Mental Health Coding and Billing

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Dr. David E. Marcinko MBA

By Dr. David Marcinko MBA

http://www.CertifiedMedicalPlanner.org

Coding Classification

The classification and coding systems used by mental health insurers, both diagnosis-related groups (DRGs) through revenue codes for facility and program services and current procedural terminology (CPT) for in and out patient professional services and consultations, are still being defined through historical methodologies and are vague compared to the medical classification coding structure.

Example:

As an example, mental health insurers classify Tourette Syndrome (TS) as a “mental disorder.” In fact, TS is an inherited, neurobiological disorder, and both neurologists and psychiatrists treat TS with the same medications. If TS were reclassified under the medical coding structure, TS would not only receive potentially a better reimbursement but public perception of TS as a “mental disorder” would be changed.

DSM-IV-TR

The Diagnostic and Statistical Manual of Mental Disorders (4th edition, text revision), also known as the DSM-IV-TR, is a manual published by the American Psychiatric Association (APA) that includes all currently recognized mental health disorders. The coding system utilized by the DSM-IV is designed to correspond with codes from the International Classification of Diseases, commonly referred to as the ICD. Since early versions of the DSM did not correspond with ICD codes and updates of the publications for the ICD and the DSM are not simultaneous, some distinctions in the coding systems may still be present.

For this reason, it is recommended that users of these manuals consult the appropriate reference when accessing diagnostic codes. In addition, DSM5 was last updated in May 2013.  For more information, contact the APA at (800) 368-5777.

Assessment

Besides the above coding manual, the International Statistical Classification of Diseases and Related Health Problems” produced by the World Health Organization (WHO) is another commonly used manual which includes criteria for mental health disorders.

Conclusion

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On a NEW economic hybrid medical reimbursement system

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Enter Hybrid Reimbursement!

dem-2By Dr. David Edward Marcinko MBA CMP®

http://www.CertifiedMedicalPlanner.org

As we know – not withstanding ACOs or bundled care reimbursement models – current medical reimbursement structures involve the submission and payment of medical CPT® coded claims.

Still, some doctors feel they need to “up-code” to maximize revenue or even “down-code” for fear of having a claim denied.

The Outcome

The upshot is that contradictory business goals bastardize the system into a payer versus provider tug-of-war, with patient care as a potential bargaining chip. Instituting quality metrics should be included in this equation and, a hybrid reimbursement model may be a viable option while integrating quality care metrics and reducing costs for all stakeholders.

Enter Hybrid Reimbursement Models

This hybrid reimbursement system might use a two-payment structure.

  1. For the first payment, claims would be paid at hypothetical rate of 60% within one week of submission.
  2. The second payment, consisting of the remaining zero to 40% of some total maximum allowable fee, be paid quarterly. It would be based on scores like patient satisfaction and stewardship of healthcare resources by analyzing a statistically valid sample of patient encounters taken from the electronic health record.

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Flag MOney

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Assessment

Such a hybrid system would remove unnecessary steps, like re-submitting claims, and would lower the operational and administrative costs of claims processing. These changes would decrease operational cost and drive quality stewardship of the healthcare dollar. 

Conclusion

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Health Coverage and the Un-Insured

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For 2016

By http://www.MCOL.com

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Key Hospital Employee Benefits

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For KEY Hospital Employees

By PERRY D’ALESSIO; CPA

[D’Alessio Tocci & Pell LLP]

Dr. David E. Marcinko; MBA CMP®

http://www.CertifiedMedicalPlanner.org

Effective January 1st 2014, the limitation on the annual benefit under a defined benefit plan under Section 415(b)(1)(A) was increased from $205,000 to $210,000.

For a participant who separated from service before January 1st 2014, the limitation for defined benefit plans under Section 415(b)(1)(B) is computed by multiplying the participant’s compensation limitation, as adjusted through 2013, by 1.0155.

The limitation for defined contribution plans under Section 415(c)(1)(A) is increased in 2014 from $51,000 to $52,000.

