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News & Press: Clinical Alerts

From Beacon Health Options: Trainings and Updates to the Payment Integrity Compliance Reviews

Monday, December 11, 2017   (0 Comments)
Posted by: Jamie Klufts
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Beacon Training Schedule for All Massachusetts Providers

Beginning on December 15, 2017, the Beacon Payment Integrity Department and the Special Investigation Unit will be presenting monthly webinars specific to compliance, regulations, payment integrity, fraud and abuse, and provider responsibilities. The webinars will be hosted by Payment Integrity and presented through WebEx. Subsequently, Beacon will send a monthly bulletin with reminders from the monthly webinar. Providers will be expected either to attend the live training or to review the presentation once posted on-line or distributed by emailPlease register for the trainings via the links below the training date and title. Once you are approved by the host, you will receive a confirmation email with instructions for joining the session. The live presentations are limited to 500 participants, so please register as soon as possible. 

 

 

December 15, 2017 11:00 AM: Introduction to Compliance

 January 16, 2018 3:00 PM: Minimum Documentation Standards

 February 15, 2018 10:00 AM: Documenting, Coding, and Billing E&M and Other Codes

 March 15, 2018 10:00 AM: HIPAA and Releasing Records

 April 16, 2018 2:00 PM: Compliance with Medicare and Medicaid

 May 15, 2018 10:00 AM: Provider Compliance Programs

 https://beaconhealthoptions.webex.com/beaconhealthoptions/k2/j.php?MTID=te32bb0b875c0de8a04fd91838c21e18d

 

 June 15, 2018 2:00 PM: Compliance Refresher and Upcoming Audits

 https://beaconhealthoptions.webex.com/beaconhealthoptions/k2/j.php?MTID=t5c3f17da694d31c44337b3244da1e380

 

Providers are expected to adhere to federal and state guidelines. The purpose of these trainings and bulletins is to provide additional technical assistance and assist providers with coding and documentation standards.

 

Basic documentation standards include:

  • All entries must be legible
  • All billable activities must have a start and stop time or duration noted on the encounter documentation
  • A full clinician signature, with credentials and dates, must be written on all documentation
  • Detailed progress notes for all encounters, and any amendments thereto, must be clearly marked
  • Service codes used in claims for payment must match the codes used in health records
  • The number of units billed must match the number of units in the health records
  • Services provided/documented must meet service definition for the code billed

Additional documentation tips:

  • Treatment plans should be reviewed and signed by the clinician and the member and should be updated when necessary
  • Activity and encounter logs should not be pre-signed, and progress notes should not be duplicated from other patients or dates of services (i.e., no "cloned" records)
  • Progress notes should be written after the group/individual session
  • All entries should be in blue or black ink for handwritten notes (no pencil or white-out)
  • Record of appropriate supervision provided by a licensed clinician to an unlicensed clinician rendering and billing for services must be documented
  • Records should be stored securely and collected in one location for a given member

 

Additional Information from Beacon

Extended Appeal and Corrected Claim Opportunities

As an accommodation to Massachusetts providers, Beacon will temporarily broaden acceptable documentation for authentication and duration of services. For services provided through December 31, 2017, and for Massachusetts providers, only, Beacon will accept progress notes, psychotherapy notes (redacted to meet HIPAA requirements), encounter forms, and billing sheets to authenticate the services and to confirm the duration of services reported on claims submissions. Beginning February 1, 2018, however, this temporary accommodation will end and providers will be expected to meet documentation requirements for authentication and duration of services on the progress notes. Extraneous documentation will not be accepted.

 

As a further accommodation for Massachusetts providers for services rendered prior to December 31, 2017, Beacon extends an opportunity to submit corrected claims if they had been cited for missing the actual duration of services provided. To avail themselves of this opportunity, providers missing the duration of services (and not other findings) may submit a corrected claim form for the lowest service code with one unit of service.

 

  •  Example 1: if a provider submitted service code 90837 and the provider did not document the actual duration of service, the provider may submit a corrected claim form for service code 90832, which is the lowest service code for psychotherapy. Future progress notes should include actual duration of time on progress notes.
  •  Example 2: if a provider submitted service code 90882 with two units and the provider did not document the actual duration of service, the provider may submit a corrected claim for 90882 with one unit. 90882 is a unit-based service code for other psychiatric services, therefore the lowest unit value is one. Future progress notes should include actual duration of time on progress notes.

Adjusted Compliance Reviews


Beacon makes the following adjustments:

  • For open self-audit reviews: Beacon will continue to work with providers and grant, as appropriate, extensions of time and technical assistance for self-audits reviews.
  • For open medical record reviews: Beacon will adjust and simplify the scope of a record review.
  • Beacon will not initiate any new compliance reviews before July 1, 2018, thereby allowing providers to take advantage of available trainings and provider education.
  • Beacon will not initiate any new requests for provider self-audits before January 1, 2019.

Contact Information and Resources

For additional guidance, you can access:

 


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