Behavioral Health

Quality Measures Finalized for 2019

CMS recently announced that the quality measures for 2019 have been finalized. There are new eligible clinicians so be aware of how that may affect your organization. New ECs are:

  • Physical therapists
  • Occupational therapists
  • Qualified speech-language pathologists
  • Qualified audiologists
  • Clinical psychologists
  • Registered dietitian or nutrition professionals

The following are changes to Electronic Clinical Quality Measures (eCQMs) available for eligible professionals and eligible clinicians for 2019 reporting:

In January, the U.S. Department of Health and Human Services (HHS) issued updates to the privacy regulations regarding the confidentiality of patient information of substance use disorder patients (42 CFR Part 2).  This notice included references to better alignment with HIPAA regulations, but did state that Part 2 is more protective in order to retain "important privacy protections for individuals seeking treatment for substance use disorders." 

Preventive Medicine: Coding and Billing Information

This is an educational tool, not meant to be viewed as coding or billing guidelines.
Preventive Medicine Coding and Billing Info
Telehealth applicable codes will be indicated with a phone icon. 
(Click on a topic to view the information or scroll down to view all topics)

HIPAA and the Opioid Crisis

In response to the opioid crisis, the Trump administration and the Department of Health and Human Services (HHS) have issued additional information relevant to both providers and patients. A December 18, 2017 press release included the following highlights of these actions:

Intensive Outpatient Treatment (IOP)

Intensive Outpatient Programs (IOPs) are considered to be an intermediate level of care which is commonly considered after the patient has been discharged from inpatient care. For some patients and/or conditions they can also provide an effective level of care when hospitalization is not clinically indicated or preferred. The following ...

Psychiatric Partial Hospitalization Programs

BACKGROUND

According to the official ICD-10-CM Guidelines, in situations of maltreatment (e.g., adult and child abuse, neglect, etc.), the sequence of coding is important. Regardless of whether it is suspected or confirmed, it is important to document the type of abuse. Use the following sequence:

Diagnostic Criteria for Behavioral Health

In order to arrive at a diagnosis and check for related complications, a healthcare provider needs to evaluate the patient condition. This may include:

60 Day Final Rule

Effective March 14, 2016, the CMS Final Rule regarding the reporting of overpayments took effect. This ruling clarifies the standards that have been unclear for years since the the PPACA created what is called the "60-day rule." The problem has been the unclear standards on what it means to "identify" an overpayment and when the 60 day clock begins running.

Now, the 60-day rule requires anyone who has received an overpayment from either Medicare or Medicaid to report and return the overpayment within the latter of:

PQRS Measures for Behavioral Health (2015)

Performance Measurement Codes for Behavioral Health:

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