The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that helps protect the privacy of individual health information. For individuals living with mental illness, this law is important, because it helps protect confidential mental health treatment records. The HIPAA Rules are designed to protect the privacy of all of an individuals’ identifiable […]
Services provided in outpatient mental health settings are subject to a 62.5% limitation. The limitation applies to claims for professional services that represent mental health treatment furnished to individuals, who are not hospital inpatients, by physicians, clinical psychologists, clinical social workers, and other allied health professionals. Items and supplies furnished by physicians or other mental […]
While the majority of people with mental health conditions will likely not need to spend time in a hospital or treatment center, an individual may need to be hospitalized so that they can be closely monitored and accurately diagnosed, have their medications adjusted or stabilized, or be monitored during an acute episode when their mental […]
Original Medicare is made up of Part A (hospital insurance) and Part B (medical insurance) and includes certain coverage for mental health care when the care comes from a Medicare-assigned health-care provider. Medicare Part A covers hospital inpatient mental health care, including room, meals, nursing, and other related services and supplies. This care can be […]
The only legal way to be paid for a service is to bill using the correct CPT code. You must document that the level of service claimed was medically necessary and delivered. Fraud occurs when a person knowingly does something wrong that benefits them or another person. Abuse (and Waste) occurs when the use of […]
Medicare Part D also called the Medicare prescription drug benefit, is an optional United States federal-government program to help Medicare beneficiaries pay for self-administered prescription drugs through prescription drug insurance premiums. Let’s discuss Medicare part D coverage for mental health in this article. Eligibility and Enrolment Individuals on Medicare are eligible for prescription drug coverage […]
Many people have had the unhappy experience of being denied insurance coverage for mental health treatment they, their family, and doctor agree is medically necessary. Appealing denials for mental health can be complicated, frustrating, confusing, and difficult to navigate. Below are definitions of some of the most common terms used when health services are denied. […]
Medicare Part B (Medical Insurance) helps to cover outpatient mental health care and visits with these types of health professionals (deductibles and coinsurance may apply): A psychiatrist or other doctor Clinical psychologist Clinical social worker Clinical nurse specialist Nurse practitioner Physician assistant Part B covers outpatient mental health services, including services that are usually provided […]
Mental health care includes services and programs to help diagnose and treat mental health conditions. These services and programs may be provided in outpatient and inpatient settings. Medicare part A helps cover outpatient and inpatient mental health care, as well as prescription drugs you may need to treat a mental health condition. Mental health conditions, […]
The ability to make a successful clinical appeal when requested treatment services are denied by an insurer is an important skill for the psychiatrist to have in today’s environment. No one strategy will prove successful at all times and in all situations; often success will lie in a combination of approaches depending on the case in hand.
