Posted by Soraya Hareez on Tue, Jul 27, 2010
By Vālant guest author: Heather Grube
Mental health providers frequently have questions regarding the possibility of using evaluation and management (E&M) codes to report their services for patients. The Centers for Medicare and Medicaid Services (CMS) gives very specific guidelines in two documents (the 1995 Documentation Guidelines for Evaluation and Management Services and the 1997 Documentation Guidelines for Evaluation and Management Services) on the elements of, and documentation required for, using E&M codes. Used in conjunction with the most current edition of the Current Procedural Terminology (CPT) publication, these documents provide the most accurate guidelines and instructions for coding services.
In brief, E&M services contain a history of present illness (HPI), examination, and medical decision making. The history can be brief or extended, which is determined by the number of HPI elements (out of a possible 8) addressed in the exam. The examination includes a verbal review of systems (ROS) and a physical examination of recognized body areas and organ systems, based on the chief complaint of the patient.
Recognized body systems are constitutional symptoms (e.g. fever, weight loss), ears/nose/throat (ENT) and mouth, cardiovascular, respiratory, gastrointestinal, genitourinary, musculoskeletal, integumentary (skin and/or breast), neurological, psychiatric, endocrine, hematologic/lymphatic, and allergic/immunologic.
Recognized body areas and organ systems are head, neck, chest, abdomen, genitalia, back, each extremity, eyes, ENT and mouth, cardiovascular, respiratory, gastrointestinal, genitourinary, musculoskeletal, skin, neurologic, hematologic/lymphatic/immunologic, and psychiatric.
The number of body systems addressed, and number of body areas and organ systems physically examined, help to determine the level of E&M code that may be billed. An assessment of the patient’s family and social history is also needed for documenting an E&M code.
Psychiatrists working in a multi-specialty practice may find they frequently do meet the documentation requirements for billing their services as an E&M code, and should bill their services at the appropriate level when this is the case. Mental health practitioners working in a strictly mental health clinic setting may more commonly find they are providing therapy services, and should bill their services as such. Non-prescribing mental health practitioners are not eligible to use E&M codes.
Posted by Soraya Hareez on Fri, Apr 30, 2010
The decision of how to manage your practice's medical billing is a significant one, with many factors to consider. This helpful article, published by Software Advice, displays the pros and cons of outsourcing a practice's medical billing versus keeping it in-house. The article compares the costs of both approaches, as well as the qualitative factors of each.
Posted by Soraya Hareez on Wed, Sep 23, 2009
Understanding the behavioral health billing process can be a daunting task. We have created the following guide as a best practices framework for psychiatrists and other mental health professionals. While this may go without saying, we will say it anyway: first and foremost, be knowledgeable of your state's laws and regulations regarding medical billing. Now, for the good stuff...
Checking eligibility and gathering patient information
Confirm eligibility and benefits prior to the patient's first visit. When checking benefits, specifically request mental health benefits. Be sure to confirm the name and address of the mental health payor. Frequently, it is not the same as the company name listed on the insurance card. If prior authorizations or referrals are required, obtain these prior to the patient's first visit.
Advise new patients to verify their own mental health benefits prior to their first visit. This can help alleviate the possibility of patient distress over a bill he/she did not anticipate. Part of mental health benefits verification is to confirm whether there is a deductible or per-visit copayment responsibility for the patient.
Collect patient demographic and insurance information during the patient's first appointment, if not before. If the patient is a minor, obtain complete guarantor information and be certain that bills are addressed to the guarantor (not the minor).
Insurance credentialing and contracts
Accelerate the credentialing process by making sure that all documentation and signatures are in place when returning the initial contract to an insurance payor. Even in the best case, the entire credentialing process can be very lengthy - from four to twelve months depending on the carrier.
Understand your insurance contracts if you choose to participate with insurance carriers. Keep an electronic copy of all contracts in an easily retrievable place. File original copies for safe keeping.
Keep your practice information current. If any information about your practice changes (i.e. your address, tax ID number, billing or payment address), be sure to notify all insurance companies of the change at the earliest date possible. Electronic claims will be rejected if the information you are transmitting does not match the information file within the payor account.
Applying courtesy discounts
Create a financial hardship waiver before granting courtesy discounts. If you offer courtesy discounts due to financial hardships, make sure you have a signed agreement in place prior to providing the discount. Agreements should be effective for a limited amount of time and re-verified for applicability/validity on at least a quarterly basis. Understand your state laws and regulations and/or insurance contract restrictions regarding this activity.
Keeping your accounts receivable balance low
Be aware of your patients' balances as you are seeing them. A patient receiving weekly services can quickly accumulate a large balance. It is good practice, and frequently a requirement according to the terms of insurance contracts, to collect copays at the time of service.
Create a schedule for submitting insurance claims. Choose one or two days per week that best fits your schedule. For electronic claims, be sure to check your electronic claims reports with the same frequency to ensure that claims are successfully transmitted to the appropriate carriers.
Print and mail patient statements on a regular basis. Most providers prefer a monthly cycle for patient billing.
Document insurance and patient payments regularly. Creating the habit of applying payments as they come in is a good way to ensure that patient statements will always reflect the most current balance due. Regularly updating your billing system will also help you keep an eye on accounts that need special attention.
Use Explanation of Benefits (EOB) documents to verify patient payment responsibility. EOBs usually state the amount for which the patient is responsible for a particular visit. Verify that this is the amount that remains to bill the patient after applying the insurance payment. Consider any copayments that may have been collected at the time of service.
Verify that bank deposit totals equal the amount entered into your billing system. Many mental health billing systems offer the ability to create a day sheet. Day sheet is a name given to a report that could also be called an accounting summary. It is a summary of all charges (visits and procedures) and credits (payments and adjustments) that have been created since the last day sheet was generated. The day sheet is a tool to confirm that all of the money deposited into your bank account has been applied to specific dates of service. Make sure that the totals of your deposit slip equal the total per the deposit record of your day sheet. If you accept credit/debit card payments, remember that credit card payments are set up to link directly with your account and will be automatically transmitted when the credit card transaction is processed. Because of this, credit card payments are not part of your actual deposit summary, but do appear as part of the credits applied within your account. A quick glance at your transactions (charges) and adjustment totals can let you know if any keystroke errors might have been made in either place.