4 Common Billing Challenges for TMS Therapy That

1. 4 Common Billing Challenges for TMS Therapy That Psychiatry Practices Face  Credit: MyFcbilling.com

2. 1. Understanding Insurance Requirements Before your practice offers TMS therapy, you will need to decide which insurances you will contract with for providing TMS. Just because a doctor is in-network with insurance, does not automatically include TMS therapy treatment in the contract. Take some time to verify contract coverage. If provider feels that reimbursement rate for TMS is acceptable, fill out the necessary forms to request contract extension to include TMS therapy. Keep a copy of the updated and signed contract on file. Also, keep a copy of the fee schedule on file and check each year for any reimbursement changes. You will need to read through, understand, and keep a note of all insurance pre-requirements, guidelines for documentation, limitation for service frequency, number of allowed sessions, and authorization expiration date.

3. 2. Establishing Need for TMS Therapy As in the case of most high value medical services, doctors will need to demonstrate the need for TMS therapy for a patient in order to receive insurance authorization to render treatment. One major factor insurance look for is the establishment of need. Doctors will need to make detailed exam notes of all treatment methods tried to lessen the symptoms of depression. Insurances will look to see which treatment methods have been tried and their outcome. Patient’s medical records will establish the need for the TMS therapy in the documentation of failed treatments. Patient’s record might include psychological counseling, medication, psychotherapy, and other methods. Details of each treatment method and its outcome need to be clearly documented.

4. 3. Obtaining Authorization for TMS Therapy When submitting request for TMS therapy prior authorization, include all treatment records. Attach all records in order of service date. Make it as easy as possible for pre-authorization department to review your request. If necessary, include a forwarding letter from the provider stating the need for the treatment.  Well-prepared and well-presented documentation leads to successful outcome. Be sure to keep detailed notes in patient’s file of what has been submitted to insurance. This will make it easier to do follow-up with insurance as well as patient. If request for treatment is rejected by insurance after you have followed all protocols, request a peer-to-peer review. Always keep patient informed. Having patient work with the practice to obtain authorization helps speed up the process. It is important to keep detailed notes of all correspondence with insurances. Note the time of call, call reference number, representative name, and a summary of the conversation. Once you receive the authorization, note the number of visits allocated, treatment details, and expiration date. Inform the patient as soon as you receive the authorization to make appointment for TMS therapy. Document the authorization number on the claim for each session. Following is a sample authorization.

5. 4. Submitting TMS Therapy Claims for Payment TMS therapy is a high-value procedure requiring prompt payment. Brining in payment with first claim submission is essential for maintaining good patient care and a profitable practice. Billers have to keep current LCD on file for all contracted insurances for TMS therapy. Before submitting claim, ensure all patient and insurance information is correct. Having incorrect patient information will cause a claim denial with remark code “Patient cannot be found”. If payor ID for insurance is not correct, claim will either be sent to wrong insurance or not transfer over to insurance at all from your clearinghouse. It will stay in the clearinghouse as an Error Claim. If insurance ID is not correct, claim will be rejected by insurance with same remark code, “Patient cannot be found”. Cross-check CPT and diagnosis with the exam notes to be sure correct codes are being billed out. Cross-check diagnosis codes with LCD list to be sure your claim has LCD supported diagnosis. Check all other information on the claim for errors. Submitting clean claim with insurance supported CPT and diagnosis will get your claim paid faster. If insurance rejects your first submission for any reason, you need to understand the rejection reason and review your submission for any other additional error. It is important to get TMS claim processed before patient’s next session.

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