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Revenue Cycle Management
Effective Revenue Cycle Management (RCM) is critical for SUD treatment centers in Minnesota to ensure financial stability and support their mission of patient care. RCM for SUD treatment has specific challenges and requires specialized practices compared to general healthcare.
Patient access and registration: Includes thorough insurance verification, financial policy clarification, and detailed demographic information collection.
Charge capture and coding: Ensuring accurate coding (CPT, HCPCS, ICD-10) for all services, adherence to payer requirements, and supportive clinical documentation.
Claims submission and management: Pre-submission claim scrubbing, adhering to payer submission rules and deadlines, and tracking claims through the entire process.
Payment posting and reconciliation: Accurate posting of payments, reconciliation against claims, investigating discrepancies, and applying contractual adjustments.
Denial management and appeals: Identifying reasons for denials, implementing corrective actions, and pursuing appeals as necessary.
Specific considerations in Minnesota
Medicaid coverage: Medicaid in Minnesota covers a wide range of SUD treatment services, including residential and outpatient care.
ASAM Levels of Care: Providers must be certified to provide specific ASAM (American Society of Addiction Medicine) levels of care to be reimbursed by Minnesota's Medical Assistance program (MHCP).
1115 SUD System Reform Demonstration: Providers can be eligible for enhanced rates under this demonstration.
DAANES reporting: In Minnesota, Substance Use Disorder (SUD) treatment providers are required to report client-level data to the Drug and Alcohol Abuse Normative Evaluation System (DAANES). This reporting is mandated by Minnesota Statute 254B.05, subdivision 1b. (3). All SUD clients, regardless of funding source, need to be entered into DAANES for each admission episode.
