Contextual Background. Coding and Billing in a Biofeedback Practice. Ronald L. Rosenthal, Ph.D. authorization is not a guarantee of payment
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1 Coding and Billing in a Biofeedback Practice Ronald L. Rosenthal, Ph.D. authorization is not a guarantee of payment Contextual Background Federal Policy State Statutes Insurance Regulations/LMRP Business Practices Clinical & Theoretical Orientation 1
2 Purpose of Presentation Increase Reimbursement Increase Range, Type & Quality of Services Increase Compliance Provide Guidelines for Professional Services Maintain Professional Stature Within Psychology Increase Professional Stature Within Health Care Add Value to Society s Perception of Biofeedback Practice Models (or how to get the money) Fee for Service Third Party Reimbursement Mixed Collection Methods Section 403(c) Billing Prerequisites Diagnostic Code Procedure Code 2
3 Diagnostic Coding DSM IV for psychological disorders ICD-10 for physical disorders Procedure Codes Current Procedual Terminology (CPT code book) Primarily oriented to physicians and treatment of physical ailments 3
4 Biofeedback Codes Biofeedback training by any modality Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry Biofeedback and Psychotherapy Combination Codes Individual psychophysiological therapy incorporating biofeedback training by any modality (face to face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy) minutes Retired Biofeedback Codes Prior to 1997 (the Golden Age) there were multiple codes specific for modalities of biofeedback 90900, 90902, 90904, 90906, 90908, and
5 Alternative Codes For Biofeedback Neuromuscular reeducation of movement, balance, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities. Alternative Codes For Biofeedback Development of cognitive skills to improve attention, memory, problem solving, (includes compensatory training). Formerly Health and Behavior Assessment And Intervention Codes These codes describe services to patients who present with established illnesses or symptoms, who are not diagnosed with mental illness, and may benefit from evaluations that focus on the biopsychosocial factors related to the patient s physical health status. 5
6 Rationale: Specific Examples Patient Adherence to Medical Treatment Symptom Management & Expression Health-promoting Behaviors Health-related Risk-taking Behaviors Overall Adjustment to Medical Illness New Subsection Six New Codes Assessment Intervention Overview of Codes Established Medical Illness or Diagnosis Focus on Biopsychosocial Factors Relative Values for Health & Behavior Codes Assessment RVU = Reassessment RVU = Intervention RVU = Group RVU = Family (with pt) RVU = Family (w/o pt) RVU =.44 6
7 Reimbursement Rates and Relative Value Units (RVUs) Three components Physician Work Practice Expense Liability Insurance Relative Value Units and Reimbursment (2) The RVU is multiplied by a conversion factor to determine payment Biofeedback codes have modest RVUs CPT Modifiers Acceptability Medicare = about 100% (??) Others = approximating 90% Modifiers 22 = unusual or more extensive service 51 = multiple procedures 52 = reduced service 53 = discontinued service 7
8 Modes of Claim Submission Hard Copy--Mailed Electronic Transmission Electronic Submission of Bills and HIPAA HIPAA compliance mandated when an office engages in electronic transmission of information. Small offices are exempted from HIPAA compliance if they do not use electronic transmission of information. Problems with Biofeedback Codes Not universally covered. May require prior authorization. Limitations on number of sessions. Limitations on types of patients/disorders eligible for reimbursement. Poor reimbursement rates. Time consuming to get authorization. 8
9 Medicare and Biofeedback Requires the use of a modifier (GP for physical therapy) for payment. Possible cap on outpatient rehabilitation services (current moratorium). Medicare and Biofeedback Medicare standards often adopted by other insurance companies. Coverage only for muscular retraining. Excludes Limited diagnostic codes eligible. Payment is less than $45 regardless of the length of session for
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