Washington, DC (PRWEB) February 04, 2015
Hospitals should challenge any upcoming prepayment audits of outpatient psychotherapy, advises a compliance officer in the Feb. 2 issue of Atlantic Information Services, Inc.’s (AIS) Report on Medicare Compliance (RMC). Some denials are based on outdated Medicare rules, Stephen Gillis, director of compliance coding, billing and audit at Partners HealthCare in Boston, tells RMC, and not challenging them could result in lasting, negative consequences.
The confusion over the denials stems from a four-year-old change in Centers for Medicare and Medicaid Services (CMS) policy, and relatively new codes that took effect in January 2013 when the American Medical Association transformed coding for mental health services. The new CMS policy, which was reiterated in 2011, states that “Nonphysician practitioners may provide the required supervision of services that they may personally furnish in accordance with State law and all additional requirements.” Since January 2014, however, Partners has received a number of Medicare claims denials for services provided by licensed clinical social workers. Among the reasons for the denials were invalid treatment plans, missing credentials, and incomplete or missing documentation, the Medicare administrative contractor (MAC) said.
Appealing the denials “is a lot of work for a little return [on each claim],” Gillis says, whose hospital is in the midst of a review by its MAC. “But if you don’t appeal these, they will continue to show a high error rate and you will continue to be audited.” Not only does writing off charges mean lost revenue, hospitals get a reputation for high denial rates for that service, even if a lot of the denials may not have been justified, he explains.
Visit http://aishealth.com/archive/rmc020215-01 to read the article in its entirety.
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