Coding and Billing Strategies for Optimal Reimbursement
Don't be caught off guard without training on the new CPT code changes. Denials, delays, and "more information required" are increasingly common responses from Medicare, managed care, and insurance companies for behavioral health claims and requests for payment. Procedure code and policy changes have further complicated the reimbursement process for all social workers, psychiatrists, psychologists, therapists, counselors, and clinical nurse specialists. Consolidating all of the new requirements with existing code rules and implementing proven billing techniques are the objectives of this concise, one-day seminar. Participants will learn the most current and accurate coding procedures coupled with documentation tips and complete definitions to ensure prompt and optimal payment for future insurance claims.
Course Content
CPT/HCPCS PROCEDURE CODES
u New charts by provider to maximizing reimbursement
u Codes for diagnostic assessments
u Codes and guidelines for psychotherapy
u Codes and guidelines for psychotherapy with E/M
u Codes and guidelines for psychotherapy for crisis
u How to code medication management, use of evaluation, and management codes
u Code and guidelines for interactive complexity
u Group therapy
u Family therapy
u Health and behavior assessment/intervention services
u How to code and document psychological testing
u How and when to code evaluation and management services
u History, exam, and medical decision making vs. billing based on time
u How to code RN/LPN services
DIAGNOSTIC CODING
u New tools to prepare for ICD-10-CM (October 1, 2014 deadline)
u New DSM-5 structure
u New DSM-5 diagnostic criteria for initial evaluations and treatment plans
u New case studies: neurodevelopmental disorders, schizophrenia, bipolar disorders, depressive disorders, anxiety disorders, post-traumatic stress disorders
u Coding guidelines for ICD-10-CM
FEDERAL REGULATIONS AND MEDICARE'S BILLING RULES
u Implementation of federal legislation
u Understand the Affordable Care Act changes that impact mental health
u Common forms of health care fraud and abuse
u Summary of key aspects of the Final Stark II Rule
COMPLIANCE WITH CODING AND DOCUMENTATION STANDARDS
u Gain systematic steps for implementation of new DSM-5 for diagnostic criteria medical necessity
u Understanding the CMS MAC, RAC, ZIP, and CERT program guidelines
u OIG audit focus on behavioral health services
u Components of an effective compliance plan, corrective action, and refund process
u Audit tools for psychiatric, psychological, and evaluation and management (E/M) services
u Medicare's "incident to" guidelines
- Definition of "incident to" services
u Supervision requirements
u Documentation of initial assessments and treatment plans
u Components necessary in psychotherapy documentation and progress notes
u Common problem areas of documentation
UNDERSTANDING THE REIMBURSEMENT PROCESS
u Coding for maximum reimbursement by payer type
u Links to major payer websites: Medicare, Medicaid, Blue Cross/Blue Shield, and other payers
u Payment methodologies, PPS, and fee schedules
PROVIDER TYPES AND SCOPE OF COVERED SERVICES
u Psychiatrists
u Physician Assistants
u Certified Registered Nurse Practitioner
u Psychologists
u Social Workers
u Psychotherapists
u Professional Counselors
u Marriage and Family Therapists
u Outpatient clinic and hospital
u Consultation definition and appropriate use
u Inpatient hospital
u Partial hospital program
u Nursing facility
u Discharge day management
ADDITIONAL RESOURCES
u Practice Management library
u Claims Processing
-New CMS1500 for January 1, 2014 (mandated by April 1, 2014)
-UB-04
-Modifiers
u Sample forms
u Sample letters
THE APPEAL PROCESS
u Systematic steps of the appeal
u Understanding reasons for denials
u Sample appeal letters
The State of California, Board of Behavioral Sciences will recognize and accept continuing education programs that are sponsored by providers approved by the American Psychological Association and the ASWB. Full attendance at this course will qualify for 6 hours of continuing education credit.
is an approved provider with the Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling Provider #50-466. This program is approved for 6 continuing education credit(s).
is a registered counselor continuing education sponsor approved through the State of Illinois Department of Professional Regulation (license # 197-000144). This program is offered for six (6) contact hour(s) of continuing education for counselors. Licensed counselors in other states should contact their individual state jurisdiction to review the current continuing education requirements for licensure renewal.
This educational offering consists of 6 clock hour(s) of continuing education instruction. Credit requirements and approvals vary per state board regulations. Please save the course outline, the certificate of completion you receive from this offering and contact your state board or organization to determine specific filing requirements.
Vyne Education, LLC., is recognized by the New York State Education Department’s State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors #MHC-0027. This educational offering is acceptable for 6 continuing education hour(s). Full attendance is required to receive credit for Mental Health Counselors; variable credit for partial attendance may not be awarded based on the State Board guidelines.
is approved through the State of Ohio Counselor, Social Worker and Marriage and Family Therapist Board (provider #RCT091001). This program is offered for six (6) clock hour(s) of continuing education for counselors only. Licensed counselors in other states should contact their individual state jurisdiction to review the current continuing education requirements for licensure renewal.
is an approved sponsor with the South Carolina Board of Examiners for LPC, AC and MFTs (Provider #104). This program is offered for 6 continuing education hour(s).
is an approved sponsor of continuing education for licensed professional counselors through the Texas State Board of Examiners of Professional Counselors (Provider number 2709). This course is offered for 6 clock hour(s).
