Issues in Medicare Billing, Documentation, and Coding

Practitioners working with geriatric patients need to be aware of Center for Medicare and Medicaid Services regulatory requirements, the definitions of fraud and abuse, and rules and criteria for billing and documentation. This chapter discusses these and other issues related Medicare billing, documentation, and coding. Denials for reimbursement and paybacks for audits are usually due to incomplete elements in documentation and incorrect coding. Although psychotherapy is appropriate for many elderly individuals, including those with neurocognitive disorders, it must be clear that the service is medically beneficial. A recent Department of Justice lawsuit qualifies that the patient has to have the capacity to recall what occurred in therapy from one session to the next. The changes created by DSM-5 diagnostic criteria and utilization of ICD-10 codes have had a particular impact on geriatric psychiatry. These changes in DSM-5 also have an implication in geriatric forensic psychiatry practice and are discussed in detail in the chapter.