Compliant and Competitive

Have you noticed some changes lately in revenue for your treatment center? Within the past five years, it seems like it is becoming harder and harder to find the funds to keep your center fully staffed, your utilities paid, and your clients receiving the best possible care.

Of course, as it is with any treatment center, the goal is to give the best possible care to your clients and help them reach long-term recovery. But how much longer can you just keep getting by? Are there any other ways to increase profits?

The answer is not at all hard to find. It actually comes with compliance and responsibility that you can increase your bottom line revenue with ease. The answer lies in collecting patient responsibility.

What Is Patient Responsibility, and Why Does It Matter?

Patient responsibility is exactly as it sounds. It is the portion of a bill that the patient is responsible for — their deductible, co-insurance, or other out-of-pocket expenses.

Patient responsibility often represents about 16% of total revenue, up from only 6% several years ago. That's a lot of revenue that you need to perform your services.

Talking about money — especially collecting it from patients and families that may have financial troubles stemming from their addiction or mental health disorder — is not an easy topic for anyone. However, it is a must-have conversation for any treatment center that wants to remain open and successful.

In looking at collecting patient responsibility, there are two separate factors to consider as a treatment center: revenue and compliance.

The battle to remain competitive and thriving in the current climate of treatment is a financial challenge. As revenue streams have shifted in the past decade, it is on each treatment center to figure out how to remain profitable, a challenge that is increasingly hard to meet.

It is also the job of the treatment center to remain compliant to law. To gain a competitive edge, the easiest route seems to be cutting corners and giving patients added incentive in what is offered. Most times, this is the opposite direction of what must be done and is often an illegal practice.

Figuring Out Finances

As mentioned above, it is not easy to talk about money in general, but especially in treatment. Those that run treatment centers have seen all walks of life enter treatment with financial burdens from their substance use disorder, not to mention the strain it puts on a family.

The reality is though, now more than ever, these conversations must happen as we see changes in revenue streams across the landscape of treatment.

TJ Ferris, President and Founder of The Revenue Solution, explains why we have seen changes in revenue at treatment centers and why it has become increasingly more important for centers to understand where money needs to come from in 2021.

“Patient responsibility continues to grow,” Ferris said. “Deductibles continue to rise for individuals, out-of-pocket maximums are rising, and their premiums are also increasing. These things going up leads to a patient’s financial portion of treatment meaning more and more. In just the last 10-15 years, the portion that patients are responsible for paying has probably tripled.

“At the same time, insurance reimbursements have gone down,” Ferris said. “Treatment centers are not receiving as much money as they have in years past from insurance companies. This makes it ever more important for treatment centers to get a strong understanding of patient responsibilities and the importance of collecting it, while also maintaining a reputation of successful treatment.”

To stay competitive in 2021, learning the correct way to collect patient responsibility is the key.

Who Is Responsible for Compliance Anyway?

Standing right beside the financial aspect of patient responsibility is compliance. It is easy to not consider maintaining complete compliance to laws and regulations, but when the problem arises, it arises in a very big way.

Compliance in patient responsibility requires strong and exhaustive documentation and good faith attempts at collection. When brought into question by an insurance company, evidence is key in protecting yourself and your center.

“Plain and simple, a treatment center is committing insurance fraud if they are not running exhaustive efforts in collecting patient responsibility,” Ferris said. “There is a huge risk in waiving patient responsibility for many clients if you are a treatment center. You run the risk, most commonly, of being put on a pre-payment review from an insurance company. In this situation, the insurance company will refuse to pay your center until a full review is completed. Those reviews happen on ‘insurance time’ meaning however long it should take to complete the review, multiply that by four and then expect to wait longer. And it gets [worse]: if your center cannot demonstrate that they have been making exhaustive efforts to collect these funds then payers will attempt to claw back the last three years of payments. These delays in paying claims and clawbacks are designed to choke out providers, plain and simple.”

The issues that can come from a lack of compliance do not end there.

“In the grand scheme, you run the risk of losing your livelihood,” Ferris said. “It does not take long for a treatment center to have to close their doors when insurance money stops coming in. Also, let's not overlook the fact that insurance fraud can lead to criminal penalties as well.”

Call Upon the Experts

Through years of work, The Revenue Solution has come to perfect the art of securing substantial amounts of patient responsibility. With years of service in substance use and mental health treatment among the staff at The Revenue Solution, there is an understanding of the delicate and serious nature of treatment. This keeps clients and families happy and able to feel comfortable throughout treatment.

Along with collection efforts, The Revenue Solution also steps in to help your program remain compliant with detailed documentation to protect you from clawbacks from insurance companies.

The Revenue Solution Is Here for You

If interested, please know that The Revenue Solution does not charge up-front fees nor monthly fees to their clients. As a client of The Revenue Solution, you should know that they do not get paid until you get paid.

If you are ready to begin the process of getting a leg up on competition with compliance and revenue, The Revenue Solution is ready to hear from you. You can reach TRS online at, emailing, or by calling (844) 314-8867.