This title slide introduces "Outpatient Therapy Billing Training for LCSWs." The subtitle lists key topics: Documentation, Eligibility, Systems, and Claims.

Outpatient Therapy Billing Training for LCSWs

Documentation, Eligibility, Systems, and Claims

Source: Training presentation outline

The Training Goals slide outlines key objectives for billing training. It covers understanding the workflow from intake to payment, mastering CPT codes, eligibility checks, and documentation, plus learning tools like TheraNest and Availity with common pitfalls.

Training Goals

• Understand billing workflow from intake to payment
• Master CPT codes, eligibility checks, and documentation
• Learn tools like TheraNest, Availity & common pitfalls

The "Using TheraNest / EnSora" slide features a grid of five key tools for mental health practices. It highlights Client Intake Forms for onboarding, Progress Notes with templates, Superbill Generation, Insurance Batch Claims, and automated ERA Posting for efficient billing.

Using TheraNest / EnSora

{ "features": [ { "icon": "📋", "heading": "Client Intake Forms", "description": "Streamline onboarding with customizable digital forms." }, { "icon": "📝", "heading": "Progress Notes", "description": "Document sessions efficiently using templates and auto-save." }, { "icon": "🧾", "heading": "Superbill Generation", "description": "Instantly create superbills for self-pay clients." }, { "icon": "📦", "heading": "Insurance Batch Claims", "description": "Submit multiple claims efficiently in one batch." }, { "icon": "💳", "heading": "ERA Posting", "description": "Automate payment posting from remittance advice." } ] }

The slide on Diagnosis & Charge Capture stresses using ICD-10 codes that match services provided and documenting medical necessity for all services. It also advises capturing charges on the same day while avoiding unbundling to ensure compliance.

Diagnosis & Charge Capture

• Use ICD-10 codes matching services provided
• Document medical necessity for all services
• Capture charges on the same day
• Avoid unbundling to ensure compliance

The slide details insurance verification steps in two columns: Availity (login, patient search, benefits check for copay/deductibles/auth, with screenshots) and PA-specific NaviNet (access portal, enter details, review copay/auth/PA coverage, with screenshots for compliance). It emphasizes capturing screenshots for records and eligibility summaries.

Insurance Verification (Availity & NaviNet)

| 1. Login to Availity portal.

1. Search patient by ID/name.
2. Check benefits: copay, deductibles, auth req.

Capture screenshots of verification screens for records. | 1. Access NaviNet portal.

1. Enter patient details for real-time eligibility.
2. Review copay, auth req, PA plan coverage.

Use screenshots for eligibility summary and compliance. |

This slide on PA Medicaid & PROMISe ID lists key steps for providers. Enroll in the PROMISe portal, obtain a provider ID, verify Medicaid eligibility daily, and bill with the correct taxonomy.

PA Medicaid & PROMISe ID

• Enroll in PROMISe portal
• Obtain PROMISe provider ID
• Verify Medicaid eligibility daily
• Bill with correct taxonomy

The PerformCare Overview slide instructs to obtain pre-service authorizations, include the auth number on claims, and appeal denials with notes. It highlights a common issue: missing prior auth.

PerformCare Overview

• Obtain pre-service authorizations
• Include auth # on claims
• Appeal denials with notes
• Common issue: Missing prior auth

Telehealth billing requires using the GT modifier on claims, documenting patient consent and location, and applying Place of Service code 02. Commercial payers accept telehealth claims, but Medicaid mandates video.

Telehealth Billing

• Use GT modifier on telehealth claims
• Document patient consent and location
• Commercial payers: OK; Medicaid requires video
• Place of Service code: 02

Source: Outpatient Therapy Billing Training for LCSWs

The slide "Billing Scenarios" details two cases: Commercial copay collection for an Aetna client, involving intake payment verification via Availity, documentation in TheraNest, and approval within 14 days. For PA Medicaid, it covers eligibility/PROMISe ID checks on Availity/NaviNet, entry into EnSora/TheraNest, no prior auth for routine therapy, and successful weekly-monitored billing.

Billing Scenarios

Source: Outpatient Therapy Billing Training for LCSWs

The slide, titled "Common Errors," presents a table listing three frequent issues and their fixes. These include missing diagnosis (add ICD-10), wrong modifier (use GP), and no authorization (verify prior).

Common Errors

{ "headers": [ "Error", "Fix" ], "rows": [ [ "Missing dx", "Add ICD-10" ], [ "Wrong mod", "Use GP" ], [ "No auth", "Verify prior" ] ] }

The "Best Practices" slide lists key recommendations for efficient operations. It includes performing daily eligibility checks, generating timely superbills, auditing 10% of claims, and training staff on updates.

Best Practices

• Perform daily eligibility checks
• Generate timely superbills
• Audit 10% of claims
• Train staff on updates

The "Resources & Tools" slide lists key platforms for administrative tasks in healthcare. It covers TheraNest for documentation and billing, Availity.com for insurance eligibility, NaviNet for payer authorizations, and the PROMISe Provider Handbook for Medicaid rules.

Resources & Tools

• Access TheraNest login for documentation and billing
• Use Availity.com for insurance eligibility verification
• Log into NaviNet portal for payer authorizations
• Consult PROMISe Provider Handbook for Medicaid rules

Source: Training Document

The conclusion slide "Key Takeaways" emphasizes three main points: master the workflow, always verify, and document thoroughly. It includes billing support contacts (billing@clinic.com | 555-1234) and invites Q&A.

Key Takeaways

• Master workflow

• Verify always
• Document thoroughly

Contact billing support: billing@clinic.com | 555-1234

Q&A

Master workflow, verify always, document thoroughly.

Source: Outpatient Therapy Billing Training for LCSWs