Category: Mental Health

Having an effective revenue cycle management in place for your center is essential in optimizing performance and margins. From the first contact with patients, such as verification of benefits and authorization preparation, to efficient service coding and billing, to finalizing and collecting on all claims. 

Throughout the whole process, there are key elements in ensuring success with revenue collections that we will cover in this article. Finding the right people to facilitate and function technology, getting real-time eligibility and service authorizations, using data to build a successful game plan for claims denials. 

Finding the right people to facilitate and function technology: Billers are in high demand now days and technology tools continually advance in ways of making jobs and tasks streamlined and accommodating for centers and their treatment teams, however, you still need people with the ability to use the tools available to them. They have to be able to use those tools effectively while understanding the billing and collection process behind them. Payers advise that we use their online tools to obtain the information we need, so it is very important to utilize those tools available to prevent delays or denials. A solid process and accountability of each person involved, maintenance training, and incentives are all factors in maximizing your revenue cycle management.

Getting real-time eligibility and service authorizations: More than 20% of denied claims are usually caused from an authorization issue. Prioritizing real-time verification of benefits and authorizations has to be the main ingredients to ensure success from beginning to end. Many payers allow the ability to get this information online also, making it even more convenient when you don’t have to call someone and wait on hold forever. Create structured processes, that is frequently updated, for prior authorizations for each payer including any benefit coverages or medically necessity requirements. 

Using data to build a successful game plan for claims denials: The only way to prevent claim denials is to use data from denied claims to improve the process. Understanding the how, why, and what caused claims to be denied, you can adjust accordingly to prevent it from happening again with future claims, resulting in an improved revenue cycle management process. There are cases where it may seem impossible to overturn a denied claim, but if you do your due diligence, respond in a fast and timely manner, there’s a good chance you may surprise yourself. Exhaust all options before archiving denied claims. 

These are just a few ways to possibly help increase your insurance reimbursements for your patients and decrease claim denials. This is so beneficial to everyone involved, from the insurance companies to the staff and treatment team at the center, and most importantly, the patient and their family. 

I would like the opportunity to hear what has worked for your center in the past or present? What obstacles do you frequently run into when dealing with your insurance claims? I look forward to discussing more ways to improve. 

The UTAH State Board of Education has put an entity to provide oversight for those Utah mental health adolescent programs that are approved NPS providers for California!

Since it will take them some time to get up and running, the Board will provide a temporary certification to RTCs that apply for certification by August 30, 2019, until their application can be reviewed and a site visit conducted, at which time each RTC will either be approved for a 2-year term or denied certification. Both California and Illinois will accept Utah’s temporary certification.

August 30th is the deadline so if you have not filled out the attached application, you are running out of time.

RTC Special Education Program Certification Application

On June 6th, 2019, Anthem, Inc. announced that they are in the definitive stages to acquire Beacon Health Options, Beacon currently serves more than 36 million individuals across all 50 states, and 3 million of those under comprehensive risk-based behavioral programs.

“Our member-focused, integrated clinical care model helps individuals and their families cope with their physical and behavioral health challenges. Together, we will expand access and enhance the quality of care for our mutual members. I am proud of the talented and committed team at Beacon, and we look forward to our future with Anthem.”Russell C.Petrella, Ph.D., Beacon Health Options President and CEO

Anthem didn’t disclose a price it is paying Bain Capital Private Equity and Diamond Castle Holdings for Beacon Health, which is privately held. The acquisition is expected to close in the fourth quarter of 2019. However, this is a great opportunity for Anthem to utilizing Beacon Health Options, already stellar business model, not to forget they are the country’s largest independently held behavioral health provider.

“As Anthem works to improve lives, simplify healthcare and serve as an innovative and valuable partner, we’re focused on providing solutions that address the needs of the whole person,” -Gail K. Boudreaux, President and CEO, Anthem

The acquisition will offer the opportunity to combine both successful business models to diversify the health services and deliver market-leading integrated solutions. Progressing towards a stronger portfolio of specialized services, improved clinical expertise, and ability to offer broader provider networks and establishing positive relationships.

