CLINICAL

 

As health care providers, we know you want to offer the very best quality care to each of your clients.  Understanding their coverage will help ensure they are receiving maximum benefits, and resolve confusion or conflict that may arise by using other medical billing specialists.  At Skyline, we are an industry leader working primarily with substance abuse and mental health facilities, including sober living environments, rehabilitation centers, inpatient and outpatient facilities, and more. Our goal as a medical claims and billing specialist is to make your facility run smoothly from the technical and billing side.  We are able to collaborate with you to provide any specific billing services that your company requires.  We pride ourselves in an ethical and effective approach that allows facilities to focus on the treatment of the patient.  The patient is always our top priority and we believe our superior knowledge of insurance criteria allows for the staff at your facility to focus on the treatment of the patient.

Medical Necessity

Skyline Billing’s Clinical Team has expertise in demonstrating co-morbid mental health disorders that are frequently associated with elongated exposure to substance use.  This allows us to assist in training your staff in documentation of medical necessity per each Insurance payors unique criteria.  Insurance Companies thrive on co-occuring disorders involving mental health and substance dependence.  By documenting these symptoms and providing a unique treatment plan tailored to addressing both mental health and substance dependence the necessity for continued stay has validity.   It is paramount in order to receive the most days possible at the highest level of care to document these symptoms and treatment in a way that ensures medical necessity.

 

Demonstrating that each client has unique symptomlogy consistent with physiological, emotional, and behavioral dependence on drugs or alcohol is our primary purpose ensuring the client is authorized for admission into a drug rehab or alcohol treatment program for substance abuse.  We value our staff as experts in demonstrating co-morbid mental health disorders that are frequently associated with elongated substance use. Providing up to date clinical notation allows you to focus on treating the patient while you have confidence that our trained and licensed clinical staff has the necessary expertise to maximize the level of care and number of day's authorized for your clients stay.

 

Pre Authorization

The initial phase of making sure a client receives the services your facility has to offer, is making sure the insurance company has the necessary information to make a determination that your facility will meet the requirements for the level of service the client will need. Making sure the initial intake assessment provides a thorough background of information surrounding the client’s history of use, biomedical concerns, family problems, emotional and behavioral problems and many other intricacies that will allow your facility to garner more day's at a higher level of care. The intent when seeking treatment for a client is to make sure the services being rendered match the current level of intoxication, withdrawal or dependence to ensure the client has a continuum of care that will allow the most effective treatment plan for sustained recovery.

 

The initial process of releasing the information pertinent to the client receiving the treatment they need, is one of the most important processes in utilizing the benefits the client has access to through their insurance benefit. Making sure notation is meticulous and provides the necessary information that clinicians look for when determining what level of care a client needs. This enables our team the opportunity to help your clinicians understand correct notation while walking them through the proper level of care guidelines will ensure your client receives the most possible day's at the maximum allowable level of care based on medical necessity.

 

Utilization Review/Concurrent Reviews

Our Utilization Review approach encompasses a comprehensive means of treatment for clients, ultimately guaranteeing you faster response times along with more day’s authorized for each client. Many billing companies do not understand the importance of clinical expertise when it comes to the utilization review process, this limits their ability to build a case that treatment is medically necessary. With our experienced staff who approach the concurrent review with the same tenacity that most insurance companies employ to validate denials.

 

 Incorporating our Clinical approach along with a dedicated billing department separate from the medical portion of our staff, we utilize a tool that most companies have failed to recognize. A clinical based approach that drives the billing practice, allowing for more days through the review process as a clinician is handling the basic needs of the client, garnering a greater validation of medical necessity through clinical formulation. Basically, what we do works, less hassle, less question, more money. That Simple!

 

Residential Substance Abuse/Mental Health Insurance Billing

Residential Treatment utilizes 24 hour monitoring and structure to ensure the client is not a danger to themselves or others.  This level of care is usually provided when a client has failed at lower levels of care or has escalated substance use or route of administration.  A client that enters into this level of care has severe psychosocial stressors that have been exacerbated by the clients continued use.  This level of care incorporates a more aggressive medication management regime and identification of skills that later can be implemented in lower levels of care.  Rule out of differential diagnosis as the client clears from illicit substances and a treatment plan can be developed to obtain enough information to effectively treat the client in a lower level of care.  Creating a firm foundation for the clients treatment that demonstrates a multi-faceted approach ensuring safety and ability to step down to a lower level of care.

 

Partial Hospitalization Insurance Billing

Partial Hospitalization or PHP, drug treatment programs, use a multi-dimensional approach to substance abuse treatment, both treating the addictive disorder itself while also addressing the underlying cause and condition of the behaviors associated with the addiction.

 

 The key benefactor or creating a multi care level of treatment truly is the client;  This is why we do our best to make sure your clients have the necessary authorizations for Partial Hospitalization levels of care, ensuring your client stays with you as long as medically necessary. Not only does this allow the client to engage in a much longer treatment stay, it enables our approach to emphasize medical necessity that each client’s meets individually to allow maximum days of billable services

 

Intensive Outpatient Drug Treatment Billing

Clients who have either been through a higher level of care or are admitting initially into an outpatient level recovery program require the same authorizations as those in a higher level of care. Most often, we utilize outpatient benefits as a step down, for those who have been through previous treatment at your facilities residential drug treatment or partial hospitalization substance abuse treatment program. Outpatient Drug Rehab is a great continuum of care for those looking to emphasis what your program has to offer. This allows us to maximize days of authorization at a lower level of care, once the client has shown stable mood and affect, along with marked progress at a higher level of care.

 

Utilizing outpatient drug counseling and addiction therapy as a primary level of care, is generally used when an individual has no Residential benefit on their policy, or they show signs they can adapt and function in everyday life without a highly structured environment. Clients that are not dealing with any post-acute withdrawal symptoms, may also be prime candidates for a less intensive level of care, as their physical condition does not warrant 24/hour a day medical supervision.

 

For outpatient levels of care it is vital to document in the client’s medical records an exposure to psychosocial stressors and is provided an added level of accountability while attempting to implement the skills taught in a higher level of care.

 

General Outpatient Behavioral Health Billing

General outpatient is more often used as a step down level of care from an intensive outpatient level of care, making sure clients maintain their treatment plan is vital in long term sobriety, our effort is to make sure clients are provided the necessary authorizations from their insurance benefit, to ensure they have the necessary days allowed to maintain their treatment stay. This is done through both live and submission reviews, of medical records, to ensure the client meets medical necessity for general outpatient drug treatment, in accordance with each insurance company’s independent criteria.

"Our mission is to offer the highest level of service that is focused on streamlined systems and procedures. We  strive to implement our experience and knowledge of insurance billing that enables our facilities to focus on their patients and have full transparency of the billing process at their disposal.”

          - Kevin Monson, CFO

Skyline Billing