How to Avoid Penalties
by Leigh-Ann Renz, 5.13.13
Changes to codes, amendments to laws, updates to deadlines: what’s mandatory? What’s not? How does it all apply to you as a mental and behavioral health care provider!? How do you get started and stay on top of everything? Let us help (click here to access this information as a downloadable, printable guide):
How do these issues apply to you as a mental and behavioral health care provider?
Aside from what your practice may be tackling on a local, state or individual level, there are several nationwide compliance issues that you need to be aware of now for mental & behavioral health, including substance abuse treatment: HIPAA (and the recent Omnibus revisions); ICD code changes; CPT bill code changes; and DSM diagnostic code changes.
Getting Started and Additional Resources
CPT: Current procedural terminology (CPT) codes (in conjunction with ICD) are what you use to bill for mental & behavioral health care services: for example, 90801 is a CPT code. Effective January 1, 2013, the AMA changed several CPT codes for mental & behavioral health: deleting some, replacing others and adding granulation via add-on and E/M codes. For all dates of service after 1/1/13, the new codes are to be used and the old codes eliminated. Click here for our CPT Codes Resource Center.
DSM: Before the end of this month (May 2013), the American Psychiatric Association will release the DSM-5, the standard diagnostic manual for mental & behavioral health. While this is technically not a compliance issue (ie, DSM codes are not mandated nor required by law), it can affect your billing, which is. Currently, a psychologist or psychiatrist typically diagnoses using DSM-IV, which are then translated into ICD-9 by your biller. However, the DSM-5 is quite different from IV, which means that if you start using DSM-5, whoever does your billing will need additional training to ensure accuracy. Click here for more details about how DSM, CPT and ICD codes interact and affect your practice.
HIPAA: All health care businesses that handle PHI (personal health information) are subject to HIPAA compliance, including mental & behavioral health. A 563 page revision / amendment to HIPAA went into effect on March 26, 2013 (the Omnibus Rule); and compliance is mandatory by September 23, 2013. There has already been an increase in the number, type and severity of violations administered, including against small practices. All businesses subject to HIPAA must protect themselves against breaches--click here for a simple how-to guide; or here for our comprehensive HIPAA Resource Center.
ICD: Effective October 1, 2014, the ICD-9 codes referenced above will be changing to ICD-10. While it’s tempting to see that 2014 compliance date and put tackling this issue off, it’s critical to start planning for it now. This code change will be huge: providers and insurers will have to switch out the current 14,000 codes for 68,000! We’ll be covering ICD-10 in depth over the next few months, but the most important thing is to keep it on your radar and start educating yourself and your staff now.
How does all of this connect to PIMSY EHR?!
PIMSY was created specifically by and for mental and behavioral health care providers. It wasn’t patched together a few years ago in order to meet Meaningful Use requirements or hastily extrapolated from a larger medical system; it was painstaking designed with the user in mind, to be a great system, period. PIMSY offers a Meaningful Use version (Platinum), but it also offers 3 other tiers to meet your unique needs and budget. We have a strong, dedicated team that believes in our product and is fully invested in its evolution, because we know what an incredible system we’ve built.
As a PIMSY client, we provide resources and functionality to keep up with the ever-changing landscape of compliance issues:
- Free client webinars to tackle industry-wide revisions like 5010, CPT code changes or ICD-10.
- Quarterly updates with new features, and free webinars to show you what’s changed and how to make the most of it.
- Comprehensive training and support: we make sure you know how to use PIMSY as fully as possible and help you tackle questions or issues that may arise.
- Printable, downloadable whitepapers and guides, such as a crosswalk of old & new CPT codes.
We do the research and compliance checking for you, providing a mental health EHR that grows with your practice, so you can focus on your clients.