“We are excited to partner with Anthem to serve the behavioral health needs of more than 60 million Americans,” –Russell C. Petrella, Ph.D., Beacon Health Options President and CEO

Once the acquisition is complete Beacon, combined with Anthem’s behavioral health business, will operate as an integrated team within Anthem’s Diversified Business Group. Russell C. Petrella, Ph.D., Beacon Health Options President and CEO, as well as other key members of Beacon’s senior team, will join Anthem’s Diversified Business Group to lead the efforts to offer innovative behavioral health solutions and further expand this business.

“With an extensive track record in behavioral health, Beacon fits well with our strategy to better manage the needs of populations with chronic and complex conditions, and deliver integrated whole health solutions. Together with Beacon, we will enhance our capabilities to serve state partners, health plans and employer groups as they seek to address consumer behavioral health needs.” -Gail K. Boudreaux, President and CEO, Anthem

We are excited and believe this is very significant as more insurers are working on addressing the determinants of care for mental illness that fall outside of the traditional medical care. One out of every five adults suffers from mental illness, and is only increasing, according to the National Institute of Mental Health.

What are your thoughts on this acquisition? Is this good or bad, why so?

Comprehensive and accurate coding is vital as behavioral and mental health claims are on the rise. We frequently find ourselves progressively adapting to learn nuances with each insurer differently to avoid claim delays or denials. Making improvements accordingly helps make the overall patient experience a lot smoother for the facility’s care team, the engagement with the insurer, and of course the patient’s family.

Nowadays, entities like behavioral health facilities are far more prone to denials and payer audits more than any other medical coverage a patient may have. This puts mental health services at risk as the insurers concentrate on the coding accuracy and things like the duration of services rendered.

The insurance carriers are all about its utilization. They perform plenty of data mining, so all mental health providers regardless what profession they are like psychotherapist, licensed clinical social worker, physician, licensed mental health counselor, or non-physician practitioner, all require that documentation be accurate to avoid delay or denial of claims.

What are CPT codes?

For those who are reading this and not familiar with how claims are paid, they all start with a medical code that can be billable to the insurance carriers.

CPT (Current Procedural Terminology) codes are extremely important and are used for payment for services, especially when it is to be reimbursed by the insurance companies. The American Medical Association developed the CPT codes and assigned from surgical to diagnostic codes for medical providers to use for their patients.

What type of documentation do insurance carriers want to see from providers to avoid any scrutiny?


  • Patient’s diagnosis. This is critical as the insurance carriers use this information to determine if therapy is medically necessary and if the specific therapy type is warranted. For instance, insurers may question the validity of therapy sessions provided to a patient with a neurological or cognitive deficit or a chronic brain injury when a drug intervention may be more appropriate.
  • Therapy type. Physicians likely provide supportive therapy while other mental health providers may provide an array of options, for example, cognitive behavioral therapy, psychoanalysis, or insight-oriented therapy. This is important when initially verifying coverage and benefits, and specifying therapy type, facility, etc… to ensure it will be a billable service provided.
  • Therapy goals: What treatment plans are set in place for the patient, short and long term?
  • Progress reports: Is the therapy being provided benefiting the patient?
  • Duration of sessions: What is the therapy start and stop times, to the exact minute.

How to know what psychotherapy codes to use?

As of 2013, CPT codes distinguishes between physician and non-physician providers performing psychotherapy services. Physician and Non-physician providers doing psychotherapy services use CPT codes such as 90832, 90836, or 90837, but all are based on the duration of the session. Aside from coding these services accurately, they should always be accompanied with documentation supporting the time spent providing the psychotherapy service.

Coding tips when billing for mental health services.

  • Clearly document the time spent and benefits of the psychotherapy. The carriers want to see that a physician billing for psychotherapy is actually doing a therapeutic intervention. Spending extra time talking with the patient does not translate to a billable psychotherapy service. Generally, insurance carriers are worried about over-use of psychotherapy services, particularly if it appears the patient gets no benefit or shows no progress. If in some cases the patient is resistant to psychotherapy interventions or is not taking sessions to heart, it’s not going to benefit them.
  • Documentation justifies any sessions extending beyond 45 minutes. The carriers want to see and know why time extension was necessary. Without proper supporting documents, claims may receive lower reimbursement or even denial.
  • Use group therapy (CPT code 90853), when appropriate. Group therapy is great for patients because they can meet and talk with others with similar problems and usually looked at as very beneficial. Carriers may also consider patients who go through bereavement counseling during a public tragedy or for a court-ordered group setting counseling session for whatever reason valid to use this code.

