Help With Low Paid / No Paid Insurance Claims For Out of Network Billing
The Importance of Charting
Providing substance abuse services that help turn hopeless lives into something more beautiful is why we work in this industry. However, if your business isn’t being compensated for providing service then it is difficult to keep your doors open.
It’s critical to understand that proper charting throughout a client’s stay at your facility and into aftercare is essential in guaranteeing you get to keep your reimbursement money rather than having to give it back with a charge back.
Charting can be time consuming on staff and in many instances feel excessive, but if you only document for UR’s and assessments you are headed for trouble.
Here are the aspects of charting that may seem obvious, but can lead to a reversal of reimbursement monies:
Screening prior to Admission
Depending on your facility’s processes, this could include an application for care that clearly shows your Center has done an adequate job of screening your client for the appropriate care and fit at your facility. This needs to be completed with every patient prior to being admitted for care.
Client’s first day of Care
Your facility should provide an assessment and biopsychosocial with the proper Diagnosis within the first 24 hours of admission. The insurance provider is also looking for a comprehensive treatment plan that would include a patient’s discharge from your facility at completion. We will write about treatment plans below
All insurance payors are looking for detailed psychiatric evaluations for any patient admitted into an inpatient, residential setting. Most payor want these evaluations within the first 2-3 days of your client’s stay and then weekly thereafter. This is required for “acceptable” management of medication, planning, and adjustments to diagnosis codes where applicable.
Client’s Treatment Plan
Your client’s chart should have an initial treatment plan that consists of basic goals within the first couple days of admittance into your program. Your insurance payor is going to want to see a more in-depth and detailed plan no more than 48 hours after admittance and they are best suited when all S.M.A.R.T elements are included.
Chart all Treatment!!
We all know that each level of care, whether it’s RTC all the way down to IOP, requires a minimum number of hours to receive per diem payment.
DTX: requires monitoring 24 hours per day and you need to chart for all nurse checks throughout your patient’s stay in Detox.
RTC, PHP & IOP: your facility must chart for every hour of therapy whether they are group, family, or individual therapy sessions. Most payors require 6-7 hours for per diem reimbursement for RTC, although may want seven. Partial hospitalization (PHP) is typically five days a week for 6 hours per day; and finally IOP level of care is 3 days per week with each session lasting 3 hours.
In closing, holding staff accountable to appropriate charting can not only improve patient care, but also guarantee your reimbursement dollars stay where they belong.