The Code provides that various other dollar amounts are to be adjusted at the same time and in the same manner as the dollar limitation of Section 415(b)(1)(A). These dollar amounts and the adjusted amounts are as follows:

  • The limitation under Section 402(g)(1) on the exclusion for elective deferrals described in Section 402(g)(3) is increased to $17,500.
  • The annual compensation limit under Sections 401(a)(17), 404(l), 408(k)(3)(C), and 408(k)(6)(D)(ii) is increased from $255,000 to $260,000.
  • The dollar limitation under Section 416(i)(1)(A)(i) concerning the definition of key employee in a top-heavy plan is increased from $165,000 to $170,000.
  • The dollar amount under Section 409(o)(1)(C)(ii) for determining the maximum account balance in an employee stock ownership plan subject to a 5‑year distribution period is increased from $1,035,000 to $1,050,000, while the dollar amount used to determine the lengthening of the 5‑year distribution period is increased from $205,000 to $210,000.
  • The limitation used in the definition of highly compensated employee under Section 414(q)(1)(B) is increased from to $115,000.
  • The dollar limitation under Section 414(v)(2)(B)(i) for catch-up contributions to an applicable employer plan other than a plan described in Section 401(k)(11) or Section 408(p) for individuals aged 50 or over is increased from $5,000 to $5,500. The dollar limitation under Section 414(v)(2)(B)(ii) for catch-up contributions to an applicable employer plan described in Section 401(k)(11) or Section 408(p) for individuals aged 50 or over remains unchanged at $2,500.
  • The annual compensation limitation under Section 401(a)(17) for eligible participants in certain governmental plans that, under the plan as in effect on July 1, 1993, allowed cost‑of‑living adjustments to the compensation limitation under the plan under Section 401(a)(17) to be taken into account, is increased from $380,000 to $385,000.
  • The compensation amount under Section 408(k)(2)(C) regarding simplified employee pensions (SEPs) is increased from $500 to $550.
  • The limitation under Section 408(p)(2)(E) regarding SIMPLE retirement accounts is increased from to $12,000.
  • The limitation on deferrals under Section 457(e)(15) concerning deferred compensation plans of state and local governments and tax-exempt organizations is increased to $17,500.
  • The compensation amounts under Section 1.61‑21(f)(5)(i) of the Income Tax Regulations concerning the definition of “control employee” for fringe benefit valuation purposes is increased from $100,000 to $105,000.  The compensation amount under Section 1.61‑21(f)(5)(iii) is increased from $205,000 to $210,000.
  • The Code also provides that several pension-related amounts are to be adjusted using the cost-of-living adjustment under Section 1(f)(3). These dollar amounts and the adjustments are as follows:
  • The adjusted gross income limitation under Section 25B(b)(1)(A) for determining the retirement savings contribution credit for married taxpayers filing a joint return is increased from $35,500 to $36,000; the limitation under Section 25B(b)(1)(B) is increased from $38,500 to $39,000; and the limitation under Sections 25B(b)(1)(C) and 25B(b)(1)(D), from $59,000 to $60,000.
  • The adjusted gross income limitation under Section 25B(b)(1)(A) for determining the retirement savings contribution credit for taxpayers filing as head of household is increased from $26,6250 to $27,000; the limitation under Section 25B(b)(1)(B) is increased from $28,875 to $29,250; and the limitation under Sections 25B(b)(1)(C) and 25B(b)(1)(D), from $44,250 to $45,000.
  • The adjusted gross income limitation under Section 25B(b)(1)(A) for determining the retirement savings contribution credit for all other taxpayers is increased from $17,750 to $18,000; the limitation under Section 25B(b)(1)(B) is increased from $19,250 to $19,500; and the limitation under Sections 25B(b)(1)(C) and 25B(b)(1)(D), from $29,500 to $30,000.
  • The applicable dollar amount under Section 219(g)(3)(B)(i) for determining the deductible amount of an IRA contribution for taxpayers who are active participants filing a joint return or as a qualifying widow(er) is increased from $95,000 to $96,000. The applicable dollar amount under Section 219(g)(3)(B)(ii) for all other taxpayers (other than married taxpayers filing separate returns) is increased from $59,000 to $60,000. The applicable dollar amount under Section 219(g)(7)(A) for a taxpayer who is not an active participant but whose spouse is an active participant is increased from $178,000 to $181,000.
  • The adjusted gross income limitation under Section 408A(c)(3)(C)(ii)(I) for determining the maximum Roth IRA contribution for married taxpayers filing a joint return or for taxpayers filing as a qualifying widow(er) is increased from $178,000 to $181,000. The adjusted gross income limitation under Section 408A(c)(3)(C)(ii)(II) for all other taxpayers (other than married taxpayers filing separate returns) is increased from $112,000 to $114,000.

