerable. The new laws in California are going to directly affect the ability to operate in the state if they are operating unethically. To survive the difficult changes in behavioral healthcare centers need to adopt a healthy business and marketing mix.

California Drug Rehabs Need Proven Business and Marketing Strategies

Substance abuse treatment centers in California are finding it more difficult to operate. All the centers are not playing by the rules. This is a time for ethical operators to work together to clean up the industry. Without unity many ethical operators with fall. We have seen this happen in Florida when their new laws were put into place about a year and a half ago. This is clear if you look at the governing body of California drug and alcohol addiction treatment centers in California. The California Department of Healthcare Services (DHCS) website displays a Temporary Suspension Order, Revoked and Notice of Operation in Violation of Law Program List. This list has 84 substance abuse treatment centers.

California substance abuse treatment centers and sober livings are going to have to adopt ethical business and marketing practices to survive. They need to look at and understand what happened in Florida over the past 1-1/2 years to navigate the new and difficult landscape. Some ethical treatment centers in Florida were forced to close their doors. Whether California drug rehabs are operating ethically or participating in some form of patient brokering, they must adopt new business and marketing strategies. Digital Darwinism is the #1 reason these centers have failed. Substance abuse facilities across the nation are losing the battle between drug rehab SEO vs digital Darwinism.

Florida Addiction Conferences Providing Ethical and Proven Strategies Coming to California

In Florida, many substance abuse treatment centers received ethical and proven business strategies at 14 EMP (Ethical Marketing Practices) Addiction Executive Conferences. This addiction conferences EMP Series is coming to Costa Mesa, California on 1/22/19. This behavioral health conference series is not the typical conference offered in the industry. It provides a unique talk show host and town hall forum with no powerpoint presentations. The event features 8 proven, Executive Thought Leaders on a panel. They are asked several questions by the host, and then the event is an open forum. The event is structured for CEO, Executives, Directors, and Outreach to get ethical and proven business and marketing solutions that they can put into place immediately. This California premiere event is Co-hosted by Awakenings drug rehab Agoura Hills. Awakenings is an intensive outpatient drug addiction treatment center that also specializes in behavioral health issues.

What Are the Patient Brokering Laws for California Drug Rehabs?

Senator Ricardo Lara (D-Bell Gardens) signed the SB 1228, Lara. Alcoholism or drug abuse recovery and treatment services: referrals law on September 27, 2018. This law demonstrates that California will no longer tolerate patient brokering by substance use disorder treatment centers and individual’s partaking in unethical marketing. Lawmakers still have much work to do with sober homes and enforcing the new laws. Sober homes legislation will hit California even harder as it did in Florida. These new laws should be adopted mid to late 2019.

While California used Florida laws to mold their legislation, it has some more severe ramifications that deter unethical practices. For instance, under the law, either the addiction treatment center or individual professional can have their license or credentials revoked, extended or denied. If a substance use disorder (SUD) facility loses their license, it will take about 18 months to reopen. Florida does not have this law on the books for drug rehabs West Palm Beach.

What Does Patient Broker Law SB 1228 Say?

The intent of this article is to provide educational information to drug and alcohol addiction treatment centers, sober living facilities and the general public. It is not to be construed for legal advice. you should consult with a California behavioral healthcare law firm on any legal advice.  Below is SB 1228 law for informational purposes:

Section 2 – 11831.6 is added to the Health and Safety Code, to read:

The following persons, programs, or entities shall not give or receive remuneration or anything of value for the referral of a person who is seeking alcoholism or drug abuse recovery and treatment services:

  • Alcoholism or drug abuse recovery and treatment facility licensed under this part.
  • An owner, partner, officer, or director, or shareholder who holds an interest of at least 10 percent in alcoholism or drug abuse recovery and treatment facility licensed under this part.
  • A person employed by, or working for, alcoholism or drug abuse recovery and treatment facility licensed under this part, including, but not limited to, registered and certified counselors and licensed professionals providing counseling services.
  • Alcohol or other drug program certified by the department in accordance with the alcohol or other drug certification standards established pursuant to Section 11830.1.
  • An owner, partner, officer, or director, or shareholder who holds an interest of at least 10 percent in an alcohol or other drug program certified by the department in accordance with the alcohol or other drug certification standards established pursuant to Section 11830.1.
  • A person employed by, or working for, alcohol or other drug program certified by the department in accordance with the alcohol or other drug certification standards established pursuant to Section 11830.1, including, but not limited to, registered and certified counselors and licensed professionals providing counseling services.
  • Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department, until regulations are adopted.

