InSights for Behavioral Health and Substance Abuse Disorders

2025 at a Glance: Demand Up. Expectations Higher.

From coast to coast, providers reported spikes in patient volume and case complexity. But the rise in acuity came with rising administrative burdens.

• 🕒 Clinicians lose up to 14 hours/week to documentation—nearly 35% of their time.

• 📉 BH claim denials surged 30% higher than general medical specialties.

• 💸 Revenue leakage of 20–30% is common when billing workflows aren't aligned.

• 💰 SUD patients cost employers $15,640/year more in healthcare (JAMA).

• 📊 Societal costs (per HPI):

  • Alcohol: $166.5B

  • Smoking: $138B

  • Drug misuse: $109.9B

2025’s story was clear: clinical quality and billing accuracy must now move in lockstep.

Clinical Teams: Documentation & Telehealth in the Spotlight

For Clinical Directors and Program Leaders, 2025 brought sharper focus on documentation alignment and proof of care quality.

New requirements emphasized:

• Diagnosis-to-treatment-plan consistency

• Psychotherapy minutes and telehealth modality documentation

• ASAM criteria mapping

• Clear progress toward goals

At the same time, new tools made it easier to manage:

• ✅ ASAM-certified EHR workflows

• ✅ Digital intake + measurement-based care

• ✅ AI-powered predictive insights for relapse and crisis risk

• ✅ Fewer after-hours notes with automation

The goal? Less paperwork, more care.

Billing & RCM: Denials, Documentation Gaps, and What’s Next

Certainly, BH and SUD treatments can include physical procedures, but so much treatment and so many encounters are based on conversation.

If 2025 had a theme for billing leaders, it was this: adapt or fall behind.

Here’s what stood out:

• 📉 Denials hit a high—up to 1 in 3 claims rejected.

• 💬 Telehealth billing clarified—including approvals for audio-only mental health, family psychotherapy (90849), and home-based services.

• 📂 Documentation issues remained the top cause of denials.

With Medicare’s 2026 Physician Fee Schedule finalized (3.26% conversion factor bump but targeted service cuts), accurate coding and billing compliance will be more important than ever.

Where Tech Made a Difference in 2025

Forward-thinking organizations didn’t wait—they embraced automation to reduce burden and boost performance.

The top tech trends?

• 🧠 AI-supported therapy note generation

• 🔍 Predictive relapse/crisis identification

• 🧾 Smart claim scrubbing to catch denials pre-submission

• 📑 Automation of ASAM criteria into treatment planning

These aren't "nice to haves" anymore—they're essential.

Before 2026: What to Review Now

As we close the year, now’s the moment to evaluate where you stand.

✅ Documentation workflows
✅ Denial patterns
✅ Telehealth billing compliance
✅ ASAM documentation consistency
✅ EHR readiness for clinical + billing needs
✅ Alignment with 2026 Medicare changes

Start the New Year Strong with ADS

Whether you're looking to optimize your in-house workflows or prefer a fully outsourced model, ADS is here to support your care teams, your billing staff, and your patients.

✅ Request a documentation or workflow audit

✅ Schedule a presentation of our ASAM- and ONC-certified MedicsCloud EHR

✅ Ask for a denial pattern analysis on your 2025 claims

✅ Review your telehealth documentation before January 1

✅ Build a 2026 compliance checklist with our team

Need proof it works?

See how Harbor Hall and other BH/SUD providers rely on ADS to drive revenue, streamline workflows, and ease clinical documentation:

Let’s get you ready for 2026—with confidence.