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1. AUTUMN 8 BILLING FOR MULTIPLE PROVIDERS ON SAME HCFA FULL
2. AUTUMN 8 BILLING FOR MULTIPLE PROVIDERS ON SAME HCFA CODE

AUTUMN 8 BILLING FOR MULTIPLE PROVIDERS ON SAME HCFA FULL

This is why I stated earlier, that clinical documentation is a key element in supporting the full 180 minutes per day, otherwise you’ll end up with a denied claim. Although IOP, technically provides only two to three hours per day, most payers require at least 180 minutes of active therapy per day in order to reimburse the per diem rates. Just like with all inpatient level care services, most insurance companies require all IOP services obtain a pre-authorization before reimbursement is complete. Similar Article: 5 Insurance Billing Errors Drug Treatment Centers Can Avoid Pre-authorization, clinical and IOP all go hand in hand

AUTUMN 8 BILLING FOR MULTIPLE PROVIDERS ON SAME HCFA CODE

Also, another thing to remember when billing for IOP services, if the patient has a dual-diagnosis for both substance abuse and mental health, you can generally only bill for one IOP session per day, even if both were being addressed in therapy. IOP billing codes may differ depending on what the patient’s diagnosis is, and what services are provided primarily either for substance abuse or for mental health issues. Having a responsible expected time to treat the patient, generally allowing between 12 to 16 weeks of IOP care.( Clinical are an important determining factor in authorization and concurrent authorization for the patient.) Being consistent with clinical best practices.

Addressing the diagnosis(s) that required admission.Adhering and being consistent with the initial treatment plan for the patient.The attending provider must supervise the patient at all times.Most facilities will set up a weekly schedule for IOP patients, consisting of meeting at least two hours per day, and from three to five days a week.ĬMS guidelines required in order for the facility to be eligible for reimbursement for IOP services are: If a facility is offering IOP services, they must be licensed at the state level and usually will treat substance abuse and most mental health disorders. Similar Article: The Secret To Getting Reimbursed Quicker- Claims Follow Up Typical services covered in IOPs There are so many different modalities and service types when billing for IOP, compared to inpatient and hospital-based programs, which in turn makes it more challenging when trying to get reimbursement. Intensive outpatient programs, known as IOP, where the patient is provided with behavioral health services for at least 9 to 19 hours a week for adults, and for children and adolescents at least six hours is generally acceptable.Partial hospital programs, better known as PHP, providing services in an ambulatory setting, and generally requires 20 hours per week.Residential treatment programs, also known as RTC, which is more of a sub-acute facility based monitoring, offering other behavioral health services.Hospital-based inpatient programs, that require medical monitoring, nursing care, and other behavioral health services treated 24/7.Behavioral health levels of careīehavioral health facilities essentially provide four types of services that insurance companies may consider reimbursement when treating a patient. From the patient being able to continue their treatment, to the doctors treating the patient, and of course, making sure the insurance companies are on board with allowing the overall treatment to happen. When dealing with IOP billing specifically, there are generally a few more requirements and consistent attention needed to make sure everyone involved is happy. There are new requirements coming from UHC, BCBS, Cigna, Aetna and all the rest for all levels of care including RTC and PHP billing all the way through outpatient services. Are you seeing changes in IOP billing for mental health in 2021? We certainly are.