Metro NeuroHealth TMS & Psychiatry Services Blog

Understanding the Intricacies of TMS Therapy Billing

tmswebsites@tmsstartitup.com (Kimberly Mercille) — Mon, 05 Aug 2024 19:54:27 GMT

Transcranial magnetic stimulation (TMS Therapy) is a more holistic approach now used by many health care providers in the outpatient setting to treat mental health conditions. However, integrating TMS into outpatient healthcare

practices requires a deep understanding of the patient intake and prior authorization process and medical billing services . This article will explore the complexities of TMS therapy billing , including coding, documentation, compliance, and new developments in the field.

OVERVIEW OF TMS THERAPY & BILLING PRACTICES

TMS uses electromagnetic pulses to target certain parts of the brain, providing a non-invasive solution for depression and obsessive-compulsive disorder (OCD). TMS is also used to treat other conditions, such as anxiety and various mental health conditions, but is typically not reimbursed by insurance. With the increasing popularity of TMS therapy, healthcare professionals need to handle the intricacies of medical billing to maintain the financial stability of their clinics.

Precision in medical billing is essential for the success of healthcare practices, especially for those offering TMS therapy treatment. Ensuring accurate billing is crucial not only for financial reasons but also to comply with regulations . Proper billing practices facilitate fair compensation for services rendered while upholding contractual obligations between insurers and providers.

Common Challenges in TMS Therapy Billing

The process of billing for TMS therapy presents distinct challenges that healthcare providers need to address effectively. These challenges range from:

coding inaccuracies
insurance denials
providing treatments outside the prior authorization dates, and
poor documentation

These challenges require providers to have the skills to recognize and resolve them. Specific challenges include maintaining precise records of treatment sessions and understanding the complexities of insurance regulations pertaining to TMS therapy.

To reduce TMS therapy claims denials, it is vital to implement the following:

Implementing a comprehensive review process: Establish a thorough review process to ensure that all claims are meticulously examined for accuracy and compliance with policy requirements. This includes verifying patient eligibility, reviewing medical records, and confirming that the treatment provided aligns with the approved treatment guidelines.
Enhancing communication with healthcare providers: Improve communication channels with healthcare providers to ensure clear and timely exchange of information. This can be achieved by implementing electronic health records (EHR) systems, which facilitate the sharing of patient information across different healthcare settings.
Implementing a comprehensive quality assurance program to ensure adherence to processes and minimize errors.
Providing thorough documentation and clear communication with healthcare providers and patients to reduce misunderstandings and disputes.
Regularly reviewing and updating procedures to align with current best practices and regulations.
Implementing a patient intake and TMS prior authorization process and onboarding checklist to minimize errors and claims denials
Defining the roles and responsibilities of the TMS therapy technician. The TMS technician's role is multifaceted, encompassing a wide range of responsibilities crucial to not only a good outcome for the patient, but also to ensure that claims are not denied. These responsibilities include:

Patient intake process and procedure
Defining the roles and responsibilities of the TMS technician
Utilizing TMS treatment room tools for the TMS technician to keep track of prior authorization dates, missed treatment sessions, and monitoring of depression and anxiety screening assessments

Understanding current billing procedures for TMS is vital. Many providers mistakenly believe that billing is simple due to the limited number of CPT codes for TMS treatment. However, the challenge often lies in resolving denied claims that are unrelated to how the claim was billed.

From the initial TMS patient registration and confirmation of insurance coverage to the filing of claims and the process of getting paid, every phase demands careful focus. It's important for medical professionals to focus on thorough record-keeping to back up claims and make the billing process smoother.

For assistance with policies and procedures to streamline the TMS patient intake and prior authorization process, visit Metro NeuroHealth to schedule a complimentary consultation.

Coding and Documentation

Specific Current Procedural Terminology (CPT) codes are associated with TMS Therapy. Let’s explore the CPT codes in detail.

90867 Therapeutic repetitive transcranial magnetic stimulation (TMS), initial, including cortical mapping, motor threshold determination, delivery and management
90868 Therapeutic transcranial magnetic stimulation (TMS) treatment, subsequent delivery and management, per session
90869 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment, subsequent motor threshold re-determination with delivery and management

Proper coding and documentation not only facilitate billing but also contribute to successful insurance claims, thus reducing the likelihood of denials. One of the biggest mistakes that many TMS therapy practices fail to understand is the need for astute documentation with every treatment.

Daily documentation should include:

Subjective assessment
Objective assessment
Weekly or a minimum of bi-weekly depression screening assessment

Imagine your documentation as a collection of photographs. This collection should depict a patient experiencing moderate to severe depression, whose symptoms progressively diminish over a span of 6 to 9 weeks (the duration of TMS therapy treatment). These images, when requested from insurance companies, should clearly paint a picture of the patients’ progress while undergoing TMS treatment. Essentially, these images (or documents) should represent a patient who is gradually improving with each week of treatment.

