Wiki Partial Hospitalization Program

[jennyherod]

I do Physicians' billing for a group of Psychiatrists. We have a PHP (partial hospitalization program). There are new rules implemented July 1 for billing PHP. They have suspended some of this eff 07/07 and I am quite confused. Does anyone know if this is for Physicians' billing or could it be just for Hospital billing? CMS is asking for patients to be in the program for a minimum of 20 hrs a week and IF they do come for 20 hrs in the week, for it to be billed together. Then I read something about condition code 41 must be used and that is for a different form. We bill HCFA 1500. It's prompted me to think this is not even meant for me? Pleawse help!

 

[danskangel313]

Basically, the plan was to change it so you'd have to bill one claim for one calendar week showing at least 20 hours of in-person therapeutic services. The patient's plan had to reflect that and a provider would have to write off on that plan. The are multiple reasons that prompted the suspension of the edits. One of the main reasons is that the policy goes against an already existing policy allowing the billing of one day, one week, one month. Also, if the patient didn't reach 20 hours for that week, the entire claim would be denied. So let's say the patient only logged 19 hours. The ENTIRE claim would get denied, including the 19 hours, meaning there'd be no payment for the hours actually provided. There's also arguments about the fact the 20 hours rule was going to be mandated in order to qualify for payment of any calendar week, even those weeks in which holidays occurred, which policies already exist to cover weeks like that as exceptions. It's my understanding it would impact provider billing, but I'd assume facility charges would also get denied if the provider is not paid for the professional services.

http://news.aha.org/article/160707-...-for-partial-hospitalization-program-services

IMO, this will never actually get implemented. I think someone made a big whoopsy.

 

[jennyherod]

thank you SOOO much for your reply. I totally agree that this will never get implemented. The whole nature of the service just doesn't seem like it'd allow for 20 hrs to be billed in order to get ANY payment. I mean, we hardly have any patients that come every time they are supposed to. This would put a big dent in our revenue. Again, I appreciate you and I totally agree, just needed confirmation.