The Collections Continuum- Reimbursement Guide from Treatment to Payment

The Collections Continuum- Reimbursement Guide from Treatment to Payment

October 28, 2020

We teamed up with the law firm Nelson Hardiman to put on a webinar for professionals in the behavioral health industry to provide education and tips on how to get the most out of their collections. In this webinar, CA Billing Co-Founder Abdul Ahmed and Nelson Hardiman Partner, Zach Rothenberg talk about the importance of maintaining immaculate documentation, how to best execute appeals, how to be proactive in dealing with “special investigative units”, financial hardship, patient financial responsibility, and how to best maintain data to help you moving forward in your business.

You can watch the full webinar below!


Would you like to learn more about CA Billing and what we can do for you? Visit our website to learn about our services or check out our frequently asked questions page. You can also call or email us to request a free consultation.


Behavioral Health HIPAA Compliance

Behavioral Health HIPAA Compliance

September 1, 2020

If you work anywhere in the realm of healthcare, you’re likely very familiar with HIPAA and the compliance required within the industry. In this blog post, we wanted to cover what HIPAA is, why it is so important within the behavioral health space, and what steps are needed to ensure compliance.

What is HIPAA?

HIPAA stands for the Health Information Portability and Accountability Act that was passed by Congress in 1996. The HIPAA Privacy Regulations require healthcare providers and organizations, as well as their business associates to follow procedures that protect health information and ensure the confidentiality of patients. This applies to all transferring, receiving, handling, or sharing of protected health information (PHI).

What is PHI?

Protected Health Information is considered to be any personally identifiable information as it pertains to the past, present, or future health status of an individual. This covers any health information that is created, collected, transmitted, or maintained by a healthcare organization. Examples of protected health information can include diagnosis, prescriptions, treatment information, and medical test results. This also includes personal information of the patient including their name, social security number, date of birth, emergency contact, phone numbers, and email addresses. All of this information needs to be protected and kept secure to ensure that a healthcare organization can be HIPAA compliant.

Why is HIPAA So Important for Behavioral Health?

Keeping privacy protected in healthcare is always important however with behavioral health-related issues it becomes even more important. Unfortunately, there are still so many stigmas associated with mental health. Many people still believe addiction to be a moral failing and so many still don’t see the validity of mental health conditions. There are ramifications that can come with someone’s treatment being discovered including loss of job, reputation, and relationship issues. Because of these reasons, behavioral health patient information must be protected.

Precautions To Ensure HIPAA Compliance

During the billing process, patient information including diagnosis codes, medications, clinical notes, and other information must be shared from facility to biller, and then to the insurance provider in order for claims to be processed and paid. This means it is essential that the billing company is HIPAA Compliant. All emails, communications, and transfers of information need to be done securely and with compliance in mind.


HIPAA and Telehealth

In the age of COVID-19, more than ever, people still need treatment for mental health and substance abuse-related issues. This has driven many providers to make the switch from in-person treatment to telehealth. This comes with concerns as providers must take extra precautions in order to ensure that HIPAA guidelines are still being met. Luckily there are many HIPAA Compliant platforms and services available including video conference and messaging applications.
CA Billing takes HIPAA compliance very seriously. Each employee, no matter what their department is certified in HIPAA compliance. We take great care to ensure the privacy and confidentiality of each patient’s claim that comes through our office.

Choose a Behavioral Health Billing Agency You Can Trust

Healthcare providers must ensure they are in compliance with HIPAA laws and that means they must choose their business associates carefully. When you choose us for your behavioral health billing, you can rest assured that we will not take your trust for granted and will do everything possible to protect the privacy of each and every one of your patients.

Would you like to learn more about CA Billing and what we can do for you? Visit our website to learn about our services or check out our frequently asked questions page. You can also call or email us to request a free consultation.


Tips to Avoid Claim Denials

Tips to Avoid Claim Denials

August 6, 2020

The world of behavioral health billing can be a confusing one. There are a lot of moving parts that go into submitting claims, getting authorizations, sending the right paperwork, etc. The hope is that by doing all of this your claims will pay in a timely manner, so your business can continue operating. However, we all know that sometimes you think you’ve done everything correctly and claims still get denied.

In this post, we’re talking about the top five things to consider in an effort to make sure your claims don’t get denied.

Understand the relationship between Utilization Review (UR) and Billing

 In the billing process, getting treatment services authorized in a timely fashion by the UR team is extremely important. After authorization is obtained, it is equally important to bill correctly according to the authorization and the insurance providers’ preferences. Claims can be rejected because the billed codes don’t match what the insurance provider put on the authorization or because certain insurance providers don’t consider certain codes acceptable for a level of care (we’ll discuss this later in the article). We’ve also encountered insurance providers incorrectly inputting authorizations into their system, for example, filing it under the wrong tax ID or marking authorizations as denied when they were not.