Documents that are compliant and accurate coding helps providers in avoiding delays and denials. Staying up to date with best practices seems to be a never-ending task, however,  we are glad we could share some insight with you about the significance of correctly utilizing CPT codes when billing for mental health services.

Did you know that nearly one out of every five Americans had a mental illness last year? Denying coverage is now being looked at deeper than just a financial issue, as some see it as a human rights issue.

Families are suffering from the strict system placed on behavioral health insurance processes. A system that fails the needs of people who need it the most, because of not meeting insurance company’s, medical necessity, clause.

Without a reasonable doubt, this is more than a concern for so many Americans who suffer from behavioral health illnesses and can’t seem to get the adequate treatment needed to overcome this difficult roadblock.

A psychiatrist once said,

“Before I decided to specialize in psychiatry, I assumed a person in need of mental health care would have the same access to treatment one has for medical conditions like kidney stones, pneumonia or seizures. Instead, mental health patients and their providers face a mountain of bureaucratic obstacles that other patients are spared.”

Imagine being a doctor, and having to tell someone or even a child who desperately needs treatment, that they aren’t considered depressed enough, or their presenting conditions do not meet the most critical states of mental illness in order to be treated.

With adolescent mental health illnesses on the rise, this has to be one of the most ignored issues that we face in America today. According to the new report, diagnoses of “Major Depressive Disorder”,  have risen to over 30 percent since 2013, and now affects an estimated 9 million commercially insured Americans.

Teen depression rates are increasing so rapidly, if we don’t figure out a better solution, we will be headed for an array of consequences. The Centers for Disease Control and Prevention estimates there were 72,000 deaths from opioid overdoses last year and more than 43,000 suicides reported in 2017.

Nowadays the requirement to even be admitted into a psychiatric facility is set so high, it can be very frustrating when attempting to get prior authorization for treatment. Even if patients have just attempted suicide, shockingly many insurers still require prior authorization by phone before they can step foot inside of the facility.

“Even in spite of the fact that we’re in the midst of the biggest public health crisis of our time of overdose and suicide, we as a nation have yet to come to grips with this in the way that it needs to be,” – Former congressman and mental health care advocate Patrick Kennedy. 

For any other medical hospitalization, nothing is really required and the insurers trust the judgment of the providers. Not the same for psychiatric hospitalizations and treatment centers. In the U.S., denials for mental health care occur three times as frequently as denials for general medical care.

The process of finding and funding adequate mental health treatment is a very daunting task, and most times insurers will simply deny treatment initially knowing that most people are going through so much that will won’t challenge denials of care, leaving them feeling lost and confused and only adds to the stress they are already dealing with.

It’s time to make mental health illness a priority in not only fighting the stigma but also the discrimination set forth from the insurance companies. This system continues to get worse and totally does everything they can to stop treating those who need it, simply based on the fact that they are not considered depressed enough, or suicidal enough to please their extreme criteria. Ask yourself, why isn’t mental health illnesses being looked at as serious as cancer, diabetes, or cardiovascular diseases?

It’s quite frustrating when just 10 years ago, a law passed called the  Mental Health Parity and Addiction Equity Act, also known as the Federal Parity Law. The law requires most insurers to cover illnesses of the brain, such as depression or addiction, no more restrictively than they cover illnesses of the body.

“There are still tons of roadblocks on the policy side and, frankly, in spite of the fact Congress thinks they’ve appropriated some gargantuan amount of money, it still represents less than one-fifth of what we were spending on HIV/AIDS during the AIDS crisis when we were losing far fewer people than we’re currently losing today,” – Patrick Kennedy

In a recent study conducted by a private research company and Georgetown University, researchers found the following listed below.

  • Insurers regularly denied coverage to people with pre-existing mental or substance use conditions;
  • Insurers imposed a 20 to 50 percent increase in premiums for people with a history of mental health or substance use conditions;
  • Insurers offered superficial coverage that did not meet essential needs; and
  • Insurers actively created barriers and limited access to mental health and substance use treatment.

The only way we can see any change is by standing up and speaking out on unjust insurance denials and registering a complaint with your health plan. The more we do this, we can help pressure elected officials, insurance commissioners, and the attorneys general to enforce federal and state parity laws in favor of the patients who need the attention and treatment their insurance plan should be covering.

