Complete Story
06/21/2017
Priority Health Announces...
Behavior Health Trends and Billing Irregularities
Priority Health periodically reviews provider claims data to identify trends, billing irregularities and other potential concerns. During their recently analysis, they identified irregularities related to behavior health services and announced via listserve.
Irregularities Priority Health has observed -
- Exclusively billing only one code when peers are billing a variety of codes
- Excessively billing high level codes (i.e.90837)
- Billing a high number of units for time-based codes
- A lack of medical record documentation to support the level of service billed
Recommendation from Priority Health is to evaluate office coding practices and, if your practice is non-compliant, that process and billing adjustments are made within the next three months.
Priority Health has offered resources for billing and coding compliance best practices within the listserve.
What can you expect from Priority Health:
They will continue to monitor claims through the summer looking for modifications on the part of individual practices. Those providers who coding practices continue to show irregularities with no attempt to change will be subject to a medical record audit in later 2017. And, if errors are identified in an audit, subject to corrective action including recovery of overpayment, a corrective action plan, a second audit, or termination from the network.
Questions - email SIU@priorityhealth.com