Document, Document, Document 

Sufficient medical record documentation is key for successful behavioral health billing. Inadequate documentation can trigger all sorts of issues with insurance providers including medical necessity denials, allegations that services were not rendered as authorized or billed, as well as audits. All of which can lead to delays and denials for claims billed. Documentation training is also key so all clinicians and staff are fully aware of how to document properly.

Be Familiar With Individual Insurance Providers

While many insurance providers expect a lot of the same things when it comes to processing claims, there are differences and subtleties between providers. Different policies may require different documentation so it’s important to be aware of that. In addition, certain providers will only pay for certain types of facilities. Lastly, certain insurance providers are more likely to deny services for medical necessity. Because of this, it is so important to have knowledge and experience with the insurance landscape and the specific needs of each insurance provider.

Keep An Eye On the Client’s Policies

 A simple mistake that can be made leading to a claim denial is if a patient’s policy ends or lapses during their stay at a facility. It’s key to ensure that all clients’ policies remain active throughout the duration of their treatment and that coordination of benefits is completed when needed.

Ensure All Paperwork Is Signed Up Front

Getting clients to sign paperwork is one of those things that can easily be breezed past, thinking you’ll just get to it later. However, the issue is that it can get missed entirely and facilities are unable to contact clients after they discharge. When the paperwork isn’t signed, reimbursement for entire stays can be lost. We advise getting all client paperwork signed upon admission — including documents assigning rights to the facility for payment.

At CA Billing, we pride ourselves on extreme attention to detail so none of these key elements for proper claim processing slip through the cracks. As a business, we know how important it is that claims get paid, so you get paid — so we do everything in our power to make sure that happens. Learn more about how we can help you with behavioral health billing and avoid claim denials by contacting our office and requesting your free consultation.

Let’s Talk About Verifying Benefits (VOBs)

Let’s Talk About Verifying Benefits (VOBs)

June 18, 2020

What is a VOB? 

A VOB, or a Verification of Benefits is a process by which the insurance benefits are checked for a potential incoming client at a substance abuse or mental health facility. This process entails making sure their health insurance is active, the payments are up to date, finding out the deductible and out of pocket max, as well as a variety of other questions.

This process can either be done by someone in-house at a facility or it is often times done by the outside billing company.

Why are VOBs so important? 

Verifying benefits for an incoming patient is crucial. By checking all of the information needed a facility will do its best at limiting any surprises when it comes to a patient’s insurance coverage, or more importantly what it won’t cover. In addition, because the billing cycle is typically a week behind, if a VOB is not done properly there is a chance a patient will be in your care without valid benefits and as a facility you won’t receive any financial compensation. VOBs are also often times used when it comes to payment appeals. If an insurance company comes back and says something isn’t covered, the biller can refer back to the VOB and use that as proof that payment should be given.

Most important factors of doing a VOB: 

1. The right form asking the right questions 

You can’t do a proper VOB without having the right questions to ask. Often times insurance companies aren’t always the most forthcoming with information so it’s imperative to make sure you’re armed with the right questions.This is important because often times different insurance companies have different stipulations, variations, and needs for each policy.  That means each VOB form should have the correct questions for each of insurance company. Asking all the right questions will also help identify any red flag policies that could potentially slip through the cracks. For example, every VOB form needs to include the insurance representative’s name and reference number for the call – if that isn’t noted it will be near impossible to appeal a claim later on. Ideally, the VOB call is recorded to refer to if necessary during claim follow up or the appeal process.

2. Accuracy

 Once you have the right questions to ask, the next step is to make sure everything is collected carefully and accurately. The information collected through a VOB is used by each facility to determine if a patient is going to be a good fit for their program. If the information collected is inaccurate, it doesn’t equip the facility to make the correct decision. In addition, as mentioned earlier in this post, VOBs are often referred back to and if the information is inaccurate this can affect every stage of the billing cycle.

3. Timeliness 

The behavioral health space can often times deals with immediate crises. Calls come in at all hours from patients needing help. This makes it all the more important that a VOB be done in a timely manner as to not miss the window of opportunity to have a patient come in. There is always going to be variation depending on hold times but most VOBs can be done within 60 minutes during a normal business day.

