Overcome falling reimbursement rates in substance abuse treatment

Substance use treatment facilities panic over reimbursement rate cutsInsurers are doing to substance abuse treatment what they’ve done with the rest of the medical field — cut reimbursement rates, den claims, and raise the bar on getting paid. It’s no wonder, since spending on substance abuse will almost double by 2020.

This is creating distress and near-panic among substance use treatment providers. Most are searching for options to increase revenues or lower costs. Some are talking about closing their doors. Others are laying off staff or downsizing. Several are trying to become in-network providers for major carriers. 

With all the changes happening in addiction treatment, it can feel like everything is spinning out of control. Even knowing who will walk through your doors is an unknown. Most treatment facilities rely on verification of benefits (VOB) from insurance companies that only work “normal” business hours. With so many clients seeking treatment on weekend or off hours, obtaining VOBs before admission is sometimes not possible. If you’re a facility in the western United States or California, it can be especially challenging working with payers on the East Coast.

Regain control of your business

What if you could know how much insurance coverage a client had even when the insurance company was closed? If you even knew what the reimbursement rates were going to be? What if you could predict what level of care and length of stay that insurer was going to provide? And what if you could improve upon those predictions to increase billings even further?

Inspira allows you to know all of those things. We deal with insurance companies from across the United States. We know what their requirements are, what their reimbursement rates are for specific plans, and we know how to get the most from them — right down to the phrases they like to see on pre-authorizations.

Because we know these things, our customers know them, too. Inspira customers see predictions of what an insurance plan covers, what level of care they usually authorize, the length of stay they normally approve, guidelines for labs and diagnostics, and much more.

Predict billings for prospective clients

The power in predicting your client’s ability to pay is amazing. It removes the risk and worry of providing services that you will never be able to bill for. It also allows you to bill for services that might otherwise have been uncollectable.

One of our customers uses forecasted revenue to know how much effort to put into bringing the client to their facility. If the client has a Cadillac insurance plan, our customer might pay for a flight or a driver. If the insurance plan is particularly weak, it might be better to refer the client to another facility.

Knowing how much a client’s insurance will reimburse is just as important as knowing that they have insurance at all. That knowledge is valuable to facilities that have to allocate their beds wisely or that simply want to better project future cash flows. Seeing that data in real time — without waiting for an insurance company to open its doors — could mean the difference between expanding your business and closing your doors. 

Learn More

Inspira would welcome the chance to tell you more about how we can help you predict reimbursement rates and project future revenues. Contact us to schedule a discussion or give us a call at 844-877-7562. We look forward to hearing from you!