Behavioral Health|Psychiatry|Psychology - Articles

Federal Workers Compensation Information
October 1st, 2019 - Wyn Staheli, Director of Research
When federal employees sustain work-related injuries, it does not go through state workers compensation insurance. You must be an enrolled provider to provide services or supplies. The following are some recommended links for additional information about this program. Division of Federal Employees' Compensation (DFEC) website Division of Federal Employees' Compensation (DFEC) provider ...
Medical ID Theft
August 16th, 2019 - Namas
Medical ID Theft "So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...
The OIG Work Plan: What Is It and Why Should I Care?
August 9th, 2019 - Namas
The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...
5 Ways to Minimize HIPAA Liabilities
July 12th, 2019 - BC Advantage
Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability. Take ...
Biofeedback - Is it Medically Necessary?
April 24th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Biofeedback is used for many reasons, and most commonly used for pain management. Each payer should be consulted with to verify coverage when treating with Biofeedback to verify if the treatment is considered experimental or investigational. The majority of payers will list Biofeedback on an exclusions list. Others such as BC ...

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Finalized Confidentiality of Alcohol and Drug Abuse Patient Records Regulations
August 31st, 2018 - Wyn Staheli, Director of Research
In January, the U.S. Department of Health and Human Services (HHS) issued updates to the privacy regulations regarding the confidentiality of patient information of substance use disorder patients (42 CFR Part 2).  This notice included references to better alignment with HIPAA regulations, but did state that Part 2 is more protective ...
Importance of Depression Screenings
August 16th, 2018 - Wyn Staheli, Director of Research
Why would a chiropractor be concerned about depression screenings when you aren’t trained to be a mental health provider? The answer lies in patient outcomes. Many quality care organizations recommend depression screenings for patients with a chronic condition. According to The National Institute of Mental Health, “People with other chronic ...
Preventive Medicine: Counseling to Prevent Tobacco Use
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Counseling to Prevent Tobacco Use Procedure Codes 99406: Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes 99407: Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes ICD-10-CM 99406-99407: No specific diagnoses Frequency 99406-99407: 2 attempts a year, ...
Preventive Medicine: Depression Screening
May 9th, 2018 - Find-A-Code™
Preventive Medicine Topics Page Depression Screening Procedure Codes G0444: Annual depression screening, 15 minutes 96127: Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument ICD-10-CM G0444, 96127: No specific diagnoses Frequency G0444:Once annually 96127: No specific frequency guidelines Additional Information 96127 Only covered for ages ...
Payment Rates Increase for Behavioral Health Office Services
February 13th, 2018 - Wyn Staheli, Director of Research
Behavioral health providers may see some improvement in payment rates for office-based behavioral health services. This is due to the fact that the overhead expense evaluation portion of the RVU was increased. The following information is from the Federal Register (see References): We agree with these stakeholders that the site of service ...
Psychiatric Partial Hospitalization Programs
January 25th, 2018 - Wyn Staheli, Director of Research
Psychiatric Partial Hospitalization Programs (PHPs) are a more comprehensive level of care than Intensive Outpatient Programs (IOPs - click here to read more about IOPs). When the patient requires a minimum of 20 hours per week and hospitalization is not clinically indicated, a PHP can be the most effective type of ...
Medicare's Integrated Behavioral Healthcare Services and Collaborative Care Program
January 18th, 2018 - Wyn Staheli, Director of Research
Over the last several years, primary care has begun to integrate behavioral health services to better address shortfalls in patient quality of care. Some of the first codes were the Health and Behavior Assessment/Intervention (96152-96155) codes, which were added in 2002. Since then, many different models have been experimented with and have ...
Intensive Outpatient Treatment (IOP)
January 11th, 2018 - Wyn Staheli, Director of Research
Intensive Outpatient Programs (IOPs) are considered to be an intermediate level of care which is commonly considered after the patient has been discharged from inpatient care. For some patients and/or conditions they can also provide an effective level of care when hospitalization is not clinically indicated or preferred. The following ...
GeneSight Psychotropic Testing and Documentation
January 9th, 2018 - Find-A-Code
According to Wisconsin Physicians Service Insurance Corporation, there is limited coverage for the GeneSight® Psychotropic (AssureRx Health, Inc, Mason, OH) gene panel. GeneSight® testing may only be ordered by licensed psychiatrists or neuropsychiatrists contemplating an alteration in neuropsychiatric medication for patients diagnosed with major depressive disorder (MDD) (in accordance with DSM IV/V criteria) who are suffering with refractory moderate to ...
Medicare Improper Payment Report for Behavioral Health Services (2016)
September 1st, 2017 - Wyn Staheli
The Medicare Improper Payment Report for 2016 has been released by the OIG. Please note that the improper payment rate does not measure fraud. Rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from ...
Proposed Telehealth Changes for 2018
August 4th, 2017 - Wyn Staheli
Medicare has proposed making some changes to policies regarding telehealth services. They are adding some new codes to their covered list of telehealth services and propose eliminating the requirement to use the GT modifier. Since many payers adopt similar policies, watch for further announcements...
New payments for Psychiatric Collaborative Care Services (COCM) from Medicare
June 29th, 2017 - Chris Woolstenhulme, CPC, CMRS
Medicare has agreed to make separate payments to physicians and non-physicians for Behavioral Health Integration (BHI) services beginning Jan. 1st, 2017. Any condition new or pre-existing behavioral health or substance use disorders are eligible. Beneficiaries may have comorbid, chronic, or other medical conditions they are being treated for as well. Using the ...
Psychiatric / Psychological Testing with Bill Type 12X
June 23rd, 2017 - Chris Woolstenhulme, CPC, CMRS
Providers submitting claims with bill type 12X are to report revenue code 0918 (psychiatric / psychological testing). Note: Revenue codes do not apply to physicians; other professionals and suppliers bill these services to the Part B MAC They are used only with providers who bill these services to the fiscal intermediary or Part ...
Diagnostic Criteria for Behavioral Health
February 16th, 2017 - Wyn Staheli
In order to arrive at a diagnosis and check for related complications, a healthcare provider needs to evaluate the patient condition. This may include: History: This can include the patient's personal history as well as that of the patient's family. Physical exam: The healthcare provider will try to rule out physical problems ...
Psychotherapy Notes Provision of HIPAA
February 2nd, 2017 - Wyn Staheli
Of special interest to all behavioral health practitioners (both Covered Entities and NON-covered entities) is HIPAA's provision for psychotherapy notes. The privacy rule recognizes that psychotherapy notes need more protection than other types of PHI. Even if you are not a covered entity, we recommend understanding and implementing office procedures ...
Medicare Coverage of Behavioral Health Services
February 1st, 2017 - Wyn Staheli
Medicare's coverage of mental health services is based upon the medical necessity as defined within the Medicare Benefits Policy Manual and the Local Coverage Determinations (LCDs). It should also be noted that not all types of providers may perform all Medicare covered services. For example, an...
G-Codes eff Jan 01,2017 for additional payment for Psych - Collaborative Care
January 2nd, 2017 - Chris Woolstenhulme, CPC, CMRS
Medicare has agreed to make separate payments to physicians and non-physicians for Behavioral Health Integration (BHI) services beginning Jan. 01, 2017. Any condition new or pre-existing behavioral health or substance use disorders are eligible. Beneficiaries may have comorbid, chronic, or other medical conditions they are being treated for as well. Using the ...

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