Nothing will ever change if we don’t speak up and hold insurance companies accountable. We must demand equality for those with mental health and addiction challenges. We cannot stand idly by while insurance companies break the law, at the expense of American families.

Help for Mental Illnesses. Get Immediate Help. If you are in crisis and need immediate support or intervention, call, or go the website of the National Suicide Prevention Lifeline (1-800-273-8255). Trained crisis workers are available to talk 24 hours a day, 7 days a week.

Have questions or need help with insurance claims and or denials, we are always here to answer or help in anyway possible.

Truly being yourself now days is a constant battle, and a lot of times it inhibits our true potential in life.

When you add opinions from others, generational religious beliefs, stigmas of all sorts, or blatant hate into the picture, you can see why mental health illness is such an epidemic in our day in age. Many will have their own theories for why it has come to be, and I would like to share mine with you in this four-part blog called, Mental Health Illness- Cause & Cure.

I believe there’s an undeniable dynamic between the Cause and effects of our daily lifestyle and the Cure that is administered that sometimes not always formulated or executed properly…leaving more and more people in a spin cycle for the rest of their life.

Daily life for most consists of extreme stress, expectations, disappointments, and very little joy. We emphasize our trials in life so much that we take very little notice of the happiness that we encounter. Where our attention is spent the most on a daily basis is what will trigger good or bad thoughts and feelings. 

Our brain is one of the most powerful parts of our body…of course, we need our heart to keep us alive ultimately, but what I’m referring to is the impact our brain has in setting the stage for our day to day life, interpreting feelings appropriately, etc. The magic that can be done by just thinking of something great and wonderful, the goosebumps you get when you go to a concert and hear your favorite song live, the tears of happiness you shed on your daughter’s wedding day. These are all feelings and emotions that start and manifest in our brain.

Think positive, be positive! So cliche, right? It sounds really simple and easy, but for some because of their past experiences and or current situations, that way of thinking is very foreign. Honestly probably excluded from consideration because they just don’t believe in anything going right for them or do not want to think positively because it seems so bad.

One thing that we may not even consider to be an issue in today’s modern age is Social Media. We all love waking up to notifications that 50 people liked your Instagram picture you posted of what you ate last night at your favorite cantina in San Diego. Or the comments we get on our Facebook page about who’s going to your 20 years high school anniversary. These are all fine and dandy, and in a perfect world, that’s all it would be. Right? It’s not!

We all know we can’t have the good without the bad. Maybe we have caused some of that bad in some fashion. The stress and anxiety associated with dealing with the negative impact of social media can cause one to become consumed and engulfed in their online personas, that it takes away from us being happy in real life. Those endorphins we feel from 100 likes are just as real as the emotional breakdown from an argument or debate we have on about things on social media that didn’t go our way.

Over time all we are doing is playing a game on a daily basis of good vs. bad feelings by loading up our social media guns. All we are doing is taking shots at each others posts, and giving our opinion regardless is if hurts someone feelings and don’t even realize it most times because we love the feeling of being right or the bearer of information. We all deal with life differently and have our individual ways of thinking about certain touchy issues, so what you perceive as innocent may really be negative to someone else. 

Now don’t get me wrong, I understand there are useful and genuine posts that are intended to help someone who is going through a hard time or motivational memes that brightened up your day, but let us be honest..after awhile no one wants to see or hear that all day long. We want drama, bad news from around the world, gossip over meaningless reality shows, video clips that enrage our souls, and a platform to stand upon and give your own two cents. That’s what Social Media is for right?

But don’t you think after all of the back and forths and rights and wrongs, that it has a negative impact on your mental health in some manner? I think so and it is just the beginning of how I feel technology is being used against the good of humankind because we are too overly informed about every subject in the world you can think of, and we want the information right now!

The American Academy of Pediatrics has warned about the potential for negative effects of social media in young kids and teens, including cyber-bullying and what they call, “Facebook depression.” But the same risks may be true for adults, across generations.

In a previous blog about Social Media and Mental Health, you can see how bad of an influence it can have on our child’s lives even though it a very familiar way of communication for kids nowadays. This is something that I believe will not get better going forward, as big businesses and users now know how to target and track each person’s online activity, making it extra hard to avoid desired or unwanted feeds on social media. 

