Common Billing Mistakes in Substance Abuse Treatment

Substance abuse treatment billing includes multiple levels of care, authorization timelines, and payer-specific rules. The most common billing issues usually come from small workflow gaps that compound over time.

Below are the mistakes we see most often—and the process fixes that prevent them.

1. Incomplete intake documentation

When intake documentation is missing clinical details or payer-required forms, the claim starts weak. This leads to delayed submissions, rework, and denials.

Fix: Use a standardized intake checklist that includes diagnosis, level of care, coverage details, and consent forms.

2. Authorization tracking handled inconsistently

Authorizations that expire mid-stay create immediate denial risk. This is especially common when multiple clinicians share responsibility.

Fix: Centralize authorization tracking and assign clear accountability for updates and renewals.

3. Claims submitted outside authorization limits

Even correct codes can be denied if they fall outside approved service windows or levels of care.

Fix: Tie billing review to authorization dates and levels of care before claims go out.

4. Credentialing gaps for new providers

New clinicians may begin seeing patients before payer credentialing is complete. Claims submitted under the wrong provider or before enrollment are often denied.

Fix: Track credentialing status for every provider and align scheduling to payer approvals.

5. Denials tracked without root-cause analysis

Many teams appeal denials but never identify why they happened, leading to repeated denial cycles.

Fix: Log denial reasons, categorize them, and adjust documentation or workflows to prevent repeats.

Final takeaway

Substance abuse billing errors are rarely about one bad claim. They usually reflect a missing step in verification, authorization, documentation, or follow-up. A structured workflow with clear accountability protects revenue and reduces rework for clinical teams.