Eating Disorder Facility - Coding, Billing & Reimbursement

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I am assisting in the opening of an eating disorder facility in South Texas.

Can anyone help me with any information such as:

A superbill for an existing facility?
Services and codes provided at an eating facility?
Any source of information for the services provided to an eating disorder program?

Thank you,

John Arceneaux
 
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As a consultant for many large healthcare facilities, I can tell you that if you are opening a brand new facility, you will need to do a substantial amount of work more before you can even address billing codes and forms. I'm talking about things like NPIs, contracts, credentialing, licensing, state and federal approvals for a wide variety of things (eg, Dept of Health), and on and on and on. Figuring out billing codes and so forth would be the last thing on the agenda. Please don't take this the wrong way, but if you aren't up to speed, inside and out, on how to bill or code for this type of facility, then perhaps it might be in your best interest to discontinue pursuing this venture. Nonetheless, I suggest hiring a consultant that could help guide you along the way.
 

Pam Brooks

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No disrespect, danskangel313, in consideration of your vast consulting knowledge, but the OP did indicate that they are assisting with the opening of a new facility. Let's assume that the principals and clinicians are taking care of those details. But John will need to know what to ask. There's no one specific kind of eating disorder practice/facility. Let's try to encourage our coding colleagues and not make them feel bad.

I ran an eating disorders practice for many years. Here are some questions, John:

Is this an outpatient office location (if so, POS 11). If it's a facility, or linked to a facility, you may be billing on a UB instead of a 1500, but you need to determine that.
Is this a multidisciplinary clinic? if so, you'll be billing both E&M for the medical visits, and the psychotherapy visits for the counseling. Dietary visits may also be included. Find out how the clinicians will be credentialed and their scope of practice so you can find out if you need to bill under a supervising provider. Will group and family therapy sessions be provided? Have a plan in place for insurance pre-authorization. Eating disorders are notoriously difficult to treat, and most treatment is very long term. Not having pre-auth, billing multiple visits and getting denials will put you under in no time. Be sure to also have a policy about getting insurance verification. Not only is every plan different with regards to coverage but the mental health piece is often managed by a third party. Medicare does not cover eating disorders, so they are not very much help.

You won't be able to devise a superbill until you have these questions answered.

There are a number of Eating Disorders resources: NEDA (National Eating Disorders Association) is one.

Good luck. Let me know if you need any more help. Pam
 
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Eating Disorder IOP & Inpatient Service Items

Hello Pam,

Thank you so much for your information. I am preparing the business plan, financial projections, cash flow models, etc., etc. I am looking for any data regarding reimbursement revenue for inpatient eating disorder facilities. I spoke to a couple of third party billers who are mining their databases for me.

Do you have a list of services provided by IOP and inpatient eating disorder facilities?

Thank you,

John

No disrespect, danskangel313, in consideration of your vast consulting knowledge, but the OP did indicate that they are assisting with the opening of a new facility. Let's assume that the principals and clinicians are taking care of those details. But John will need to know what to ask. There's no one specific kind of eating disorder practice/facility. Let's try to encourage our coding colleagues and not make them feel bad.

I ran an eating disorders practice for many years. Here are some questions, John:

Is this an outpatient office location (if so, POS 11). If it's a facility, or linked to a facility, you may be billing on a UB instead of a 1500, but you need to determine that.
Is this a multidisciplinary clinic? if so, you'll be billing both E&M for the medical visits, and the psychotherapy visits for the counseling. Dietary visits may also be included. Find out how the clinicians will be credentialed and their scope of practice so you can find out if you need to bill under a supervising provider. Will group and family therapy sessions be provided? Have a plan in place for insurance pre-authorization. Eating disorders are notoriously difficult to treat, and most treatment is very long term. Not having pre-auth, billing multiple visits and getting denials will put you under in no time. Be sure to also have a policy about getting insurance verification. Not only is every plan different with regards to coverage but the mental health piece is often managed by a third party. Medicare does not cover eating disorders, so they are not very much help.

You won't be able to devise a superbill until you have these questions answered.

There are a number of Eating Disorders resources: NEDA (National Eating Disorders Association) is one.

Good luck. Let me know if you need any more help. Pam
 
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