In this insightful episode, we dive into one of the most commonly overlooked areas in healthcare compliance—behavioral health. Sonal Patel joins Jennifer McNamara and Maya Turner to discuss why behavioral health compliance deserves more attention, especially as demand for services grows. From documentation pitfalls to the nuances of medical necessity, we highlight key risks that can lead to denials, audits, and even enforcement action if ignored.
What You'll Learn:
Why behavioral health is a high-risk area for compliance breaches
The unique challenges providers face in documenting time-based services
Medical necessity requirements that often go unmet
Telehealth-specific compliance issues in behavioral care
How compliance audits can proactively reduce risks
Steps providers can take now to strengthen behavioral health compliance
Hot Topics Covered:
Time-based E/M codes and psychotherapy documentation
CMS expectations for medical necessity
Common audit triggers in behavioral health
Modifiers and telehealth policies under scrutiny
Real-world compliance examples and red flags
Takeaway Message:
Behavioral health is not immune from audits or enforcement. As the industry grows, so does regulatory scrutiny. Providers need proactive education and tools to remain compliant and protect their practices.
Resources Mentioned:
CMS Behavioral Health Guidance
OIG Compliance Recommendations
Telehealth Modifier Guidance