Credits

Handouts

Faculty

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Additional Info

Program Information

Access for Self-Study (Non-Interactive)

Access never expires for this product.

Target Audience

Coding, Billing, and Finance Personnel, Psychiatrists, Psychologists, Social Workers, Psychotherapists, Counselors, Marriage and Family Therapists, Nurse Practitioners

Outline

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 New: 2018 code changes and online tools to prepare for ICD-10-CM New: DSM-5 structure New: DSM-5 diagnostic criteria for initial evaluations and treatment plans FEDERAL REGULATIONS AND MEDICARE'S BILLING RULES New: Explore free online tools for access to federal and payer rules Affordable Care Act changes that impact mental health New: 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 ADDITIONAL RESOURCES Claims Processing CMS1500 UB-04 Modifiers THE APPEAL PROCESS Systematic steps of the appeal Understanding reasons for denials

Objectives

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

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