Insurance Coverage

Understanding the terrain of insurance coverage for TMS is essential for both healthcare providers and patients. There are differences in coverage that exist across various insurance policies. It’s important to know the payer networks guidelines as they relate to transcranial magnetic stimulation to secure pre-approvals and interact efficiently with insurance companies to guarantee smooth payment.

Remember that TMS CPT codes are more than just billing three (3) CPT codes. There are several considerations and variables that can significantly impact whether a claim gets paid. These might include things such as correct modifiers, prior authorization dates, incorrect benefits and eligibility, payer guidelines, etc.

While most insurance networks medical guidelines for TMS are similar, they often leave out other factors that influence prior authorization approvals. For example, the trial dates of medications or the length of remission for a patient with a history of a substance use disorder. The list can be extensive, but the bottom line is the network typically seems to be more inclined to deny a prior authorization request over approving it. Therefore, it is essential to know your patients, request medical records, be familiar with the network's guidelines for TMS therapy, and back up your request with good records to armor yourself well for a peer-to-peer review or appeal. If the medical guidelines do not back the reason for a denial, then you have plenty of legs to stand on when responding to a denied TMS prior authorization request.

Leave the Headaches of TMS Therapy Billing to the Experts

For some healthcare practices, outsourcing TMS therapy billing services may be a strategic decision.

Practical examples showcase how TMS billing is applied in real-life situations. By examining case studies, providers can understand the obstacles encountered and learn from successful billing approaches, offering valuable insights to fellow professionals in the industry.

The landscape of medical billing is dynamic, and TMS therapy billing is no exception. It's essential for billing service providers to remain abreast of emerging trends, such as changes in reimbursement models, medical policy updates, and the impact of evolving healthcare policies on TMS therapy billing practices.

It is recommended to find a billing provider that focuses on TMS therapy billing and has a thorough understanding of the patient intake and prior authorization process. Metro NeuroHealth is a top choice in outpatient and specialty psychiatry billing, with extensive experience in managing TMS therapy clinics to guarantee the success of your practice.

Schedule a Complimentary Consultation

1-833-TMS-HELP (867-4357)

Info@TMSStartitup.com

Private Practice vs Insurance-Based Practice Can I Take Insurance and Private Pay?

tmswebsites@tmsstartitup.com (Kimberly Mercille) — Wed, 12 Jun 2024 23:33:20 GMT

How can I sustain my private cash-pay practice while still enabling patients to access insurance for otherwise unaffordable treatment services?

Nowadays, medical professionals and other healthcare providers are increasingly choosing to adopt cash-based practices, primarily to avoid dealing with all the hassles of insurance. However, this decision often poses difficulties as most patients find the cash pay services offered to be unaffordable, especially treatments like TMS therapy and Spravato. Therefore, it is crucial for providers to comprehend the intricacies of managing such situations to ensure their patients have access to treatment without losing the patient.

As the owner of a clinic, it is crucial for you to determine whether you will opt for accepting healthcare insurance or if you prefer your services to be cash-based, where the patient pays a fixed rate for each session. Both payment options have their advantages and disadvantages, so your decision should align with the goals you have set for your clinic. It is important to note that there are some limitations on transitioning from accepting healthcare insurance to offering cash-based services at a later stage.

Cash-based practices have become more prevalent in recent years due to providers' frustration with having to adhere to insurance regulations. Additionally, they are weary of insurance companies dictating patient treatment and the ongoing struggle to resolve unpaid claims. Consequently, the question arises:

How can I sustain my private cash-pay practice while still enabling patients to access insurance for otherwise unaffordable treatment services?

It is important to acknowledge that an increasing number of owners of insurance-based practices are expressing an ardent desire to transition to a cash-based practice or at least increase the number of self-pay patients they serve.

However, many of these individuals lack an understanding of the legal aspects involved in this process and the potential issues they may encounter, particularly when it comes to establishing cash-pay rates. To ensure compliance with contractual obligations and state laws, certain considerations must be evaluated. Nevertheless, this article will NOT delve into the topic of converting an insurance-based practice to a private cash pay practice. Instead, our focus will be on maintaining your existing private cash pay practice while also having the ability to bill insurance for more expensive treatments.

The following areas must be considered: the legal entity, Medicare status, and knowing the network’s contractual rules.

What legal entity are you conducting business under?

