As clinicians, we are taught many things about documentation. Most of us are taught it to put the least amount of information necessary to ensure the client’s process is protected. However, with an increasing number of consumers wishing to utilize insurance this is often a double-edged sword. Most insurance carriers have a set of criteria that they follow to determine what level of care and how much care they will authorize. Some carriers use ASAM criteria, some use a combination of different guidelines, and some have developed their own set of criteria which can be confusing to navigate (looking at.
Fraud & Abuse
2016 was a game changer in the field of Behavioral Health. We have quickly become one of the most costly business units for Insurance Carriers. In turn, carriers and government agencies are uncovering incredible amounts of fraud and unethical practices. What does this mean for your facility? Have you gotten inquiries from insurance carriers wanting to audit your claims? Call AVA to schedule a free consultation and let our expertise work for you. http://www.fiercehealthcare.com/special-report/healthcare-fraud-a-look-back-at-a-pivotal-year.
Blue Cross/Blue Shield Health Index
Has your facility wondered why insurers continue to squeeze Treatment Provider’s reimbursements? Did you know Substance Use Disorders are in the top 5 most financially impactful medical conditions insurance carriers face, as reported by The Blue Cross Index. Substance Use Disorders now rank alongside depression/anxiety/mood disorders; hypertension; diabetes; and high cholesterol for most costly medical issues. AVA can help in making sure your organization is setup in a manner to ensure proper payment from insurance carriers, maximizing your reimbursements, and more. Give us a call for a free consultation today! https://www.bcbs.com/about-us/capabilities-initiatives/health-america-initiative/blue-cross-blue-shield-health-index.