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Sherry Marchand – Coding and Billing for Mental Health Services 2018 Code Updates: CPT, ICD, DSM-5, and HCPCS Level II Code

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Faculty:
Sherry Marchand, CPMA
Duration:
5 Hours 51 Minutes
Format:
Audio and Video
Copyright:
Jul 12, 2018

Description

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

  • 2018 code changes and online tools to prepare for ICD-10-CM
  • DSM-5 structure
  • DSM-5 diagnostic criteria for initial evaluations and treatment plans

FEDERAL REGULATIONS AND MEDICARE’S BILLING RULES

  • Explore free online tools for access to federal and payer rules
  • Affordable Care Act changes that impact mental health
  • 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

CLAIMS PROCESSING

  • CMS1500
  • UB-04
  • Modifiers

THE APPEAL PROCESS

  • Systematic steps of the appeal
  • Understanding reasons for denials

Faculty

Sherry Marchand CPMA Related seminars and products: 2


SHERRY MARCHAND, CPMA, is a reimbursement analyst and a billing, collection, and chart-auditing consultant with more than 25 years of experience in the health care industry, including hospital and physician group billing, and collection management. She has served as an expert witness/consultant in Medicare, Medicaid, ALJ hearings, and criminal fraud cases. Her vast knowledge of the practice management process has come from working in various levels of health care accounting, including the management of international hospital billing. As a certified, self-employed practice management consultant and chart auditor, Ms. Marchand has helped numerous medical offices take control of their cash flow through implementation of billing and documentation processes. Her specialties include Internal Medicine, Obstetrics, Mental Health, Physical Therapy, Cardiology, ENT, and Surgical Specialties. Ms. Marchand is skilled in installation training and implementation of hardware and software systems that are right for the health care arena. Ms. Marchand has many tips and tools to assist your office on the road to healthy patients and insurance collections.

Speaker Disclosures:

Financial: Sherry Marchand is the owner of Advanced Physician Services. She receives a speaking honorarium from PESI, Inc.

Non-financial: Sherry Marchand is a member of the American Academy of Professional Coders.


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