 Section 3 – 11831.7 is added to the Health and Safety Code, to read:

The department may investigate allegations of violations of Section 11831.6. The department may, upon finding a violation of Section 11831.6 or any regulation adopted pursuant to that section, do any of the following:

  • Assess a penalty upon alcoholism or drug abuse recovery and treatment facility licensed under this part.
  • Suspend or revoke the license of alcoholism or drug abuse recovery and treatment facility licensed under Chapter 7.5 (commencing with Section 11834.01), or deny an application for licensure, an extension of the licensing period, or modification to a license. Article 4 (commencing with Section 11834.35) of Chapter 7.5 shall apply to any action taken pursuant to this paragraph.
  • Assess a penalty upon alcohol or other drug program certified by the department in accordance with the alcohol or other drug certification standards established pursuant to Section 11830.1.
  • Suspend or revoke the certification of alcohol or other drug program certified by the department in accordance with the alcohol or other drug certification standards established pursuant to Section 11830.1.
  • Suspend or revoke the registration or certification of a counselor for a violation of Section 11831.6.
  • The department may investigate allegations against a licensed professional providing counseling services at an alcoholism or drug abuse recovery and treatment program licensed, certified, or funded under this part, and recommend disciplinary actions, including, but not limited to, termination of employment at a program and suspension and revocation of licensure by the respective licensing board.
  • Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the department may, if it deems appropriate, implement, interpret, or make specific this section by means of provider bulletins, written guidelines, or similar instructions from the department, until regulations are adopted.

California Drug Rehabs Must Learn From Florida

Florida was the first state to focus on patient brokering laws in the substance abuse industry. They have set the pace for the nation, but it has affected some ethical operators that did not change their business and marketing strategy. The media was quick to jump on the bandwagon providing, for the most part, unethical journalism.

The negative “Florida shuffle” press and isolated exposure of patient brokering in Florida caused individuals seeking addiction treatment to stay away. This caused some ethical drug and alcohol addiction treatment centers in Florida to close their doors. More importantly, it may have put them into life-threatening situations that are happening across the nation. This negative press is now being experienced by California with the media’s “Rehab Riviera” label.

California drug rehabs need to adopt ethical and healthy business best practices. Many need to look closely at their current marketing plan and drug rehab marketing mix. As Florida has experienced, relying on laissez-faire strategies will put your business at extreme risk. Mainly using boots on the ground, calls centers and PPC are not enough with the rapidly changing environment. You may want to join the exclusive California Addiction Professionals Referral Groups to stay up to date and connect with California addiction professionals.

We’d love to hear your thoughts on the regulation in the drug rehabilitation industry. Leave a comment below.

Drug Rehabs Losing Business Marketing Focus

Drug rehabs during 2018 and for approximately the last five (5) years have been experiencing a trend which has been infecting the financial health and welfare of the addiction treatment industry. Dale Redlich, CEO of Pay2Patient and well respected past treatment center owner for over 20 years provides this article with his insight on some issues that owners are facing in our industry with this article.

A Snapshot of the business and Drug Rehabs Marketing Side

Drug rehabs have been experiencing a trend that has manifested itself in recent years with;

  • downsizing
  • bankruptcies
  • selling off of assets
  • staff firings
  • lack of staff replacement
  • lack of staff additions
  • lower staff salaries
  • changes in marketing techniques
  • development  of joint ventures with financially sound publically traded companies
  • mergers and acquisitions

In addition, there is a desperate attempt by many owners and operators of addiction treatment facilities (including the detoxification and lab segment) to develop new relationships. These include banking, investment, and other financial relationships which might result in an infusion of new capital into an otherwise unhealthy marketplace. Basically, inexperienced drug rehabs and operators where wasting financial resources in an attempt to “out do “ their competitors. They are trying to offer more and more luxury within their drug rehabs. They are attempting to compete for a very limited supply of high paying clients

This trend has and will continue to affect not only full-service outpatient, PHP, inpatient, and residential addiction treatment centers West Palm Beach and across the nation, but also all of the ancillary support businesses including, sober living facilities, halfway houses, and private practice therapists as well as labs.

