Inpatient and outpatient drug and alcohol billing is
entirely different than most medical billing. If the clinic is
credentialed as a facility insurance claims must be submitted on UB04
claim forms rather than the more common CMS 1500 forms.
Many drug and alcohol
facilities do not participate with insurance companies
because the billing is so different than most billers are accustomed
to. As with most of the specialties, most clients would prefer
go to a participating provider over a non-par one.
If the
clinic is listed under the provider and not a facility, you must bill on a
CMS 1500 when doing drug and alcohol rehab billing. The best
way to know which form you should be billing on is to call each individual
insurance company you participate with and ask if you are listed as a
facility or a professional provider.
The problem with billing on the
wrong form is that many insurance carriers will deny a claim
if it is not billed correctly. If you participate with an
insurance company as a drug and alcohol facility and bill on a CMS
1500 form your claims will most likely be denied. If you are having difficulty getting your drug and alcohol rehab
claims paid, we can help. We specialize in this type of billing. You can contact Michele or Alice at 1-800-490-4299.
Completing the UB04 forms
can be a challenge for anyone who has billed only on CMS 1500 forms.
There are several requirements you don't see on CMS forms. Rev
codes, value codes, and type of bill are required on the UB04
form. Here is more information on
completing a UB04 form completely and
correctly.
In New York State you
cannot counsel clients for drug and alcohol addiction except at a licensed Oasis facility. You can treat a
patient for depression who has a drug or alcohol problem, but all drug and
alcohol treatment must be done at an Oasis licensed facility.
