Residential Treatment and DCS Contracts

London, KY
Best answers
I work for a mental health facility that has a contract with DCS as a residential treatment facility. We have a building for Level 2 and Level 3 patients. If they are in the state's custody, Level 3 clients' services are only billed to DCS. If they have private insurance, Level 3 client's services are billed to the insurance. However, we are also offering outpatient services for Level 2 clients, including IOP and individual/family therapy. It strikes me as odd that we are billing DCS a daily rate for Level 2 clients, but also billing insurance (Medicaid and private insurance) for their outpatient/therapy services as well.

When I was hired here, I was told that Level 2's stay was to be referred to as a 'structured group home', yet Level 3 is a residential treatment facility. I understand they are receiving a higher level of care with Residential. But my question is, if we are contracted with DCS as ONLY a Residential Treatment Facility, shouldn't the services for Level 2 be all inclusive, same as Level 3? It feels as if we are 'double dipping' by billing insurance and billing DCS as well.

I am very new to behavioral health and state billing for that matter. I want to be sure we aren't committing some sort of fraud.

Thanks for your help and comments!