Medicare Improper Payment Report for Behavioral Health Services (2015)

by  Wyn Staheli, Director of Research
September 24th, 2016

The following information is from the 2015 Medicare Improper Payments Report by the Department of Health and Human Services.

This table shows the Improper Payment Rates by Provider Type and Type of Error for Medicare Part B claims:

Provider Type

Improper Payment Rate

Type of Error

No Doc

Insufficient Doc

Medical Necessity

Incorrect Coding

Other

Clinical Social Worker

29.8%

0.0%

100%

0.0%

0.0%

0.0%

Clinical Psychologist

28.9%

0.0%

94.9%

5.1%

0.0%

0.0%

Psychiatry

30.8%

0.2%

96.9%

2.5%

0.0%

0.4%

Average for all provider types

29.8%

0.1%

97.3%

2.5%

0.0%

0.1%


From this table, it is easy to see that the biggest problem is lack of documentation. For more information on documentation standards, see the Behavioral Health DeskBook.


References:

Medicare Improper Payment Report for Behavioral Health Services (2015). (2016, September 24). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/medicare-improper-payment-report-for-behavioral-health-services-2015-29965.html

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