What the work is
Claim submission is the smallest part. The cycle starts before admission with verification of benefits, where someone confirms the plan, the deductible, the out-of-pocket maximum, whether the facility is in or out of network, and whether the level of care needs prior authorization.
Then comes utilization review. Payers authorize a few days at a time and require a clinician to call and justify continued stay against medical necessity criteria. Miss the review window and the days are unpaid regardless of what the chart says. This is where programs lose the most money, and it is a clinical job wearing a billing job's clothes.
After discharge the work is appeals. Denials in this space are routine, and denials reverse when someone writes the appeal with chart citations instead of resubmitting the claim. A billing company that does not appeal is leaving your revenue with the payer.
The codes and levels of care they have to know
Addiction treatment is billed against ASAM levels of care: outpatient, intensive outpatient, partial hospitalization, clinical withdrawal management, and the residential levels between them. Each maps to codes and revenue codes, and the mapping is not identical across payers or states.
Behavioral health uses HCPCS H-codes and S-codes that a general medical biller rarely touches, plus revenue codes on the UB-04 for residential and per-diem billing. Psychiatric and therapy services on the professional side use the standard CPT set for evaluation and psychotherapy. A biller who has only worked in a primary care or specialty practice has usually never billed a per-diem residential day in their life.
Ask a candidate to walk you through how they would bill a client who steps down from residential to partial hospitalization mid-week. The answer tells you within two minutes whether they know the vertical.
How they charge, and what that incentive does
The standard arrangement is a percentage of collections, which pays the biller when you get paid rather than when a claim goes out. Some charge flat monthly fees or per-claim rates. Percentage deals are common enough that a flat-fee pitch deserves a question about why.
Watch what the percentage rewards. A biller paid on collections has every reason to chase the large out-of-network claims and let the small in-network ones sit. Ask for reporting by payer and by level of care so you can see where the attention goes.
The going rate to benchmark against is typical percentage-of-collections rate for behavioral health billing companies — confirm. Anything far below it usually means submission only, with no appeals work attached.
The compliance edges that matter
Substance use disorder records carry protections beyond HIPAA under 42 CFR Part 2, which restricts redisclosure of information identifying someone as a patient in a program. Your billing company touches that data constantly. They need a business associate agreement, and they need to know Part 2 specifically, since its restrictions go further than HIPAA's.
Payment arrangements that turn on patient volume can implicate the Eliminating Kickbacks in Recovery Act, which applies to recovery homes, clinical treatment facilities, and laboratories. Compensation structures for anyone touching patient referral or admission belong in front of healthcare counsel before they are signed, not after.
If a billing company also offers to send you patients, treat that as a different conversation with different legal exposure. Those two services sitting in one contract is a signal to slow down.
Where billing and marketing meet
Payer mix decides who your marketing is allowed to talk to. An in-network program with three major commercial contracts needs a different message and a different geography than an out-of-network program relying on PPO plans and private pay.
The number worth tracking is admissions and revenue by referral source, which requires call tracking on the front end and a CRM that carries the source through to the billing system. Most programs can tell you what they collected and cannot tell you which marketing channel produced it. That gap is fixable and it is not a billing problem.
We do not do billing. We make the phone ring and we build the tracking that ties a call to an admission. Claims stay with your billing company.