Coding and Billing for Mental Health Services 2018 Code Updates: CPT, ICD, DSM-5, and HCPCS Level II Code – Sherry Marchand

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Coding and Billing Strategies for Optimal Reimbursement

Comprehending the requirements for procedure code and policy changes have further complicated the reimbursement process for all psychiatrists, psychologists, social workers, therapists, counselors, and clinical nurse specialists.

This recording will provide training on the major elements of coding and billing for mental health services and consolidate all of the new requirements with existing code rules and proven billing techniques in a comprehensive course, taught by an expert speaker and a veteran reimbursement analyst and coding and billing specialist. The areas of psychiatry for evaluation and management services and medication management, psychotherapy services, health and behavioral assessments and psychological and neuropsychological testing will be covered, along with specifics such as Inpatient Psychiatric services, Partial Hospitalizations, Detox coding, Intensive Outpatient and Outpatient services. Learn with the most current and accurate coding procedures coupled with documentation tips and complete definitions to ensure prompt and optimal payment for future insurance claims.

1. Explore strategies to prepare for 2018 ICD-10-CM
2. Answer the question why are Insurance Companies not paying for ICD-10-CM Codes
3. Identify and use all current and new procedure codes for mental health services
4. Discuss problem areas of documentation for mental health services
5. Inform how MACRA will change the way providers documentation
6. Evaluate MIPS measures and gain access to resources
7. Explore Advancing Care Information and Improvement Activities
8. Document correctly and learn what is necessary to support reimbursement
9. Discuss reimbursement strategies for inpatient and partial hospital services
10. Outline procedures for conducting an internal review of coding and documentation

CPT/HCPCS PROCEDURE CODES

• New charts by program of most common used CPT/HCPCS level II codes
• Codes for diagnostic assessments
• Codes and guidelines for psychotherapy
• Codes and guidelines for psychotherapy with E/M
• Codes and guidelines for psychotherapy for crisis
• How to code medication management, use of evaluation, and management codes
• Code and guidelines for interactive complexity
• Group therapy
• Family therapy
• Health and behavior assessment/intervention services
• How to code and document psychological testing
• How and when to code evaluation and management services
• History, exam, and medical decision making vs. billing based on time
• How to code RN/LPN services

DIAGNOSTIC CODING

• 2018 code changes and online tools to prepare for ICD-10-CM
• DSM-5 structure
• DSM-5 diagnostic criteria for initial evaluations and treatment plans

FEDERAL REGULATIONS AND MEDICARE’S BILLING RULES

• Explore free online tools for access to federal and payer rules
• Affordable Care Act changes that impact mental health
• Fines have doubled in the False Claims Settlement Practice Act

COMPLIANCE WITH CODING AND DOCUMENTATION STANDARDS

• Gain systematic steps for implementation of new DSM-5 for diagnostic criteria medical necessity
• CMS MAC, RAC, ZIP, and CERT program guidelines
• OIG audit focus on behavioral health services
• Insurance companies and the focus on audits for psychiatric, psychological, and evaluation and management (E/M) services
• Medicare’s “incident to” guidelines
• Definition of “incident to” services
• Supervision requirements
• Documentation of initial assessments and treatment plans
• Components necessary in psychotherapy documentation and progress notes
• Common problem areas of documentation

UNDERSTANDING THE REIMBURSEMENT PROCESS

• Coding for maximum reimbursement by payer type
• Links to major payer websites: Medicare, Medicaid, Blue Cross/Blue Shield, and other payers
• Payment methodologies, PPS, and fee schedules

PROVIDER TYPES AND SCOPE OF COVERED SERVICES

• Psychiatrists
• Physician Assistants
• Certified Registered Nurse Practitioner
• Psychologists
• Social Workers
• Psychotherapists
• Professional Counselors
• Marriage and Family Therapists
• Outpatient clinic and hospital
• Consultation definition and appropriate use
• Inpatient hospital
• Partial hospital program
• Nursing facility
• Discharge day management

CLAIMS PROCESSING

• CMS1500
• UB-04
• Modifiers

THE APPEAL PROCESS

• Systematic steps of the appeal
• Understanding reasons for denials