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Auditing Behavior Health Visits

  1. Red face Auditing Behavior Health Visits
    Exam Training Packages
    The Director of Physican Practices wants me to audit some our behavior health claims to make sure the physicians are compliant. Although I've done physician audits for a few years now, this is my first time auditing behavior health. I'm not sure where to start. Any suggestions or advice as to what I need to look out for, the differences between auditing E/M and behavior health codes, etc is greatly appreciated.

    Teresa D
    Teresa D

  2. Default Auditing mental health
    I would check with your Medicare carrier - many have a specific publication for Mental Health. Use that as a guide. Also check for a Local Policy - here is Michigan we have several concerning Mental Health.

    From those see what codes you are looking at and the requirements ie ability to partitipate in treatment, medication side effects and overall effectivenets, mental status exam (and definition of what is included in that).

    From that make yourself a template just as you would in the old days for an E&M (pre computers)

    For me the tricky part is usually the mental status exam - the 1997 Guidlines mention a mental status exam to include the followin items listed. I usually use the items there and in the rest of the physical exam for mental health. it is a good source. Or if the practice has one they are using that at least incorporates the items listed from 1997 as a part of the mental status exam.

    Lastly, learn what the AXIS is and what AXIS 1-4 mean if they use them in their documentation. Does that help?

    Jill M. Young, CPC, CEDC, CIMC
    Past Member AAPCCA BOD 2007-2011
    Young Medical Consulting, LLC
    East Lansing, Michigan

  3. #3
    I routinely audit our providers here. I created an internal documentation guideline packet to use as a referrence based on Medicare guidelines. What I do basically, is read the note, determine the intent of the note (i.e is is therapy or is it med management or is it an EM) Once I determine category, then I check on time spent, etc. Also, if they are billing 90805,90806 etc, which are therapy codes, you need to be sure documentation reflects what the doctor is doing for the patient. Insurance companies aren't paying the patient so they don't need to see 10 pages of whats wrong with Mr Smith. They want to see what the dr is doing for him. What service he is providing. Use this as a reference, I am in WI, so it might not be valid where you are, but is a good referrence anyways. Scroll down to psychiatry and click link. Very useful tool to me

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