ICD-10 and DSM-5 for Behavioral Health

There are relatively few increases in ICD-10 codes in behavioral health relative to high impact specialties such as Orthopedics. There are 27 ICD-9 codes for Anxiety Disorders and 47 codes under ICD-10 for example, vs. thousands of code changes in some specialties. Therefore, some behavioral health providers assume in error that because there are fewer codes that the ICD-10 transition has little impact on their organization, which is not true.

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Accountable Care Organization: New Risk in ACO Model vs. Prospective Payment System

To protect against this high risk of significant financial loss, the Accountable Care Organization should plan at its inception for methods of payment and/or protection for these cases, such as secondary coverage (insurance).

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Skilled Nursing Facility Reimbursement is Dependent on Resource Utilization Groups

The Balanced Budget Act of 1997 included the implementation of a Medicare Prospective Payment System (PPS) for skilled nursing facilities (SNFs) and hospitals with a swing bed agreement, consolidated billing,…

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