These are just a few examples of how social media can negatively affect your overall mental health and maybe it’ll just make you more aware of your own usage of how and what you’re doing on your social media platforms.

Next week I’ll be talking about how another Cause that I feel contributes to the Mental Health Illness epidemic that is hindering some from being truly happy. Stay tuned!

Attention to all of the Utah based NATSAP programs and allies! Be aware of the current challenges working with outside agencies.

Many Utah programs currently are approved by the California Department of Education to provide mental health and educational services to their students.  These students are placed outside of the state of CA because the school district and the family have determined that all lower levels of intervention in their state have been tried and the student has failed.  Therefore a decision will be made during the students IEP meeting to seek placement outside of the state, sending an abundance of students here to Utah to seek treatment.

During the past few months, schools have been notified by the state of IL that they are no longer willing to seek placement for their students in Utah because the state of Utah does not regulate nonpublic special education facilities.  So all of the Utah based programs that have been working with the state of IL are no longer able to accept and work with this state.

Now the state of CA has decided to follow in the footsteps of the state of IL.  All affiliated programs will be receiving a letter from the California Department of Education in the next month indicating that they have until September 30, 2019, to come into compliance with the standard that the State of Utah Department of Education will provide regulation over the nonpublic special education facilities.

The President of the NATSAP has stated that he feels an obligation to the over 300+ families that have students currently in placement in Utah, as well as the hundreds of employees that will be affected in the programs provided if they do not address this problem right away.

Therefore they will be hosting a meeting on Tuesday, August 21st at 11:00.  You can either join the meeting by conference call or come in person to Youth Care.  This meeting is designed to lay out an action plan regarding how they can all work together to get the State Office of Education to regulate Special Education Schools.

There is no limit to the number of individuals from programs that you are interested in joining the meeting.  They anticipate that Executive Directors and Academic Directors will be in attendance, but anyone from their programs are more than welcome to attend.

Tech developers are foaming at the mouth trying to address the shortage of psychiatrists and other mental health professionals with something called telepsychiatry!

In a day in age where mental health care is at its highest it has ever been, hospitals, clinics, and treatment facilities are unable to keep up with the demand due to the shortage of mental health professionals, specifically psychiatrists. If that doesn’t grab your attention, experts say that it’s only going to get worse within the next decade.

In California, as of 2013, there was a shortage of 336 psychiatrists and forecasted to reach between 729 and 1,848 by 2025, reported by the national projections from the Health Resources and Services Administration, cited by the state Governor’s Office.

In the Chicago, the St. Bernard Hospital, CEO Charles Holland said its extremely hard to recruit psychiatrists as it expands its mental health services. Three years ago, due to the growing demand, they opened an outpatient mental health clinic and next month will expand its inpatient mental health unit from 40 beds to 60 beds.

“We feel it is an emergency. We feel it’s getting worse.”— Marvin Lindsey, CEO of the Community Behavioral Healthcare Association of Illinois


In 2005, Minnesota depression rates in women living in rural counties were as high as 40 percent, compared to only 13 to 20 percent in urban counties reported by the Department of Health. In more recent years, a report produced by the Minnesota Hospital Association indicated that from 2007 to 2014, there was a 40 percent increase in emergency department use for mental illness encounters in Greater Minnesota, compared to only a 34 percent increase in the Twin Cities.

We can see the demand is here and not stopping from rising higher and higher. So why isn’t there any young, eager students seeking a career in this much-needed industry?

Let’s just be honest, being a procedure-oriented doctor will get a straightforward payoff for fixing a broken arm or leg, rather than a broken heart where psychiatrists know their treatment is more of a lifetime plan.

“There’s no victory lap (in psychiatry) where you can say you fixed that patient, on to the next one,”- Travis Singleton, Senior Vice President of Physician Staffing Firm Merritt Hawkins.


Greater awareness, diminishing stigma and a worsening opioid crisis in America,  are making more individuals seek mental and behavioral health care. Meanwhile, nearly 60 percent of psychiatrists are over age 55, fueling a retirement wave that experts say exceeds the pipeline of the new doctors who are expected to fill the limited psychiatric residency slots.

What if I told you, one strategy that has shown effective promise for addressing this shortage is telepsychiatry? What is that exactly? Well, it allows patients to obtain psychiatric services from a provider at a distant location through technology such as video consultations. Brilliant!

