Itemized Bill Requests for Residential Treatment Facilities

Insurance companies continue to change policies around how they reimburse claims and and how they want to see services billed. In the past, residential treatment facilities submit a single code for a full day of inpatient care. This code and rate would cover all of the services provided in that day, whether the patient went to group or individual therapy, had a lab test, or received other services.

This system made it simple for providers to offer the care their patient needed and also bill easily. But lately the major insurance companies have changed the rules, requesting itemized bills for large and expensive claims. Many residential facilities have never had to submit these bills and may not even understand what is required.

For an itemized bill, payors want to see, line by line, the charges for each individual service provided during that day. They want to know how much you charge for individual therapy, a blood test, medicines, and any other services or supplies your patients used that day.

Itemized bills place a much larger burden on your facility’s staff and can present challenges such as:

New Billing Processes to Learn

Your staff members now have to ensure that they carefully record and code each and every service a patient receives. And your billing staff has to learn the correct codes for these services, too. Learning these new processes and codes can be a slow process and slow down your normal billing pace.

Takes Longer to Bill

Because each patient may also receive different services on different days, your billers now have to spend a longer time detailing each bill. Instead of being able to send off simple bills, they have to spend time with each bill, greatly slowing down their normal pace and delaying when you receive reimbursement.

Inconsistent Need for Itemized Bills

Another task that may slow down your billing staff is learning when they have to use an itemized bill. Each payor now has different requirements for when an itemized bill is used.

While typically any bill over $20,000 will require itemization, Cigna and United Behavioral Health now want an itemized bill for any bill over $10,000. Anthem requires an itemized bill for anything over $40,0000. The type of plan your patient has may also change whether or not their policy requires an itemized bill.

At Datapro billing, our experts can help you navigate new insurance regulations and train your staff to provide fast, efficient billing. Contact us to discuss your billing policies, staff training, and other services that can improve your billing efficiency and decrease unpaid claims.