You just had lunch in the doctor’s lounge and caught up with a long-time friend and colleague. Her practice, like yours, provides mental health services for your community. During the course of your conversation, she explained that her practice is being audited for possible coding violations. You let her know that you’re not worried. You have peace of mind because The Psych Biller, your behavioral health billing company, knows the right code.

Authorities are auditing her practice because they suspect the group submitted fraudulent insurance claims. She’s concerned and is exploring the possibility of outsourcing her medical billing. You recommend The Psych Biller. It’s common for a mental health services provider to have five or ten patient charts reviewed periodically by an insurance company for coding accuracy. This review, called a chart audit, is held to identify medical billing fraud. Today, mental health services are scrutinized more than ever.

Behavioral Health Billing: There Are Two Types Of Audits: Routine And Targeted Audits

Routine chart audits verify that the patient’s documented visit supports the code submitted on the claim. On the other hand, targeted audits seek out specific fraudulent misconduct prompted by claim trends or a whistle-blower’s information. Upcoding or downcoding can initiate an audit, but the Psych Biller, your dependable outsourced medical billing company, has you covered. They know the right code.

Upcoding a medical insurance claim happens when the claim’s CPT codes are for services that are higher than the services that were actually done. Upcoding can be deliberate or mistakenly coded. Remember that no matter what a mental health services provider says, documentation in the patient’s medical record must support the code. If it’s not documented, it didn’t happen.

The result of an upcoded claim is that the mental health services provider was overpaid for the actual services performed. The government and insurance companies believe that upcoding a claim is stealing. For this reason, the government, and insurance companies are motivated to identify overpayments and upcoding. On the other hand, downcoding happens when the CPT code on the claim is for services rendered that are lower than the services actually done. Downcoding can cost a mental health practice thousands of dollars. It raises a red flag and leaves your practice open to an audit. The bottom line is that both upcoding and downcoding are non-compliant. However, there are some things a mental health service provider or practice can do to limit their exposure.

Ensuring That Behavioral Health Billing Claims Are Compliant

Hire or outsource professionals

In some cases, mental health service providers choose the correct code only 30% of the time. Hiring a professional coder or using an outsourced medical billing company like The Psych Biller is priceless. Hiring professionals familiar with the rules and regulations can save you lots of headaches and money.

Utilize the right tools

A round peg doesn’t fit into a square hole. Utilize an Electronic Health Record (EHR) system designed for your specialty. For instance, use an EHR that fits your specialty. In our case, one equipped to handle the nuances of a mental health services practice.

Stay updated on current billing practices

Coding guidelines and regulations change all the time. Therefore, following the appropriate policies and guidelines specific to your practice is essential. Luckily for you, The Psych Biller’s professional staff is up-to-date on the latest coding guidelines.

Be cautious with EHRs

Cutting and pasting into a patient’s medical record can be fast and convenient but may prove incorrect. Patient visits are unique, and a cookie-cutter approach using a patient’s prior visit can be dangerous and non-compliant.

Conduct periodic self-audits

Auditing your own medical records for upcoding or downcoding can save you lots of time and money.

Everyone makes mistakes, and an internal audit is designed to catch errors. It can identify trends before the government or an insurance company comes knocking on your door.

Source: (Steps to Avoid Overcoding and Undercoding | Duke Health Referring Physicians)

To use a familiar saying – an ounce of prevention is worth a pound of cure.

The Psych Biller: Behavioral Health Billing Company – Los Angeles County, LA

Our services are geared for individual or small group practices looking to stay compliant in this ever-changing environment.  Our team is ready to hear from you. Contact us today to move forward with next steps.