Medicare psychotherapy audit do's and don'ts
The Office of Inspector General estimated that $580 million of the $1 billion Medicare paid for psychotherapy from March 2020 to February 2021 was improper.
Head of Growth and Operations, JotPsych
You finish a Medicare psychotherapy session and open your note. Write the psychotherapy time and the therapy you gave, so an auditor can match your note to your claim. Keep a current treatment plan in your patient's record.
Write the start and stop times, or the psychotherapy minutes
Keep a current treatment plan for each patient
Name the technique and the condition it should improve or maintain
Billing one session as two psychotherapy services
Billing psychotherapy your note doesn't show
Writing the note after a records request
From the audit of Medicare psychotherapy payments, March 2020 to February 2021, by the Office of Inspector General of the Department of Health and Human Services. Each item answers a deficiency the auditors counted in sampled records.
What the federal audit found
The Office of Inspector General (OIG) of the Department of Health and Human Services sampled 216 days of Medicare psychotherapy. Each day was one patient's psychotherapy on one date. OIG requested records for 212 of the days. Records for 128 days didn't meet Medicare's requirements.
Appendix H of report A-09-21-03021, May 2023, by the Office of Inspector General of the Department of Health and Human Services, also counts a sixth type against Medicare requirements, incident-to rules missed on 12 days, and two types against Medicare guidance: missing signatures on 31 days and missing telehealth modifiers on 29. Missing time led the list, so check the psychotherapy time first in each note you sign.
Do write the start and stop times, or the psychotherapy minutes
On 60 days, the record showed no psychotherapy time. If you bill psychotherapy with an evaluation and management (E/M) visit, write your psychotherapy minutes apart from the visit's total time.
Your note's minutes set your psychotherapy code. Use 90832 for 16 to 37 minutes, 90834 for 38 to 52, and 90837 for 53 or more, per the American Medical Association's CPT rules the OIG report cites.
Do keep a current treatment plan for each patient
Treatment plans came second, on 43 days. Most of those plans lacked a required part, so include the type, amount, frequency, and duration of services, the diagnoses, and the goals in your treatment plan.
Three of the seven Medicare Administrative Contractors, which process Medicare claims, required a treatment plan in their coverage rules, per the OIG report. Check your contractor's coverage rules.
Do name the technique and the condition it should improve or maintain
For 11 days, the note named no technique, such as cognitive behavioral therapy. For 6 days, the note didn't say the therapy should improve or maintain the patient's condition.
Don't bill one session as two psychotherapy services
For 12 days, providers billed more than one psychotherapy service, but the records showed one service. Use one psychotherapy code per session. With an E/M visit, your psychotherapy code is 90833, 90836, or 90838, for the same three time ranges. Add 90785 only when your note shows interactive complexity.
Don't bill psychotherapy your note doesn't show
OIG counted 24 days where psychotherapy wasn't shown or the record was missing. On 11 days, the record showed no psychotherapy. On 8 days, the provider sent no record, and on 7 days, the provider wrote the note after OIG asked for it. Two days had more than one of these problems.
Don't write the note after a records request
The 7 late notes came more than 8 months after the service. Medicare expects you to document each service when you give it and to mark the date and author of any late entry, per its Program Integrity Manual. Write your note at the session.
Choose Time in room for your session, and JotPsych writes that time onto your note and its claim.
Book 15 minutes- Office of Inspector General, Department of Health and Human Services, “Medicare Improperly Paid Providers for Some Psychotherapy Services, Including Those Provided via Telehealth, During the First Year of the COVID-19 Public Health Emergency”, A-09-21-03021, May 2023: findings and Appendix H.
- Centers for Medicare and Medicaid Services, Medicare Program Integrity Manual, chapter 3, section 3.3.2.5, Rev. 12633, May 9, 2024.