Webinar: Insurance Billing and Reimbursement Complications Within the Addiction Recovery Industry

a photo of a calculator and paperwork, with the following words superimposed: 'Insurance Billing and Reimbursement Complications Within the Addiction Recovery Industry'
  • Date Recorded: May 26, 2016
  • Presenters: Harry Nelson and Kathryn Edgerton
  • Length: a little over 36 minutes
  • CE: this webinar is not eligible for CEs
  • Price: free

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Insurance companies are increasingly conducting reviews of behavioral health and substance abuse treatment program providers and are looking for cases of fraud and abuse. Their special investigation units are demanding the recoupment of fees paid to such programs based on lack of licensure, certification, and accreditation, questions regarding the appropriateness of claims, and questions regarding the adequacy of documentation for clinical services.

What are the key issues insurance companies are raising to demand recoupment of fees from substance abuse treatment programs? What can programs do to prevent such inquiries?

In this webinar, you will learn:

  • recent trends
  • the reimbursement minefield
  • practices that raise the risk of claims of fraud & abuse
  • understanding insurance companies’ fraud & abuse arguments
  • risks related to the substance of a claim
  • risks related to the billing of a claim fraud and abuse – payor concerns
  • pre-authorization/verification of benefits
  • billing and coding challenges on the horizon
  • and strategies for reducing risk


Harry Nelson

Harry Nelson

Harry Nelson is the founder and managing partner of Nelson Hardiman, LLC, as well as the chairman of Behavioral Health Association of Providers.

Beyond his legal expertise, Harry is known nationally as a consummate leader at the intersection of healthcare law and business, as evidenced by his role in co-founding five healthcare-related start-ups in the last decade. Deeply immersed in healthcare transformation and innovation; he frequently speaks on cutting edge issues and the future of the industry itself.

Kathryn F. Edgerton

Kathryn F. Edgerton

Kathryn F. Edgerton is a partner in Nelson Hardiman’s Regulatory Compliance and Transactional practice groups.

Kathryn has built a significant practice advising hospitals, physician organizations, addiction treatment and behavioral care providers, long-term health providers, telemedicine providers, home health providers, medical spas, and other health-related organizations on the complex transactional and regulatory issues impacting the healthcare industry. Drawing on her experience as counsel to approximately 70 addiction treatment providers, Kathryn brings a practical perspective to her work advising on day-to-day operational issues, as well as business and regulatory concerns.

Webinar: Insurance Billing and Reimbursement Complications Within the Addiction Recovery Industry

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