The State of California, Board of Behavioral Sciences will recognize and accept continuing education programs that are sponsored by providers approved by the American Psychological Association and the ASWB. Full attendance at this course will qualify for 6 hours of continuing education credit.
This educational offering consists of 6 clock hour(s) of continuing education instruction. Credit requirements and approvals vary per state board regulations. Please save the course outline, the certificate of completion you receive from this offering and contact your state board or organization to determine specific filing requirements.
is an approved provider with the Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling Provider #50-466. This program is approved for 6 continuing education credit(s).
is a registered marriage and family therapist continuing education sponsor approved through the State of Illinois Department of Professional Regulation (license # 168-000172). This program is offered for six (6) contact hour(s) of continuing education for marriage and family therapist. Licensed marriage and family therapist in other states should contact their individual state jurisdiction to review the current continuing education requirements for licensure renewal.
Vyne Education, LLC., is recognized by the New York State Education Department’s State Board for Mental Health Practitioners as an approved provider of continuing education for licensed marriage and family therapists #MFT-0020. This educational offering is acceptable for 6 continuing education hour(s). Full attendance is required to receive credit for Marriage and Family Therapists; variable credit for partial attendance may not be awarded based on the State Board guidelines.
is approved through the State of Ohio Counselor, Social Worker and Marriage and Family Therapist Board (provider #RCT091001). This program is offered for six (6) clock hour(s) of continuing education for counselors and marriage family therapists. Licensed counselors and marriage and family therapists in other states should contact their individual state jurisdiction to review the current continuing education requirements for licensure renewal.
is an approved sponsor with the South Carolina Board of Examiners for LPC, AC and MFTs (Provider #104). This program is offered for 6 continuing education hour(s).
is an approved sponsor of continuing education for licensed marriage and family therapists through the Texas State Board of Examiners of Marriage and Family Therapists (Provider number 195). This course is offered for 6 clock hour(s).
is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 060313. This activity was planned in accordance with AANP Accreditation Standards and Policies. This course is offered for 6.0 contact hour(s).
This educational offering qualifies for 6 continuing education hour(s) as required by many national, state and local licensing boards and professional organizations. Save your course outline and certificate of completion, and contact your own board or organization for specific filing requirements.
is approved by the American Psychological Association to sponsor continuing education for psychologists. maintains responsibility for this program and its content. This program offers 6 CE credit(s) for psychologists. Full attendance is required to receive credit for psychologist, variable credit for partial attendance may not be awarded based on the APA guidelines.
is approved as a provider for social work continuing education by the Association of Social Work Boards (ASWB), through the Approved Continuing Education (ACE) program (an approved provider since 1999, approved period 1/27/2018-1/27/2021). maintains responsibility for the program. Social workers will receive 6 Clinical Social Work continuing education clock hour(s) for participating in this course. Licensed social workers should contact their individual state jurisdiction to review the current continuing education requirements for licensure renewal. Visit ASWB's website at www.aswb.org for more information. This educational offering is at the Intermediate level for social workers.
The State of California, Board of Behavioral Sciences will recognize and accept continuing education programs that are sponsored by providers approved by the American Psychological Association and the ASWB. Full attendance at this course will qualify for 6 hours of continuing education credit.
is an approved provider with the Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling Provider #50-466. This program is approved for 6 continuing education credit(s).
, SW CPE is recognized by the New York State Education Department’s State Board for Social Work as an approved provider of continuing education for licensed Social Workers #0043. This educational offering is acceptable for 6 continuing education hour(s). Full attendance is required to receive credit for Social Workers; variable credit for partial attendance may not be awarded based on the State Board guidelines.
File type | File name | Number of pages | |
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Handouts (12.7 MB) | Available after Purchase | ||
Presentation (2.5 MB) | Available after Purchase |
SHERRY MARCHAND, CPMA, is a reimbursement analyst and a billing, collection, and chart-auditing consultant with more than 25 years of experience in the health care industry, including hospital and physician group billing, and collection management. She has served as an expert witness/consultant in Medicare, Medicaid, ALJ hearings, and criminal fraud cases. Her vast knowledge of the practice management process has come from working in various levels of health care accounting, including the management of international hospital billing. As a certified, self-employed practice management consultant and chart auditor, Ms. Marchand has helped numerous medical offices take control of their cash flow through implementation of billing and documentation processes. Her specialties include Internal Medicine, Obstetrics, Mental Health, Physical Therapy, Cardiology, ENT, and Surgical Specialties. Ms. Marchand is skilled in installation training and implementation of hardware and software systems that are right for the health care arena. Ms. Marchand has many tips and tools to assist your office on the road to healthy patients and insurance collections.
Disclosure:
Finacial- Receives a speaking honorarium from Vyne, LLC.
Nonfinancial-No relevant nonfinacial relationship exists.
Coding, Billing, and Finance Personnel, Psychiatrists, Psychologists, Social Workers, Psychotherapists, Professional Counselors, Marriage and Family Therapists, Nurse Practitioners
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