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IRS

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Assessment

Administrators of defined benefit or defined contribution plans that have received favorable determination letters should not request new determination letters solely because of yearly amendments to adjust maximum limitations in the plans.

Source: http://www.irs.gov/newsroom/article/0,,id=187833,00.html

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Medicaid’s Most Costly Drugs

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The 5 Most Common RX’s

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More on Childhood Obesity Trends

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obesity-chart

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50 Things Every Gentleman Should Know

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Practical Psychology

54f358d389279a6e9f0b59d95f51461a

By Gus

A gentleman is one who puts more into the world than he takes out.

-George Bernard Shaw

According to a recent article in Salon, the “radical” act of paying attention to each other.…

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50 Things Every Gentleman Should Know, presented by Practical Psychology

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Reasons to Remember Death, by the School of Life

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Daily Dose

By Gus-

https://www.wisedrugged.com

Remembering that I’ll be dead soon is the most important tool I’ve ever encountered to help me make the big choices in life.

-Steve Jobs [In the spirit of Halloween being …]

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Daily Dose: Reasons to Remember Death, by the School of Life

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More on Private LTCI

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By http://www.MCOL.com

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On The Unpredictability of The Market

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On Brexit

Michael Zhuang

By Michael Zhuang,

[Principal of MZ Capital Management]

At the end of June this year, UK citizens voted in a referendum for the nation to withdraw from the European Union. The result, which defied the expectations of many, led to market volatility as participants weighed possible consequences.

Journalists

Journalists responded by using the results to craft dramatic headlines and stories. The Washington Post said the vote had “escalated the risk of global recession, plunged financial markets into free fall, and tested the strength of safeguards since the last downturn seven years ago.” The Financial Times said “Brexit” had the makings of a global crisis. “[This] represents a wider threat to the global economy and the broader international political system,” the paper said. “The consequences will be felt across the world.”

What about those self-proclaimed financial gurus? Motley Fool wrote: “Sell Everything! How Brexit Can Shatter Share Market” and Jim Cramer wrote: “Don’t Buy! Why the Mass Brexit Sell Off is Worth Riding Out.”

It turned out there was no “mass brexit sell off”

It’s true UK got a new Prime Minister, and the Pound Sterling fell to 35 years low. But within a few weeks of the UK vote, Britain’s top share index, the FTSE 100, hit 11-month highs. By mid-July, the US S&P 500 and Dow Jones Industrial Average had risen to record highs. Shares in Europe and Asia also strengthened after dipping initially following the vote.

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Assessment

Before Brexit faded away in our memory, what can we learn from this experience? I don’t know about you, here is what I learn. We don’t know what gonna happen in the future, and we don’t know how the market gonna react. And those pundits on TV and newsletter don’t know either. Prudent investing aka wealth preservation should never be based on their (or our) speculation.

Conclusion

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What is the right relationship to money?

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Money often costs too much.

-Ralph Waldo Emerson

By Gus: https://www.wisedrugged.com

Presented By J. Krishnamurti

As the Dow Jones soars to new peaks, it seems many of us feel a sense of security within the realm of money.

Less preoccupation maybe? Is th…

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Money

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What is the right relationship to money? presented by J. Krishnamurti

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Physician “Burnout” Rates

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By Medical Specialty

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Your-Physician-Can’t-See-You-Yet-–-She’s-Busy-Filling-Out-Paperwork-21

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MORE:

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Retirement Investing with Vanguard Founder John Bogle [video]

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Campaigning for Safer Retirement Investing with Vanguard Founder John Bogle

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When it comes to making retirement investing safer, Rebalance IRA strives to be on the right side of history. Our latest efforts saw Managing Director Scott Puritz joining legendary investing innovator John Bogle, and other industry leaders, in a landmark pro-consumer initiative.

Watch Rebalance IRA Join John Bogle In The ‘Campaign for Investors’

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On Prospect Theory

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And … the reality of decision making!

By David Shahrestani

In the early 1980s, Daniel Kahneman and Amos Tverskey proved in numerous experiments that the reality of decision making differed greatly from the assumptions held by economists.

They published their findings in Prospect Theory: An analysis of decision making under risk, which quickly became one of the most cited papers in all of economics. To […]

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Human Nature #9: Prospect Theory — Wiser Daily

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Are You a One Percenter?