Drug Rehabs Pain Points

The signs have been evident for a substantial time period, but the problem has been and will continue to grow more severe as time continues. The main pain points of drug rehabs are marketing and billing. These are the two hands that are feeding any addiction treatment center. Many centers have poor drug rehab SEO that is costing them big dollars in the wasted marketing budget. The second biggest pain point is the abundance of money left on the table from substance abuse billing and utilization review. The biggest concern is that some owners think they have this under control. The reasons for this trend varies but in general, it can be seen as being attributable to a number of predictable factors such as;

  • a severely growing level of competition for the same patients
  • Poor marketing strategies
  • lack of education on web marketing and SEO
  • changes in the number of payments made for treatment by the insurance industry
  • new and far-reaching legislation which has severely limited the ability of such facilities to engage in traditional marketing
  • a lack of sufficient capital from an operational standpoint
  • rapid and unnecessary expansion
  • an attempt to offer only the most high priced luxury

It may also be seen as a failure of the new wave of financially inexperienced and undercapitalized drug rehabs who have been unable to foresee such trends and also have miscalculated the effects of massive changes occurring in the insurance marketplace both for in network and out of network providers.

Insurance Companies Controlling the Drug Rehabs

One area which evidences this trend in the insurance industry. It is the growing direction for providers to attempt to change from out of network to full in-network providers. Most facilities these days are desperately becoming only in-network providers even though the amount per day paid by the carriers for in-network benefits has steadily been falling.

No longer do the carriers have to devise methods to try to forced drug rehabs to become in-network.  It was only a few short years ago when the carriers were paying exorbitant amounts per day to out of network providers and the thought process of owners at that time was to remain out of network in order to reap the benefits of the absurd amounts of money which the carriers were paying for out of network benefits.  This could not continue forever.

When Insurance Companies Send Payment Directly to Clients

In fact , there are some insurance carriers such as Federal Blue Cross Blue Shield and Empire in Florida which continued to pay large unsustainable amounts  for all of the services insurable but rather than paying the provider the carriers were ( and some continue ) issuing their reimbursement checks directly to the patient or subscriber which resulted in many cases, and still does so result, in  the insurance checks being cashed by the patient and the provider never realizing its fees for services rendered. If you are in this situation you can contact Dale Redlich, CEO of Pay 2 Patient at 954-592-1921. They specialize in collecting from insurers that pay the patient directly.

Understanding Drug Rehabilitation Centers Money Owed

Obviously, this was and continues to damage the providers financially as they are rendering services in good faith but never receiving the checks from the carriers.  The reality is that many providers did not even realize that their check-in reimbursement for services rendered had not even been sent to them by the carrier. Some of the providers were losing exorbitant amounts of money in this fashion and in some cases not even realizing that this was happening.

The result of all of the above circumstances is that the drug rehabs have split into the “have’s” and “have-nots”.  If you attend industry events you will likely realize that not only have the attendance numbers plummeted but the actual exhibitors themselves are often comprised only of the larger most well funded (and often time owned by publically traded companies). Many centers are looking for smaller, focused events that also provide business and drug rehab marketing education to survive the competitive landscape. In addition, they need to implement strategies of how to properly prepare for these addiction conferences.

Allocating Drug Rehab Marketing Dollars

It is unbelievably expensive for a facility to finance large numbers of their marketing staff to attend these events. Many are only marketing to other marketing staff from other facilities. This is financial lunacy, without getting educated on proven business and marketing strategies, unless the provider has extremely deep pockets which some of them still do.

The savviest operators realize that the money spent on traditional marketing and attendance at events that do not provide proven business and drug rehab marketing practices is much better utilized with drug rehab SEO, social media and other types of online selling of their services. One of the biggest mistakes they make is using boots on the ground as their main marketing strategy. Without a robust, healthy and planned marketing mix, many are at great risk of closing their doors.

Getting Control Over Debt Collection and Revenue Cycle Management

Substance abuse billing and revenue cycle management are critical areas for owners. So, where does this leave us? The purpose of this article is to educate drug rehabs on the vast amount of lost revenue that is left on the table. The key areas that need to be addressed are; billing,  utilization review and marketing.

However, at the same time that are certain methods which at almost no cost can result in the infusion of additional capital into a sagging P/L statement. Debt Collection with revenue cycle management for drug rehabs is one potential partial solution to the financial problems being experienced in the healthcare industry and in particular, the addiction treatment industry.

The collection of a debt is a financial strategy which has been around since the time of the money lenders in biblical times. If a company lends money, or advanced money or fails to receive legitimate funds on component aspects of its business it should be entitled to take appropriate action steps to recover the resulting debt if such debt is attributable to the loan or advancement of funds to the potential debtor. There is nothing immoral about a company taking steps to collect its fair debt, In fact, it is business malpractice not to go after the fair debt which is owed.

