Billing for Co-Occurring Disorders in Intensive Outpatient Programs
Intensive outpatient programs, or IOPs, are becoming more popular as a therapy option to hospitalization or other inpatient therapies for persons who do not require detoxification. IOPs are often offered to patients with substance abuse orders who have either completed or do not require a detoxification period and to persons with specific types of eating disorders or depression who are not in danger of self-harm. The patient benefits from retaining a presence at school or a job, reduced expenses, and the opportunity to live at home. Discover effective billing strategies for co-occurring disorders in intensive outpatient programs.
An IOP is a series of multiples on the provider side:
- Multiple treatment services (family, individual, and group therapy) and
- Treatment modalities (rational emotive behavioral therapy and cognitive behavioral therapy),
Let’s have a deep dive into the billing for co-occurring disorders in intensive outpatient programs:
Intensive Outpatient Programs (IOPs) Billing Guidelines:
- Prior authorization
- Service duplication
- Physicians’ services
- Service duration
Intensive Outpatient Programs (IOPs) Coding Rules:
The IOP billing codes will differ depending on whether the services are primarily for substance abuse or mental health issues. It's crucial to understand that if a patient has a dual diagnosis of substance abuse and mental disorders, you can only bill for one IOP session per day, even if both issues are treated in the session. You may document such information for the payer, but except in minimal instances, duplicate billing claims will usually be disallowed.In general, you will use one of two basic HCPCS codes for IOP services depending on whether the diagnosis code is for alcohol and substance abuse treatment or mental health.
- Alcohol and other substance abuse IOPs
- Mental health IOPs
Most payers regard these IOP services to be an inherent element of the per diem rate and cannot be billed separately in addition to the HCPCS codes listed above:
- Supplies
- Diagnostic and evaluative testing, including neuropsychological testing
- Ancillary services
- Medication management
- Drug and alcohol tests performed at laboratories
- Individual, group, and family therapy sessions
- Crisis intervention
Outsourcing IOPs Billing & Coding:
Is your intensive outpatient program (IOP) encountering frequent reimbursement delays or denials? You might be dealing with reimbursement issues and trying to solve them through complicated processes that frequently waste resources while delivering little or no remedy.While reimbursement delays and denials are typical in your facilities, minor changes to your IOP billing KD30 can help speed up the process. Improving your billing process lowers delays and denials while ensuring revenue is not lost due to uncaptured items. But what exactly is required for smooth IOP billing and coding?
The optimal solution is outsourcing IOP billing and coding tasks to 24/7 Medical Billing Services.
You can smoothly streamline your entire process with the assistance of these experts. In fact, your in-house billers and coders will no longer need to memorize different IOP codes after you outsource your IOP billing and coding.
See also: The Technology Revolution: Innovations In Medical Billing Outsourcing