In Ector County, Texas, Independent School District Head Nurse Laura Mathew, has utilized this technological advancement to help with students at her school when two years ago, Texas Tech’s Chair of Psychiatry, Dr. Bobby Jain, started a program where students could book telepsychiatry appointments through the school nurse. School nurse Laura Mathew says 70 kids have used the program so far.

“We should never discount the power in our pocket,” -Dr. Thomas Kim, the Austin, Texas-based Internist and Telepsychiatrist


Dr. Kim, also in Texas,  has adapted to the new wave of virtual healthcare providers, exchanging the doctor’s office, medical clinic or hospital, for a mobile-based health platform that connects with people wherever they are that need immediate help. This platform has taken high praise in the behavioral health industry, as a fast-growing field in which discreet access to health care has become monumental for improved care, and addressing the shortage of psychiatrists.

“Nowadays we can easily, across a screen, look face-to-face with somebody, and we can do what we normally would do in an office … but then we can also see how that person lives.”-  John Sharp, Chief Behavioral Health Officer for MDLive


“As telemental health care gains in popularity, it gives rise to a number of significant legal and regulatory issues, including privacy and security, follow-up care, emergency care, treatment of minors, and reimbursement, among other things,” says Rene Y. Quashie of Cozen O’Connor’s healthcare practice.

“While some federal laws and regulations (such as HIPAA) apply, most of the issues involve state law, which has resulted in an inconsistent patchwork of laws and regulations that vary widely by state. And there are a number of states that don’t address telemental health specifically in their laws.”

In a recent interview, he said, “The nation is starting to turn a corner in understanding the value of telemental health. The technology has improved dramatically. Healthcare providers are starting to realize the value of technology … in deploying the healthcare experience when and where it’s needed.”

With this new technology taking off and only getting better, it’s a great reassurance and significant step towards addressing the shortages we are experiencing in the mental health care industry.

Non-Suicidal Self-injury (NSSI), is common with all age groups, however, research shows it is alarming common amongst young children.

Hearing that really opened my eyes, and made me want to study about it, and bring awareness to this serious subject that is continuing to affect kids of this generation. If you have never heard of NSSI, it is when somebody intentionally damages or injure their body, to temporarily make them feel better. As crazy as that may sound, the idea of purposely inflicting injury to oneself as a coping mechanism, seems very counterintuitive to most of us. The reality is, it is happening and we all need to be educated on breaking down some of the most common stereotypes surrounding NSSI.

“Hush little baby, Dont you cry, Dont cut your arms, Dont say goodbye. Put down that razor, Put down that light, It maybe hard but, You’ll win this fight.” – Emily Giffin


There are already many negative stereotypes regarding mental health due to a lack of understanding, and this has led to a strong social stigma about mental illness. But most don’t realize the negative effect it has on the lives of people living with mental health problems. So let’s discuss some of the stereotypes and myths attached to self-harm/self-injury, and NSSI in particular.

Myth #1: Individuals who hurt themselves purposely are actually trying to kill themselves, even if they deny it.

Although both suicide and NSSI involve intentional injury to oneself, they are distinct behaviors. By its very definition, the term NSSI describes the intentional injury of one’s own body tissue without suicidal intent. Generally, they are trying to cope with difficult feelings or circumstances they may be dealing with in their lives, and is sometimes referred to as,“Emotion Regulation Strategy”.

However, research has shown that history of self-injury without suicidal intent is a key risk factor for attempted suicide, and visa-versa, a large number of people with a history of suicide attempts also reported a history of non-suicidal self-injury. Although the behaviors are distinct, the link between them further emphasizes the need to address NSSI.

“people say things meant to rip you in half but you hold the power to not turn their words into a knife and cut yourself” – Rupi Kaur, Milk and Honey


Myth #2: Women are usually at risk for this behavior than men.

This is simply not true! Rates of NSSI, are actually similar between men and women. Research shows when looking at cases of self-harm/self-injury, the split between men and women is usually 50/50. The way the exhibit NSSI, may be different, but both are equally likely to hurt themselves in some way. Studies show that women are more likely to cut and scratch, and men are more likely to burn themselves. How you hurt yourself is no different, and both men and women need to get help.

Myth #3: When people say NSSI, you mean they are cutting themselves.