What is Drug Rehab Revenue Cycle Management?

Revenue Cycle Management is a fancy way of describing the method of tracking accounts receivables.  Utilizing such funds at the appropriate time to pay operational internal debt on an ongoing and predictable basis is critical. Substance abuse billing and revenue cycle management are two key areas centers to look at closely. Drug rehabs are leaving 20-30% of their revenue on the table. Treatment centers need to evaluate their substance abuse billing every year. It is advantages to bring 2-3 billing providers every year.

Evaluating several different substance abuse billing and utilization companies will ensure there is no money left on the table. The insurance companies are playing games with reimbursements, and these companies on the front line. Many billing companies will get lazy after the low hanging fruit is gone. There are many drug rehabs that are owed big dollars. Not knowing how to code is only one of the issues causing this problem. This is one of the biggest areas causing centers to close across the nation. This is one of the topics we are covering in our upcoming addiction conferences EMP series event on 1/22/19.

Reclaiming Precious Drug Rehabs Operating Capital

The problem experienced by the addiction treatment industry now in many cases is that the provider company has not taken sufficient steps to ensure that it has sufficient operating capital. The money gets spent in a variety of other ways as described above. And often times there are is no margin of error for drug rehabs which results in layoffs and other dire consequences.

It defies our understanding of why a health care provider which is owed money would not take every reasonable and legal action to collect money which it is owed. It seems to be lunacy but at the least very bad business practice.

Reclaiming Drug Rehabs Receivables Doesn’t Cost Much

The ROI to employ debt collection methods is so low as to beg for utilization.  The process is very simple for drug rehabs, but at the same time there are Federal and State regulations which must be complied with and of course, the privacy of the patient/debtor needs to be protected. This can all be accomplished by utilization of the proper documentation.

Don’t get me wrong. It is not easy to collect the debt. Collections methods vary depending upon the type of debt, the age of the debt, the identity and location of the debtor, Federal and State Law, peculiarities of the court system, and other factors but the fact remains that the collection of debt can be “found’ money and help immensely in providing additional and needed revenue to the provider  to help with the covering of operational expenses. All addiction treatment centers should have a third party look at their substance abuse billing and utilization review. This will uncover a tremendous about of lost revenue.

Drug Rehabs Regaining Business Focus to Survive a New Industry

There is nothing dirty, or unseemly or embarrassing about drug rehabs taking every step possible to recover money which it is owed. After, all don ‘t companies which the provider owes money to try to collect such funds? And, if you’re worried about upsetting the debtor then think about the fact that your employees expect to be paid every week and in my own humble opinion those individuals are a lot more significant than the person who owes your facility money.

Whether you are after co-pays, deductibles, self-pay fees still owed,  insurance checks which were sent to the patient, client loans, or other debt your company is entitled to take all lawful means to collect this money.  Drug rehabs not only need to look at their collectibles, but also their substance abuse billing providers. This is one of the main reason centers are closing. The insurance companies are playing games with reimbursements.

Addiction Conferences Educating Drug Rehabs Losing Business Marketing Focus

Operating drug rehabs is a difficult task. Operators of substance abuse treatment centers need ongoing education on the business and marketing side of behavioral health. New laws, regulations and knowing how the insurance companies are operating is paramount. Marketing, substance abuse billing and utilization review mean big money for drug rehabilitation centers. Evaluating these regularly will produce large checks of operating cash. The addiction EMP (ethical marketing practices) conference series addresses these issues.

BHNR has brought 14 successful addiction conferences to South Florida. These talk show host/town hall-style conferences provided proven business and marketing strategies to operators during the regulation of our industry in Florida. We are proud to bring our Addiction EMP Series conference to Costa Mesa, California on 1/22/19.  Check out the addiction conferences EMP Series event in California.

 

 

Substance Abuse Billing #1 Costly Mistake

The Critical Role of Substance Abuse Billing

Substance abuse billing is a complicated process and mistakes can be costly. Drug and alcohol addiction treatment centers are constantly battling insurance companies for reimbursements. Billing consultants and third-party billing companies can be beneficial to maximize results and get payments quickly. Health insurance claims for substance abuse are often delayed by the health insurance provider. Many behavioral health providers account receivables get out of control very quickly. It is a constant struggle for addiction treatment centers and detox facilities. If this isn’t difficult enough, some insurance companies send payment directly to the patient.

