Maximizing Coverage through Clinical Documentation


As clinicians, we are taught many things about documentation. Most of us are taught it to put the least amount of information necessary to ensure the client’s process is protected. However, with an increasing number of consumers wishing to utilize insurance this is often a double-edged sword. Most insurance carriers have a set of criteria that they follow to determine what level of care and how much care they will authorize. Some carriers use ASAM criteria, some use a combination of different guidelines, and some have developed their own set of criteria which can be confusing to navigate (looking at.

Medicare Audit on Therapy Claims


Have you or your treatment facility ever thought about what potential changes are coming from Insurance Companies? What about the outlook for reimbursement in 4th Quarter or 2017? 2016 has seen massive sweeping changes in reimbursement rates in the first 8 months alone. The transition from ICD-9 to ICD-10, changes in medical necessity criteria and accepted CPT coding have all impacted a vast majority of treatment providers. Changes like these will continue as the industry evolves. Medicare has issued a review for 60 minute psychotherapy sessions as a potentially over used CPT code. What this means is that claims being.

Providers Steering Clients to Obamacare


This article contains important information for any facility accepting medical insurance as payment for services. Reports state that the federal government has launched investigations into healthcare providers steering and/or assisting patients into Healthcare Exchange policies when oftentimes the patients qualify for Medicare or Medicaid. Steering patients to specific policies, insurance plans, or markets drives up healthcare costs. In turn, higher costs equate to increased premiums and increases the cost of coverage for all. With health insurance, if the risk pool gets to diluted with sick or treatment seeking people, insurers begin to experience great losses. As a result, insurers begin.

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