Wiki Behavioral Health audit tool

[TTcpc]

Hello,
I am working on an audit process and would like some suggestions/links for audit tools that you use for your BH providers who can't bill E/M.

My group currently has one PsyD and is in the processing of filling other roles, so I would like to have an audit process in place before others join. To add clarification this is for clinic based services for pediatric patients and also for family counseling with and without the patient present.

Thank you!

 

[Pdeibler]

Hi there- did you ever figure out an audit process for your BH team? I have one if you would like to discuss- our pediatric clinics have integrated behavioral health services.

 

[TTcpc]

Hi there- did you ever figure out an audit process for your BH team? I have one if you would like to discuss- our pediatric clinics have integrated behavioral health services.

Hi, Our BH providers are very limited in the codes they can bill because they are both PhDs, so we took several coding references and created our own tool.

 

[amyjph]

Specific to Aetna but an example: https://www.aetnabetterhealth.com/c...ioral Health Provider Audit Tool Elements.pdf
Check MAC sites for info: https://med.noridianmedicare.com/web/jfb/specialties/mental-health
Example:

Psychotherapy Documentation​

• Beneficiary name, date of service, session length
• Encounter reason - mental status
• Relevant interval history
• Service type (individual, group, family, interactive, etc.) and pertinent themes discussed
• Type of therapy or interventions used
• Patient assessment (progression/regression)
• Treatment plan/diagnosis/medication change
• Expected treatment outcomes on periodic basis
• Indicate specific symptoms, patient complaint, etc., per Social Security Act (SSA) Section 1862(a)(1)(A)
• High risk factors (suicidal ideation (S/I) and homicidal ideation (H/I); if applicable
• Modalities/frequency of treatment furnished
• Clinical note for each encounter
• Signature (name/credentials) legibly signed
• CMS/Noridian do not have sample templates; professional associations may
  • Each provider must develop their own
• Recurrent depression may include prior treatment history, diagnosis F33.0-F33.9, etc.
• E/M time separate from psychotherapy time
• Do not overlap psychotherapy and E/M services
• E/M and Psychotherapy may be on same report; specifically, separately identifiable within note
• Time indicated in psychotherapy code
• Note: Provider clearly documents in the patient's medical record, time spent providing psychotherapy service; rather than entering one total time period (that includes E/M service)