What this guide covers
- How the psychotherapy and evaluation codes are selected, including the add-on structure that causes the most coding errors
- What counts as documenting time, specifically
- Step-by-step workflows for carve-out verification, authorization tracking, and working a denial
- Each denial pattern you'll see regularly, what the CARC means, and what to do
- The four appeal types and how to build each one
- The documentation elements that hold up when a payer reviews the chart
Two federal rules apply to behavioral health that don't apply to other specialties: the parity statute, MHPAEA, and the substance use privacy regulation at 42 CFR Part 2. Both are covered because both change what you can do when a claim is denied.
What the full playbook covers
Solo subscribers read the full playbook. Here is what it contains.
- Definitions and frequently used terms
- Typical Procedure Codes
- Workflow: verifying carve-out routing
- Workflow: authorization tracking
- Denial patterns and what to do about each
- Parity: what the law requires and how to use it
- 42 CFR Part 2
- Appeals
- Documentation that holds up on review
- Frequently asked questions
- How we work on this at ROI
- Sources