Submitting Claims for Suboxone Therapy

Suboxone is a drug that is used in treating drug addiction. It is very effective and does not require inpatient treatment. Physicians must be certified to prescribe Suboxone and have other guidelines they must follow.

For example, on the first visit the patient must come in to their appointment in the early stages of withdrawal. The dr must document their condition and then give them the first dose of Suboxone in the office. Then they have to wait for the drug to begin to take effect. The patients condition is documented again and instructions are given.

The Suboxone works much like Opoids, but unlike Opoids the patient can be weaned down and in most cases completely off of the Suboxone. This can all be done with outpatient medical visits and eliminates the need for an inpatient stay.

Sounds good so far, the problem comes in when you submit the claims to the insurance carriers. Since the diagnosis begins with 30*.** the insurance carriers pick the claim up as mental health. Many carriers handle their mental health claims differently than their medical claims and some even subcontract their mental health to a different insurance carrier. Most mental health services require preauthorization. However, suboxone therapy is a medical service and is coded as a medical office visit.

Since Suboxone therapy is a fairly new treatment many insurance carriers do not know what to do with these claims. We are finding that we have to educate each carrier as to what Suboxone is and go thru a huge process with them in order to get the provider reimbursed properly for their services. One carrier in particular was telling us when we called that preauthorization was not required, but they were denying all claims stating no preauth was obtained. After 6 months of phone calls we finally got it straightened out. They had to make some adjustments to their system to allow the claims to process correctly but the provider got reimbursed for all visits.

We still have some insurance carriers not processing the claims correctly but most are starting to get the hang of it. We just keep plugging along and educating the carriers on what Suboxone therapy is. After all, in the long run it saves them money on the inpatient stay.

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Huge Changes Ahead for Medical Billing

Something has been developing in the world of medical billing that is going to change the whole process of submitting medical insurance claims to the insurance companies in a big way. We who are immersed in the field are used to changes. Codes are always changing. We all had to get used to obtaining and the correct use of NPI numbers. Now insurance companies are telling us that we will be required to use taxonomy codes. Universal credentialing is now required by many insurance companies. But these are all small in comparison to what we will soon be seeing.

As technology develops changes are unavoidable. Often it seems as if the new technology only makes things more complicated and more expensive. Changes such as NPI numbers require new software updates which can be quite costly. As it is, a good medical billing software package can cost thousands or tens of thousands of dollars for the initial purchase. Generally a new version comes out every year requiring the additional expense of updating the software. For a small doctor’s office or a new medical billing service this expense can be out of the question. This is one of the reasons we see so many doctors joining groups directly out of school instead of opening their own practices. It is just too costly to set up their own offices.

Now we see a change coming which can turn the world upside down for the small medical office and medical billing services. SaaS technology has brought about the ability for the little guy to compete with the big boys at not only an affordable price, but a money saving plan.

The development of web based medical billing software over recent years has really changed the work flow process in the offices that could afford it. One advantage of web based software is that it has added features which eliminate the tedious work of running aging reports. Claim status can be checked automatically on a daily basis with problem claims being routed to a queue. Payments of insurance claims can be posted electronically eliminating hours of tedious data entry. And these are just two of many major time saving advantages. The big disadvantage was the cost. Web based software is generally extremely expensive. But that was before SaaS.

Software as a service (SaaS) has allowed a company to emerge which offers the same benefits of web based software for a fraction of the cost. Now for $99 a month per seat a doctor’s office can enjoy the benefits of web based software with no up front costs. The cost to a medical billing service with unlimited providers is $149 per month per user. This is much less than the cost to most offices of updating their server based software and paying for support.

The benefits of web based software are obvious but up until now the cost wasn’t justified. Now, due to SaaS, any office can enjoy all the benefits at a fraction of the cost of other web based software. For more information on Xena Health and the SaaS technology, you can contact Alice or Michele at 1-800-490-4299.