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Well … Are you Doctor?

Rick Kahler MS CFP

By Rick Kahler MSFS CFP

What would it take for you to become a one percenter? How much net worth would put you in the wealthiest one percent in the United States?

In a recent discussion with a colleague, I suggested this number was $1.2 million. He said $9 million. Turns out the real answer, which is surprisingly hard to find, probably falls somewhere in between $1.2 million and $9 million. I have read several articles that put it in the range of $3 to $5 million.

Joshua Kennon, author of The Complete Idiot’s Guide to Investing, 3rd Edition, discusses this topic in more detail in an article posted to his blog in September 2011. He cites several sources and points out the differing methods used by the Federal Reserve Board (which uses the $9 million figure) and the IRS (which favors $1.2 million) to arrive at their numbers.

Regardless of the net worth needed to enter the top 1%, the media usually focuses on the amount of a household’s annual income as what really determines what makes someone rich. We know the income of the rich is growing faster than the income of the poor and middle class. What isn’t reported as often is that the percentage of Americans considered “rich” is also increasing by leaps and bounds. This is different from the rich getting richer. This means an increasing number of Americans are joining the ranks of the rich and the upper middle class.

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In June 2016, Stephen J. Rose, a nationally recognized labor economist affiliated with the Income and Benefits Policy Center at the Urban Institute, published a report titled “The Growing Size and Incomes of the Upper Middle Class.” His research covered a 36-year period from 1979 through 2014. He found that the number of households earning $350,000 or more a year (adjusted for inflation) increased eighteen times, from 0.1% of the population in 1979 to 1.8% in 2014. The upper middle class, those households earning between $100,000 to $350,000, increased two and one-half times, from 12.9% to 29.4%.

With more people earning more money and moving into the rich and upper middle class categories, it would stand to reason that fewer people would be left in the categories of middle class, lower middle class, and poor. The middle class, households earning $50,000 to $100,000, shrank from 38.8% to 32.0%. The lower middle class, households earning from $30,000 to $50,000, declined from 23.9% to 17.1%. The poor, households earning under $30,000, contracted from 24.3% to 19.8%.

Good News?

That is really good news. It means that today, the average American is earning more money than was the case 36 years ago. Perhaps our economic system isn’t as broken as some would have us believe.

With so many political candidates and activists focused on issues like income inequality, it’s easy to assume that more and more Americans are sinking to the bottom economically. Before making such assumptions, it’s important to factor in real data like that cited in Rose’s report.

The plight of those who unfortunately remain on the bottom is a real concern that deserves attention. Yet it is only one part of the whole picture. Many others are able to move upward, an individual and societal accomplishment that is worth celebrating.

Assessment

Instead of taking more from those who do succeed, it would be more useful to focus on what we can do to help others emulate them. The middle and upper middle classes tend to receive less attention than either the poor or the rich, yet these categories make up the majority of Americans. There is always room for others to join them. 

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The State of Health Information Technology

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In Six Visuals

By Venture Scanner

The-State-of-Health-Technology

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Hippocrates and the Internet

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Langan MD[By Ira Nash MD via Michael Lawrence Langan MD]

The Hofstra Northwell School of Medicine recently graduated its second class. The commencement was a wonderful “feel-good” event, complete with beautiful weather, happy graduates and proud families…

Hippocrates and the Internet

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Is medicine the “holy grail”?

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Finding satisfaction in medical practice

By DR RNJB MD

Every day I read many letters and posts from undergraduate students who view a career in medicine as the ultimate prize for academic achievement.

While this view may keep many pre-med students on the road to high academic achievement, a more realistic view of this profession and it’s practice is a better choice for […]

942ef818796363_562d14c1238cb

Is medicine the “holy grail”(finding satisfaction in practice)? — Medicine From The Trenches

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“New Paradigm” is a business model not a medical model

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By Michael Langan MD

“I’m only here for a four day evaluation”– T-shirt sold at Talbott Recovery Center The  New York Times article below written by Robert Dupont advocates coercion to facilitat…

img1-9

“New Paradigm” is a business model not a medical model

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The Age of Technology 2006-2016

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By Public Company Market Capitalization

[via Bertalan Meskó, MD, PhD]

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Top 10 Best US Cancer Hospitals?

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US News & World Report 

By http://www.MCOL.com

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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