Medicare Payments for 2003 Part B Mental Health Services: Medical Necessity, Documentation, & Coding

In 2005, the federal Department of Health and Human Services, Office of the Inspector General (OIG) conducted a medical record review of a random sample of 452 Part B mental health services rendered by 422 billing practitioners in 2003, the most recent year for which Medicare claims data was available. Licensed psychiatrists reviewed the practitioners medical records to determine the medical necessity of the sampled services. Certified professional coders reviewed the medical records to determine proper coding. In addition, OIG auditors  interviewed 372 of the 422 billing practitioners for the sampled services. The reviewers determined that nearly half of all billing for Medicare Part B mental health services resulted in overpayments because the claims were not well documented.