Behavioral Healthcare Billing; Is Getting Paid in 14-Days with Revenue Cycle Management Possible?

Getting paid in behavioral health care is a daunting task for many providers and billing companies. Billing companies usually take the low hanging fruit from common mistakes made by recovery centers in-house billing or the previous billing companies mistakes. After this, this real work of recapturing lost revenue or getting paid quickly is the difficult task.

Not having sufficient operating cash is a common problem for many rehabilitation centers. Some rely on billing companies and trust they are doing a good job. Some do their own in-house billing. Either way, in-depth knowledge is an absolute must to get paid quickly. So, what are the common mistakes made by addiction treatment centers? We took this question to Jim Woods, CEO of Advanced Data Systems Corp, an industry leading substance abuse billing company. Here is what he had to say.

Many treatment centers are leaving large amounts of money on the table with their billing and utilization review. Many are unaware and need to look closly to recature operating cash.

Completely understanding the insurance companies and establishing relationships is the key to getting paid. Substance abuse billing vs. utilization review is a key area for many centers to address. We found this so important, that we invited Advance Data Systems Corp and two other billing related organization to be panelists at our next addiction conference.

Addiction Conference Educates on Business and Marketing Pain Points

You can learn more about increasing your cash flow, proven business, and marketing strategies at the California Addiction Conferences EMP Series event on 1/22/19. This addiction conference features 8 national thought leaders providing strategies in substance abuse billing, drug rehab SEO, website development, ethical business and marketing and tools to thrive with the new marketing laws.

Insurance Companies Are Bullying Behavioral Health Providers

Addiction treatment centers, opiate detox’s and third-party substance abuse billing companies work hard on efficient billing, billing procedures and utilization review. One mistake could cost upwards of $30,000. Obtaining the knowledge to prevent these costly mistakes is paramount. Behavioral health organizations can generate revenue in three different ways. They must play critical attention to their billing, collections, and drug rehab marketing strategies.

Insurance companies are bullying substance abuse and mental health providers. They are denying substance abuse billing claims, delaying reimbursements, questioning the medical necessity and auditing these organizations. These tactics cause severe problems for providers. The insurance companies for the treatment of behavioral health care issues are using these strategies mainly due to the Affordable Care Act. It has made health insurance available to many by providing subsidies towards the cost of health care for many individuals. It requires insurance plans to cover pre-existing health conditions and much needed mental health and substance abuse treatment. However, the addiction treatment providers are battling high deductibles and insurance company tactics that reduce what they pay out in reimbursements.

The drug and alcohol addiction treatment providers are constantly fighting Goliath to get their substance abuse billing reimbursements for services provided. Insurance providers are constantly seeking ways to cut monies they have to pay out. The insurance companies are also battling fraudulent healthcare providers submitting inflated clinical documentation, services not provided and excessive services. This has caused severe problems for ethical operators. They have to be faster and stronger to keep up with the changes occurring in behavioral healthcare.

Substance Abuse Collections

Substance abuse billing vs. utilization review is the first step in recovery centers getting paid. Outstanding receivables are generally extremely high for addiction treatment centers and detox facilities. Many times their in-house billing or third-party billing providers don’t address receivables past 90 days very well. In some of these cases, they lack the knowledge and time resources to obtain these lost funds. Addiction treatment centers and detox providers should constantly be reevaluating their providers and seeking new providers to recoup these dollars. Reevaluating all their ancillary service providers is critical due to the current state of our industry.

Pay 2 Patient Collections

We also recently sat down with Dale Redlich, Co-founder of Pay 2 Patient LLC, to investigate other costly billing issues that centers face. We found that some substance abuse providers have millions of dollars in uncollected claims. This situation arises due to lack of knowledge of some insurance policies and proven strategies to obtain the insurance payment. This is what he had to say.

Treatment providers often start treating clients are unaware of how much the insurance companies will pay. Even with their experience sometimes the payment for services is sent from the insurance company directly to their client. Usually by the time the treatment providers realizes this, it is too late. They have no idea on how to effectively get this payment and generally never do.

Pitfalls When the Insurance Company Pays Your Client Directly

To begin with, Out of Network (OON) claims are usually more costly to the insurance carrier and to the patient. As a mechanism to encourage participation in its network (certain laws mandate this to happen) in network carriers will issue payment directly to the provider on behalf of the patient.  However, some carriers do not extend this outcome to non-participating or OON providers. Rather than pay the non-participating provider directly some carriers (Empire and Federal BCBS in Florida) issue payment directly to the patient.; the reimbursement check is made payable to the patient not to the service provider.  This can disrupt the provider’s cash flow and this creates the Pay 2 Patient circumstance. This usually occurs when the insured does not execute the assignment of benefits and attest to it.

