This title slide presents "Outpatient Billing & Documentation Training" as the main topic. The subtitle lists "Peace of Mind Mental Health Group | Presenter Name | Date."

Outpatient Billing & Documentation Training

Peace of Mind Mental Health Group | Presenter Name | Date

Source: Peace of Mind Mental Health Group

This agenda slide lists key topics for a billing session. It includes billing workflow overview, TheraNest/EnSora documentation, insurance verification (Availity/NaviNet), PA Medicaid/PerformCare, telehealth rules, and common billing errors.

Agenda

1. Billing Workflow Overview
2. TheraNest/EnSora Documentation
3. Insurance Verification (Availity/NaviNet)
4. PA Medicaid/PerformCare
5. Telehealth Rules
6. Common Billing Errors

Source: Outpatient Billing Training – Peace of Mind Mental Health Group

The slide provides an overview of the billing workflow in a table format, listing seven phases from Client Intake to Denials & Corrections, each with assigned owners and key tasks. Front Office and Billing Coordinator handle initial registration and verification, Clinicians manage assessments and documentation, and Billing Specialists oversee claims, payments, and corrections.

Billing Workflow Overview

{ "headers": [ "Phase", "Owner", "Key Tasks" ], "rows": [ [ "Client Intake", "Front Office", "Register client, collect demographics & insurance information" ], [ "Verification & Authorization", "Billing Coordinator", "Confirm eligibility, BH benefits, copays; obtain authorizations" ], [ "Assessment & Plan", "Clinician", "Complete initial assessment, develop treatment plan with codes" ], [ "Sessions & Documentation", "Clinician", "Deliver sessions, document notes within 24hrs with CPT/diagnosis codes" ], [ "Claim Submission", "Billing Specialist", "Generate claims in TheraNest/EnSora, submit to payers" ], [ "Payment Posting", "Billing Specialist", "Post payments and ERAs, reconcile accounts" ], [ "Denials & Corrections", "Billing Specialist", "Review denials, make corrections, resubmit claims" ] ] }

The slide "TheraNest / EnSora Billing Essentials" lists key practices for efficient billing. It emphasizes completing notes within 24 hours, assigning CPT and diagnosis codes, documenting telehealth sessions, generating accurate claims, and reviewing ERA for payments.

TheraNest / EnSora Billing Essentials

• ⏰ Complete notes within 24 hours
• 🔢 Assign CPT & diagnosis codes
• 📹 Document telehealth sessions
• 📋 Generate claims accurately
• 📊 Review ERA for payments

Source: TheraNest / EnSora

The slide outlines best practices for insurance verification, including confirming active coverage and behavioral health benefits, verifying copays, deductibles, and patient responsibility. It also covers checking telehealth eligibility and modifiers, identifying authorization needs and timelines, and documenting details in the EHR.

Insurance Verification Best Practices

• Confirm active coverage and BH benefits.
• Verify copays, deductibles, and patient responsibility.
• Check telehealth eligibility and modifiers.
• Identify authorization needs and timelines.
• Document verification details in EHR.

The left column details steps to log into Availity/NaviNet, search patient eligibility and behavioral health benefits, verify telehealth coverage, and document findings in the EHR. The right column outlines searching authorizations by patient ID, noting details like dates and units, cross-checking needs, and updating chart notes.

Using Availity & NaviNet

| 1. Log in to Availity/NaviNet.

1. Enter patient ID, DOB, select search.
2. Review eligibility status & BH benefits.
3. Verify telehealth coverage & copays.
4. Screenshot & document in EHR. | 1. Search auth by patient/ID number.
5. Note auth #, dates, units.
6. Cross-check with session needs.
7. Paste auth details in chart.
8. Update progress notes with verification. |

This slide outlines PROMISe IDs for PA Medicaid: Group ID identifies the billing practice, while Individual ID is for the rendering provider. It requires NPI and Taxonomy to match PROMISe registration and advises verifying MCO enrollment first.

PA Medicaid & Promise ID

• ✅ PROMISe Group ID identifies billing practice
• 👤 PROMISe Individual ID for rendering provider
• 🔗 NPI & Taxonomy must match PROMISe registration
• 🏥 Verify MCO enrollment & requirements first

The PerformCare Requirements slide mandates securing referrals and approved treatment plans before services, completing initial and ongoing authorizations, and using correct POS codes (11-office, 02-telehealth, 10-home). It warns against common denials like missing/expired auths or wrong POS and requires documenting all requirements in the client chart.

PerformCare Requirements

• Secure referral and approved treatment plan before services
• Complete authorization process for initial and ongoing approvals
• Use correct POS codes: 11 (office), 02 (telehealth), 10 (home)
• Avoid common denials: missing auth, expired plans, wrong POS ⚠️
• Document all PerformCare requirements in client chart

Telehealth billing rules require documenting provider and patient locations, telehealth platform, and patient consent in notes. Additionally, append modifier 95 or GT to CPT codes and use POS 02 (telehealth) or 10 (home) codes.

Telehealth Billing Rules

• Document provider and patient locations in notes
• Record telehealth platform and patient consent
• Append modifier 95 or GT to CPT codes
• Use POS 02 (telehealth) or 10 (home) codes

The slide "Common Billing Errors" outlines frequent mistakes like incorrect CPT codes, missing modifiers, unsigned notes, wrong diagnoses, and billing non-credentialed providers. It pairs each with best practices, such as verifying CPT matches services, adding 95/GT telehealth modifiers, signing notes, using accurate DSM-5 codes, and billing only credentialed providers.

Common Billing Errors

{ "headers": [ "Common Mistakes", "Best Practices" ], "rows": [ [ "Incorrect CPT codes", "Verify CPT matches service" ], [ "Missing modifiers", "Include 95/GT for telehealth" ], [ "Unsigned notes", "Sign notes before submission" ], [ "Wrong diagnosis", "Use accurate DSM-5 codes" ], [ "Non-credentialed providers", "Bill only credentialed providers" ] ] }

The slide summarizes key takeaways: ensuring accuracy in documentation, coding, and claims; maintaining timeliness with notes within 24 hours; and prioritizing verification of coverage and authorizations. Next steps include asking questions now, reviewing payer updates monthly, and contacting billing@peaceofmindmh.com or 555-123-4567, with a thank-you and invitation for questions.

Summary & Next Steps

**Key Takeaways:

• Ensure Accuracy in documentation, coding & claims
• Maintain Timeliness – notes within 24 hours
• Prioritize Verification of coverage & authorizations

Next Steps:

• Ask questions now
• Review payer updates monthly
• Contact billing@peaceofmindmh.com or 555-123-4567**

Thank you! Questions?

Source: Outpatient Billing Training – Peace of Mind Mental Health Group