Coding Tips to Maximize Mental Health Reimbursements
Proper coding requires knowledge and practice. Most behavioral health clinicians want to spend their time and energy providing patient care; not worrying about coding and claims. E2E Medical Billing can step in and take care of the work for you so you can get back to doing what you love.
Ensure Correct Coding
To receive reimbursement, a clinician must complete accurate coding. Coding errors can lead to payment delays or rejected claims. Frequent or consistent errors could lead to an audit or charges of fraud. Strive for the highest accuracy, and cut down on simple errors like incorrect patient information or policy number mistakes. Always refer to the AMA’s most recent CPT manual to make sure you use the right codes in your practice.
Also, make it a habit to check and recheck work, and make sure to read all the notes included with the codes. Encourage staff members to do the same. One of the most common causes of claim denials is the improper use of modifiers. Therefore, make sure to familiarize yourself with modifiers before using them. Modifiers can be the difference between maximum reimbursement and reduced reimbursement, so it’s important to review the rules.
Claim only what’s medically necessary
Medicare and other payers define what’s medically necessary in their own way, but in general, it’s about doing what’s right for the patient at the right time. Making a claim for a service that is not a medical necessity will likely get denied.
To help demonstrate a medically necessary claim, make sure to choose the appropriate ICD code and link it to the associated CPT codes that are valid for the visit. This enables staff and insurance payers to see the reason for each service.
Billing for actual time of service
Many physicians spend a significant amount of time engaged in counseling patients or coordinating patient care. E/M coding defines counseling as a discussion with the patient and/or family or other caregivers concerning one or more of the following areas: Diagnostic results, impressions, and / or recommended diagnostic studies, Prognosis, Risks and benefits of management (treatment) options, Instructions for management (treatment) and / or follow-up, Importance of compliance with chosen management (treatment) options, Risk factor reduction, Patient and family education.
File Claims on Time
Claims must be submitted by a certain deadline. Medicare claims, for example, must be filed no later than 12 months after the date of service. This can vary depending on the payer, and some claims may be due within 90 days or 180 days after service. By meeting deadlines, you’ll ensure you receive the right reimbursement.
Emphasize Quality Documentation
Poor documentation can affect the reimbursement process. Make sure everyone in your practice understands the value of correct, legible and complete documentation. Otherwise, it will be difficult to make an accurate or complete claim. Documentation of each patient encounter should include Reason for encounter and relevant history; Physical examination findings and prior diagnostic test results; Assessment, clinical impression, and diagnosis; Plan for care; and Date and legible identity of an observer.
E2E Medical Billing Services delivers coding at the highest reimbursement level possible to ensure claims get accepted and you get paid. Without the need to fix errors or resubmit claims, you’ll save time, money, and energy. To know more about our medical billing services call us at 888-552-1290 or write to us at [email protected]