Confused Behavioral Health Providers

Providers become understandably confused about how this could happen considering that the provider’s substance abuse billing staff and admission staff has had the patient execute all the correct authorizations and a verified assignment of benefit (AOB) at the time of admission.  Most providers think that if all such documentation is executed by the patient that regardless of whether they are in network or out of network the insurance reimbursement checks will be sent to their office. For many providers, the assignment from the patient is unlikely to be honored by the carrier and its check will be sent to the patient anyway. This comes as a surprise to many providers who expect to receive the check from the carrier so long as it has a valid attested assignment of benefits.

In many cases, both the patient and the provider’s staff are unaware that the insurance checks will be sent directly to the patient, even when the patient had already given the provider an assignment of benefits. And, even when the staff is informed mistakes and oversights are often made. Sometimes, it is only during routine claim A/R review that the billing staff realizes that the check they have been waiting for has already been sent to the patient.  The carrier generally does not routinely inform the providers billing staff of this circumstance

Addiction Treatment Centers Can Have Millions in Receivables and Not Know It

This is when the problem becomes acute and financially damages the providers anticipated cash flow because it is extremely difficult for the provider to recover such insurance payments from the patient who has already received the check, potentially has cashed it and possibly spent the money.  Obviously, the practice of issuing checks directly to patients instead of to the provider has greatly impacted the cash flow of many providers.  Providers in Florida should make sure that the insured also executes an AOB and attests to it

Florida’s controlling law in this area is Florida Statute 627.638 in which it states;

  • Section (1) that an insurance contract “may” allow the carrier to send payment directly to the provider of services if such directive is contained within the policy using appropriate language and there is an attested authorization of benefits from the insured.
  • Section (2) of this law it is clear that the duty to pay the provider exists when the insured and not just the patient has signed the AOB and attested to it

Benefits of Insurance Companies to Pay the Client Directly

Providers have to remember that issuing checks directly to the patient serves an important benefit for the insurance carrier because this entire process might become a pressure point for more providers to join the carriers’ network and eliminate the risk of not receiving the reimbursement checks. Paying patients directly provides an important impetus for nonparticipating OON providers to join the network.

It is important to note that some states like NJ, TX, CO, NV, and others have enacted laws which protect the provider whether such is in network or OON. A very few other States have also passed similar “mandatory assignment of benefits” laws which protect providers.  But, only a handful of States have passed such laws.  In such states, the law basically says that if an AOB is executed to their provider, subject to certain rules, the carrier must send payment to the provider not the patient.

Properly Handling Empire and Federal BCBS Insurance Policies

And, if a provider provides services in Florida, if a patient is admitted on an OON basis and the client has certain insurance such as Empire or BCBS Federal and the insured does not sign the AOB (assignment of benefits) there is a distinct possibility that when it comes time for payment of the providers fees the check from these carriers might go directly to the patient.

Of course, many providers in this circumstance do try to be prudent and educate them by informing them that the insured needs to sign the AOB. However, if the insurance check is sent directly to the patient their obligation is to immediately endorse the check to their provider in payment of the fees for service.  But, many clients who receive the insurance check after they are no longer in treatment keep the check and, cash it.  Some clients go to multiple treatment centers to try to play this game to the fullest extent.  This is the dangerous result of pay 2 patient.

Remember that in states like Florida when the provider has an assignment of benefits document in the file signed only by the patient there is no actual legal protection against the carrier paying the patient directly. Finally, when and if a third party reimbursement check is sent by the carrier directly to the patient most providers and billing companies lack the resources, time or expertise to “chase” the patient for a return of the insurance check.

Substance Abuse Billing #1 Costly Mistake Chasing the Reimbursement Check

There are many areas of substance abuse billing that behavioral health organizations overlook. Getting paid quickly is paramount for many providers. This is one of the main reasons we are seeing recovery centers close their doors. Re-evaluating your current sales and service drug rehab providers including your substance abuse billing company or carefully looking at your in-house billing could be the difference of keeping the doors open. Behavioral healthcare billing is a complicated process that demands great attention. Many drug rehabilitation centers think that this is under control and unknowingly have left huge chunks of operating cash on the table.