Billing > Facility Billing

Fees for Substance abuse and Mental Health

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billingmom:
I still havent been able to find anything out on how much a facility for sub abuse and mental health charge in Florida.  If anyone knows where I can find out please fill me in.    Thanks

PMRNC:
Do you mean the provider's rate's? or are you looking for help in what to charge mental health providers.

billingmom:
No not providers.   What they are able to bill insurance companies for fees.  Im thinking there has to be a standard rate out there for inpatient and out patient substance abuse and mental health facilities as well as fees for counseling sessions etc.

billingmom:
What I mean is how much can an inpatient or outpatient facility that provides detox, inpatient treatment or counseling sessions etc. charge as a daily rate.  How do they determine the fee?  Do they just throw out a charge and tell the patients we charge 1,000 per day and we bill your insurance and they only thing your responsible for is dedcutible, co pay, and out of pocket expenses.  I'm seeing that these substance abuse and mental health facilities all charge different rates for the same program.  I came across one that charges $1395.00 per day for residential treatment and then their fees come down a little as the patient is downgraded or stepped down to PHP or IOP services but they still charge alot and bill everything on UB 04.   Im just wondering if there is a price guideline that they have to abide by or do they just set a fee and bill the ins.

DMK:
What's really important for new billers to understand is that facilities and providers can CHARGE anything they like.  The insurance companies set the ALLOWED amount, and all insurance companies have different allowed amounts.  The CHARGED amount  will vary from state to state, area to area, since overhead will vary depending on where your facility is located.  The charged amount helps to set the Usual & Customary fee for each area.  Usual & Customary fees charged are used to determine out of network benefits for some insurance companies.  So there is no specific place to go to find the magic fee for a particular service. 

You may want to call a few insurance companies and find out what they ALLOW for particular programs.  You'll need CPT codes to get allowed amounts.  The fees should always be set higher than the allowed amounts since whatever you charge will be used to determine Usual & Customary fees for your whole area.  So one facility trying to undercut other facilities by having rock bottom prices actually hurts all the other facilities by lowering the U&C average.  That's one of the reasons the whole healthcare system is having trouble.  Doctors and facilities have to be able to make a living in order to stay in business.....and it is a business.

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