4. Having the right data set to refer to 

Once all of the information has been collected accurately and in a timely manner the final factor in determining whether or not an insurance policy is a good fit for a facility is the right data to compare it to. Even with all the right questions asked and information obtained, it can still be hard to determine how well a policy will pay. However, if you have a comprehensive data set  to see how the same policy has already performed within a facility you’ll be able to make a much more informed decision. The bigger the data set you have to refer to, the less likely you are to run into a policy you’ve never seen that could end up not paying well. This is one of the benefits of using an outside billing company, they typically have a much broader scope when it comes to policy data.

Behavioral Health Billing in the Face of COVID-19

Behavioral Health Billing in the Face of COVID-19

14 April, 2020

By this time, the COVID-19 pandemic has affected almost every industry in this country, the behavioral health space included – however, this industry is rightly still considered essential and so as a behavioral health billing company, we are still operating full steam ahead for our facilities while practicing safe social distancing with our employees. We wanted to take some time to share some of our observations, insights and updates from CA Billing and the industry at large. 

  • Moving into Q2: We’ve hit April so the first quarter is over! Historically this means insurance reimbursements should begin picking up as deductibles and out of pocket maxes have been hit. 
  • Admissions still coming in: People are still seeking help for substance abuse and mental health. At CA Billing we are still running a lot of Verification of Benefits and seeing admissions come through, so even in the face of this pandemic behavioral health facilities are still providing care and services to clients.  
  • Telehealth for social distancing: Insurance companies are encouraging facilities to utilize telehealth to help stop spread this virus. The good news is that once this is set up, the reimbursements and claim processing timeframe are the same for traditional services. If you need assistance setting up telehealth, please reach out to us we’re happy to help. 
  • Strategic In-Network Contracts: As a facility have you thought about going in-network with any providers? We wanted to go through some of the benefits of being in-network: 
    • Consistency:  As an in-network facility you are guaranteed reimbursement rates for each level of care. This means as a business you are better able to project your income coming in and make more definite plans for your business.
    • Easier Claims Process: As an in-network facility your claims will be processed faster with less processing issues. Also a smaller number of claims will get denied so there will be less claim follow up.

CA Billing helps our facilities strategize which insurance carriers make sense to develop an in-network contract with. Based on your location, services you provide, and your marketing we can help you determine what makes the most sense for your business. 


If you have any questions about your billing, whether you are one of our facilities or not please feel free to reach out. Also, we have some exciting new data tools coming out in the next several months for the facilities we work with and we can’t wait to share. 

Behavioral Health Facilities, should you hire an outside billing company?

Behavioral Health Facilities, should you hire an outside billing company?

12 December, 2019

There comes a time for every behavioral health facility to decide whether it makes sense to build an in-house billing team or hire an outside company. There’s no one size fits all answer for every company but there are some advantages of hiring an outside billing company to keep in mind when making your decision.

  • Specialized in the behavioral health industry: Hiring an outside billing company can ensure that the people doing your billing will be more specialized in your industry. There are huge differences between different kinds of medical specialties and especially in something as intricate and specialized as behavioral health, there are a lot of benefits in going with an outside company. In addition when it comes to audits from insurance companies, outside billing companies typically have the resources and experience to effectively deal with the carriers to rectify the audit. Here at CA Billing we’ve been able to identify a client is in an audit when they weren’t even aware of it. If payments drop significantly or stop altogether, many in-house biller’s are not able to diagnose the root cause and we’re able to pinpoint the issue and get reimbursements back on track in a timely manner.
  • Bigger data set to see trends: One of the biggest advantages going with an outside billing company is their unique capabilities to see trends across different insurance providers. When you have an in-house billing department, you’re only really able to see what’s going on with the patients/clients you have currently in your care. While a lot of behavioral health facilities are feeling or experiencing decreases in reimbursement, our clients are seeing increases due to the extensive data we’re able to leverage benefiting all clients we work with. Combining this data set with our expertise and experience in the industry allows us to stay ahead of trends.
  • Better ability to provide information on verification of benefits based on our data: As an independent billing company we see a very broad range of policies every month,  not just a couple dozen from one facility. This along with our data-driven approach gives us the pulse on what policies are doing and what they are paying. While most facilities and billing departments are able to give a somewhat educated guess on whether or not to take a certain policy, we are able to provide detailed estimated reimbursements on what the policy will pay, giving our clients the best information to make well-informed decisions for their business.

So, do the benefits of hiring an outside billing company outweigh the cost?

  • You will have to hire someone anyway to do your in-house billing
  • With the expertise of an outside billing you will typically far more than make up for the billing fee through higher reimbursement, audit management, expert appeal response- ensuring all avenues for reimbursement are pursued.
  • Have a pro handling your billing will free up your time to focus on providing the highest quality level of care and building your brand.

While there are reasons to invest in building an in-house billing department, there are many advantages of hiring an outside company with expertise, experience, and a breadth of knowledge and data.