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