Wiki Partial Hospitalization Start up

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Does anyone have experience with a Mental Health facility billing for partial hospitalization? Our CEO wants to start a program up and researching this has my head spinning.
Is the partial hospitalization to be billed as Transitional Care Management (TCM) with codes 99495-99496 or should I be reasearching another set of codes?
Any help would be much appreciated!

Thanks,

Kristy Blankenship, CPC
HealthQuest, PC
 
KB,

I'm not sure what you mean with regards to partial hospitalization, but we just started using TCM codes. We use these codes for patients who have just been discharged from our Inpatient unit regardless of the duration of the hospitalization. The criteria to use TCM codes is very specific and they cannot be billed unless you meet the requirements based off the code description.

-JC
 
PHP programs are different from TCM. TCM is billed by (mostly) primary care providers to report post-discharge care in the outpatient/office setting. PHP programs are outpatient psychiatric programs designed for patients who are not appropriate for an inpatient admission but still need comprehensive care.

Review CMS Pub 100.02, 70.1-70.3 for the details on PHP. Also review Medicare Claims Processing Manual, Chapter 4 "Hospital Outpatient Services". Additionally, most commercial payers have very specific guidelines for PHP.

This stuff is complicated. I suggest you contract with a consultant to get you going in the right direction.
 
hi Pam- I am a CPC, and I work on EHR implementation for a Behavioral Health specific EHR company. Something being brought up recently is intensive outpatient programs, and billing using UB-04. Can you get us in the right direction for help with questions. I appreciate it. (our current system only supports HCFA)
 
Look into rev codes for Partial Hospitalizations. I bill for SA facilities who render PHP, RTC, IOP and Detox, we bill rev codes on a UB-04. It's an all-inclusive service and most CPT codes are not separately billable outside of the PHP, RTC and IOP programs.
 
Php

PHP is to be billed on a UB04, with revenue code and HCPC when insurance company requires it. You will have get the license through DCF it's a 5 hour per day 5 days week to equal 25 hours of clinical weekly, service are required to be precerted by most insurance companies. I hope this helps..
 
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