Are you experiencing frequent reimbursement delays or denials in your intensive outpatient program (IOP)? Many behavioral health organizations facing reimbursement challenges attempt to solve them through complex channels that often consume resources while providing little or no solution.
While reimbursement delays and denials are common in behavioral health facilities, simple adjustments to your IOP billing KD30 can streamline the process. Improving your billing process reduces delays and denials while ensuring you do not leave revenue on the table through uncaptured items. But what entails a perfect billing system?
An efficient billing IOP system comprises several integrated and synchronized factors. Understanding the billing codes is among the essential steps that lead to a seamless reimbursement process.
What is IOP?
An intensive outpatient program (IOP) is an intermediary treatment approach that targets patients transitioning from inpatient to outpatient services. The program also works for patients requiring more than outpatient services, but circumstances do not favor hospitalization.
IOP is similar to partial hospitalization programs (PHP) but differs in the number of hours spent with the therapist. Both programs offer intensive care, but the patient does not sleep at the facility. PHP requires 20 or more hours of participatory sessions per week, while an IOP provides behavioral services for 9 to 19 hours a week.
In addition, IOP requires clients to receive at least three hours of therapy three to four days a week. As an intermediary program, IOP has unique billing guidelines and codes that each facility should know.
IOP Billing Guidelines
The unique nature of IOP requires the billers to follow specific guidelines and procedures to reduce reimbursement delays or denials. The billers should not assume IOP works like inpatient or outpatient programs. Treating IOP like other programs may increase the delays or even lead to loss of revenue. Here are some basic guidelines for IOP billing:
Seek Prior Authorization
Many insurers require prior authorization or pre-authorization before offering behavioral health services. Pre-authorization ensures the procedures and services requested are necessary. Behavioral health organizations providing intensive outpatient programs should always seek prior approval before registering a client under IOP.
Failure to seek pre-authorization creates unnecessary reimbursement delays or even partial payments. You should also verify insurance coverage, especially if the insurer does not require prior authorization. Moreover, verifying insurance coverage and seeking required approvals minimizes the risk of costly follow-ups.
Avoid Duplication of Services
IOP offers more intensive care than conventional outpatient programs. Intensive care means the patient may receive more than one IOP therapy service unit in a day. When the patient gets two IOP therapy service units in a day, billers may bill those two units as different services.
However, such billing is rejected for duplication. For instance, if a patient receives a therapy session on substance abuse and another on depression on the same day, billing the two units is considered duplication.
Bill Physician Services Correctly
IOP can be provided in an ambulatory behavioral organization or as a hospital-based program. Billing physician services varies depending on the IOP facility. Always include the physician fees in the service rate for services offered in an outpatient IOP facility. When IOP services are offered in a hospital-based program, bill the physician fees separately.
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Record Service and Session Duration Correctly
Most carrier guidelines and state licensure laws consider IOP as a short-term intervention that should last 90 to 180 days. Exceeding the 180 days may lead to reimbursement delays and expensive follow-ups. Some payers may also require at least 180 minutes of therapy service on each visit.
Poor documentation and shorter daily sessions may worsen your reimbursement challenges.
Common IOP Billing and Revenue Codes
IOP billing uses two general billing and revenue codes. These billing codes depend on the classification of the service provided. Behavioral organizations can use IOP to offer mental health disorder treatment or alcohol and substance abuse management. Mental health disorders and substance use disorders use different billing codes, as explained below.
IOP Billing Code S9480/0905
IOP uses the general per diem outpatient code S9480 when billing for mental health disorders such as depression, anxiety, bipolar, and eating disorders. The per diem outpatient code S9480 should be paired with 0905 as the revenue code. When billing a mental health disorder (psychiatric) service under intensive outpatient programs, use the code S9480/0905.
IOP Billing Code H0015/0906
The per diem outpatient IOP code H0015 is used for alcohol and other substance abuse. Since most IOP offer alcohol and chemical dependency therapies, proper documentation is required to meet payer guidelines.
Billers should ensure the services billed last at least 3 hours a day for three days a week. Moreover, billers should take the three-hour daily sessions as one unit of service to avoid duplication. The three-hour sessions may include a combination of assessments, individual and group counseling, and crisis intervention.
The application of the billing codes may vary depending on carrier guidelines and state licensure laws. Some payers may accept the universal billing codes for the services offered under mental health disorder or chemical dependency. However, others may ask for more specific billing codes, such as:
- H2019 for therapeutic behavioral services, per 15 minutes
- H2020 for therapeutic behavioral services, per diem
- H2035 for alcohol and other substance abuse treatment programs per hour
- H2036 for alcohol and other substance dependence treatment program, per diem
Simplify Your IOP Billing and Eliminate Errors that Cause Reimbursement Delays or Denials
IOP Billing codes differ from those used in other levels of care. Mastering the commonly used billing codes and the IOP billing guidelines can help your organization reduce errors that lead to reimbursement delays or denials.
Using the correct codes also reduces the risk of losing revenue due to undocumented services. However, numerous IOP billing codes and human errors derail your goals of establishing a seamless billing process.
Logik Solutions has developed a powerful behavioral health billing software that simplifies the entire process. When you install the billing software, your billing staff will no longer need to memorize different IOP codes.
The software matches each service with its IOP billing code to eliminate human errors that have caused reimbursement delays and denials in your behavioral health organization. Schedule a demo today.