Growing up we may have heard of someone cutting themselves, and was looked at as the most common behavior of course, but actually, recent studies show that scratching and skin-picking may be as common as, if not more common than cutting.

Generally when people hear or talk about NSSI, they automatically only think of or consider cutting and burning as self-harm/self-injury. However, there are many other ways to inflict physical harm. Other common behaviors include picking at the skin or scabs, biting, self-hitting or banging their head on something, which can also lead to cognitive damage and issues.

“I can feel the hurt. There’s something good about it. Mostly it makes me stop remembering.”
 Albert BorrisCrash Into Me


Given the significant negative consequences associated with NSSI, like scarring, infection, increased risk of self-injury, depression, anxiety, and shame, it is essential that we correct these myths. Only by educating ourselves about NSSI will we be able to prevent misdiagnosis and make sure that our friend, coworker, brother, mother, or child gets the treatment that he or she really needs.

If you or someone you know needs help, use the information below.

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.

Billing for IOP in a nutshell

When dealing with IOP billing, there are generally a few more requirements and consistent attention needed to make sure everyone involved is happy. From the patient being able to continue their treatment, to the doctors treating the patient, and of course, making sure the insurance companies are on board with allowing the overall treatment to happen.

Behavioral health levels of care

Behavioral health facilities essentially provide four types of services that insurance companies may consider reimbursement when treating a patient.

  1. Hospital-based inpatient programs, that require medical monitoring, nursing care, and other behavioral health services treated 24/7.
  2. Residential treatment programs, also known as RTC, which is more of a sub-acute facility based monitoring, offering other behavioral health services.
  3. Partial hospital programs, better known as PHP, providing services in an ambulatory setting, and generally requires 20 hours per week.
  4. Intensive outpatient programs, known as IOP, where the patient is provided with behavioral health services for at least 9 to 19 hours a week for adults, and for children and adolescents at least six hours is generally acceptable.

There are so many different modalities and service types when billing for IOP, compared to inpatient and hospital-based programs, which in turn makes it more challenging when trying to get reimbursement.

Similar Article: The Secret To Getting Reimbursed Quicker- Claims Follow Up

Typical services covered in IOPs

If a facility is offering IOP services, they must be licensed at the state level and usually will treat substance abuse and most mental health disorders. Most facilities will set up a weekly schedule for IOP patients, consisting of meeting at least two hours per day, and from three to five days a week.

Typical services generally covered are:

  • Individual psychotherapy
  • Family psychotherapy
  • Group psychotherapy
  • Psycho-educational services
  • Medical monitoring

CMS guidelines required in order for the facility to be eligible for reimbursement for IOP services are:

HCPCS and revenue codes for IOPs

IOP billing codes may differ depending on what the patient’s diagnosis is, and what services are provided primarily either for substance abuse or for mental health issues. Also, another thing to remember when billing for IOP services, if the patient has a dual-diagnosis for both substance abuse and mental health, you can generally only bill for one IOP session per day, even if both were being addressed in therapy. It is always good to document that information for the insurance company, but beware to not submit duplicate claims, as they’ll inevitably get denied and or delay payment.

  • S9480/0905: The per diem outpatient IOP code for psychiatric issues which may include eating disorders, is S9480, and most times is always paired with revenue code 0905. This is generally used for private payers, as Medicare does not recognize these codes.
  • H0015/0906: The per diem outpatient IOP code for all chemical dependency is H0015, and is always paired with revenue code 0906.

Similar Article: 5 Insurance Billing Errors Drug Treatment Centers Can Avoid

Pre-authorization, clinical and IOP all go hand in hand

Just like with all inpatient level care services, most insurance companies require all IOP services obtain a pre-authorization before reimbursement is complete. Although IOP, technically provides only two to three hours per day, most payers require at least 180 minutes of active therapy per day in order to reimburse the per diem rates.

This is why I stated earlier, that clinical documentation is a key element in supporting the full 180 minutes per day, otherwise you’ll end up with a denied claim. A concurrent authorization is generally required to continue to treat the patient and sometimes referred to as short-term interventions, where all clinical and progress of the patient is considered and decided for continued authorization.

We hope this was a helpful and informative article about IOP in particular. If you have any questions about IOP billing and how to maximize your reimbursement for behavioral health services or any other billing concern, please feel free to contact us via email, or check out a ton of extra billing resources here.