PYA understands that behavioral health professionals are facing far greater compliance hurdles—among them, dealing with documentation, billing and coding, treatment plans, and medical necessity determination—that divert their focus from providing patient care.
Our compliance programs are designed not only to provide the information and guidance organizations need to stay abreast of industry regulations, but also to turn compliance into an opportunity for growth. We offer tangible benefits for managing risk and increasing productivity, such as education about ICD-10-CM coding, which unlike DSM-IV coding, is accepted by third-party payers.
Through sound research and outcomes-based practice, behavioral health entities can improve outcomes in behavioral health treatment and most effectively align practice with regulations.
PYA has experience in many facets of behavioral health and can guide your organization through ever-changing compliance regulation obstacles so you can properly bill professional services.
Our experts can assist facilities and providers by offering:
Interpreting the definition of medical necessity for psychiatric services is subjective, and rules vary between types of services and settings. PYA’s medical necessity reviews evaluate documentation that validates medical necessity for the provision of behavioral health services.
Multiple specialties require in-depth knowledge of compliance rules and annual coding changes. PYA provides coding, billing, medical necessity, and other compliance services for healthcare
clinical care and research services. An independent compliance review helps ensure compliance and can lead to opportunities for revenue capture.
Behavioral health services are under increased scrutiny by Medicare and Medicaid. With compliance consultants experienced in expert testimony and a successful track record of winning behavioral health appeals, PYA is a source of support, providing solid, defensible arguments when called upon in a court of law.
Non-compliant entities are subject to substantial monetary penalties under HIPAA-HITECH regulations. PYA’s comprehensive compliance assessment ensures clients maintain the privacy and security of protected health information, avoiding steep penalties and damaged reputations. PYA’s HIPAA Security Risk Analysis includes a system-wide assessment to identify controls, threats, and vulnerabilities relevant to regulatory requirements.
As payers place more emphasis on accurate documentation, providers face the challenge of rapidly changing billing and coding initiatives. Education on the relationship between documentation, coding, and payment is essential, as providers utilize DSM-V more than ICD10-CM. PYA’s client service team is experienced, certified in physician coding, and nationally recognized for providing education and compliance services in provider settings across the country.
Key components of a high-quality compliance program include detection and prevention of inappropriate conduct, as well as emphasis on an organization’s legal and ethical values. A successful compliance program is the result of a combination of clinical and regulatory expertise. PYA’s compliance consultants will help behavioral health organizations meet the complex compliance demands of this specialty.
