- Avoid Processing Delays by Following Proper Submission Guidelines
- Medicare Beneficiary Eligibility Checklist
- Acceptable Electronic Signatures Reminder
- Capable Recipients for the Advance Beneficiary Notice of Noncoverage
- Hospital-Issued Notices of Noncoverage
- Medicare Advance Written Notices of Noncoverage Booklet
- Primary Care Exception Guidelines
- Ordering DMEPOS Items
- Appropriate Use Criteria Program
- Assistant at Surgery Billing Documentation Reminder
- Avoid Return to Provider and Claim Rejections-Enhancing the Beneficiary Eligibility Verification Process
- Checking Eligibility and Knowing Your Point of Contact
- Cloned Documentation Could Result in Medicare Denials for Payment
- Documentation Reminder: Psychiatry and Psychology Services
- Documentation Required for Home Visits
- Electrical Stimulation Therapy: Important Coverage and Documentation Reminders
- Go Paperless Today - Protect Your Bottom Line
- Hospital Acquired Conditions and Present on Admission Resource for Physicians
- Inpatient Admission Prior to Medicare Entitlement Job Aid
- MDS Calendar
- Medicare Home Health Collaboration with Other Provider Types
- Part A Claims for High Cost Items and Certain Drugs Requiring Additional Information
- Manual Review of Claims for Replacement of Supplies and Accessories used with External Ventricular Assist Device
- Referring, Monitoring and Certifying Home Health Services
- Scribing Medical Record Documentation
- Skilled Nursing Facility Medicare Part A Benefit Quick Reference Fact Sheet
- Submit Medical Record Documentation Electronically
- Submitting Electronic Medical Records via CD-ROM
- Using the Medicare Part B PWK Fax-Mail-esMD Cover Sheet
Documentation Reminder: Psychiatry and Psychology Services
Table of Contents
- Documentation Reminder: Psychiatry and Psychology Services
- Submitting Documentation
- Provider Actions
- Related Content
Documentation Reminder: Psychiatry and Psychology Services
National Government Services conducts prepayment reviews on claims for outpatient psychiatry and psychology services. When responding to an ADR from Medical Review, it’s important to pay attention to the documentation that is being requested. Many claim denials have been issued for missing or incomplete documentation in response to an ADR. Based on these findings, providers who render outpatient psychiatry and psychology services should be aware of the documentation requirements for Medicare reimbursement purposes.
Submitting Documentation
The following documentation should be submitted when responding to an ADR for psychiatry or psychology services:
- All recent physician orders and progress notes with clear history of why beneficiary is in treatment and how they have progressed with treatment
- Signed current POC treatment plan stating the type, amount, frequency and duration of services to be furnished including diagnoses and anticipated goals
- Medical and psychiatric history and physical/history of why beneficiary is in treatment
- All certification/recertification statements
- Type and total time spent in psychotherapy
- Clinic note for dates billed which summarizes diagnosis, symptoms, functional status, focused mental status examination, treatment plan, prognosis and progress to date with signature and credentials of personnel licensed by the state to render service
- Case management services other than planning ADLs, arranging care, excursions or resolving medical insurance issues
- Medication management by personnel licensed to prescribe including a review of the medications such as dosage, side effects and response as well as dosage adjustments/changes
- Documentation to justify medical necessity of services billed
- Documentation of physician supervision if services provided off site or off facility grounds
- ABN as necessary
Provider Actions
- Share this information with the appropriate departments who may be involved in ordering, providing, billing or reviewing medical records and documentation for these types of services
- Update any internal procedures or policies with the information in this article and in the associated referenced resources.