If you are credentialed with insurance through your employer and decide to start your own private practice, such as a TMS therapy and Spravato clinic that operates on a cash-only basis, you can exclusively accept cash payments without concerns about the insurance companies you are affiliated with. This is because your insurance credentials are tied solely to your employer's entity. When you become credentialed with insurance, you are not only recognized as an individual provider but also linked to a group NPI number. This group NPI pertains to the legal entity. However, the ability to bill insurance is limited to the specific entity and does not transfer with you if you decide to practice independently.

If you were to transition to a different employer, they would need to recredential you under their group NPI and "legal entity." While the insurance company is already familiar with you and the process may be expedited the second time around, it is still necessary for you to undergo credentialing with the new employer to submit insurance claims through them.

I understand that this may seem complex. Healthcare in this country is unnecessarily convoluted by insurance companies, but that is a separate matter for another discussion. The important thing for you to grasp is the following:

If you aspire to establish your own specialized cash based business, you have the option to exclusively accept cash payments, regardless of whether you are affiliated with an insurance provider or not, as long as you operate under a distinct group NPI (your employer) with the insurance networks. This is feasible because you will be operating as a separate legal entity, specifically your own LLC for your cash-based practice.

When you are working as a separate “legal entity” it is irrelevant whether you are credentialed and in network under your employer. You are functioning as an entirely distinct entity that you own, which is not contracted with insurance, despite your personal credentialing under your employer.

Medicare Status

Please be advised that this information does not pertain to Medicare. There are other rules and regulations that must be followed for accepting cash payments while being enrolled in Medicare. While we will not discuss these regulations in this article, you may visit the CMS website for further clarification on how this applies to Medicare. But here are just a couple of things you should know.

There has been extensive deliberation regarding the implementation of cash practice and treating Medicare patients. It is imperative to understand that if you are still an enrolled provider with Medicare, you are not permitted to charge a Medicare patient cash for a covered service. This matter is straightforward and leaves no room for debate, as the regulations governing this issue are unambiguous.

Healthcare providers who treat Medicare patients but choose not to participate in the Medicare program are required to formally opt-out of Medicare. Consequently, both the provider and their Medicare patients are unable to submit claims to Medicare for reimbursement, resulting in Medicare patients having to pay for services directly.

Payer Networks Contractual Rules

However, it is acceptable to see cash patients in a practice that is credentialed with insurance. There are two approaches to consider:

- Charge cash for services that are not covered by insurance, like IV ketamine infusions for the treatment of depression, while still billing for covered services. However, you will want to be sure the service is not covered by insurance. There are a couple of networks that are now covering IV ketamine for the treatment of depression.

- Establish a separate legal entity to manage the “cash portion” of your practice.

It is important to exercise caution when billing patients for services that are considered “non-covered”. It is crucial to VERIFY that the service is truly a non-covered service or treatment with the insurance. Contacting the insurance company via phone is the best way to obtain this information, as well as applying logical reasoning. It is always a good idea to get the information in writing as well. For instance, most insurance networks do not include ketamine infusions in their coverage for depression treatment, but it is advisable to conduct thorough research before finalizing such decisions.

Billing Cash for Services Rendered When Contracted with Insurance Networks

In terms of operating a separate cash practice in your current practice, this can be done by forming a separate LLC and operating that portion of your business STRICTLY through it. Is it essential to have a separate entryway for practices, distinct from the one used for insurance acceptance. If this is not possible, then you will want to ensure that visitors are fully aware that there are two completely separate businesses in the building or suite as they enter. The necessity of this depends on the specific insurance company and the terms outlined in your contract. Therefore, it is crucial to thoroughly research and understand your contractual obligations. However, it is worth noting that many providers successfully operate under this model without encountering any problems.

Numerous healthcare providers maintain a primary practice that operates on an insurance-based model, alongside a legally distinct cash pay practice within the same premises, often in the same suite. It is crucial to ensure complete separation of all aspects, including the Electronic Medical Records (EMR). This precautionary measure is essential in the unlikely event of an audit, as it is always better to be prepared. By not billing the insurance company, you are helping them save money. However, it is important to note that this may not be a top priority for them.

If you are interested in establishing a specialized cash-based practice alongside your insurance-credentialed employment, there is no need to be concerned. It is important to remember that you will be operating under a completely distinct legal entity.

Private Pay Practice vs Insurance Based Practice

If you own a practice that accepts insurance and wish to offer cash-pay services, it is advisable to create a separate entity and ensure complete separation from your insurance-based practice.

When it comes to commercial insurance regulations for providers who have ownership in two legal entities, one being cash pay and the other contracted with insurance, the situation can be quite complex. Each insurance network has its own specific rules and regulations that physicians must follow.

Some insurance companies may mandate that the provider bills the patient’s insurance in both practices. For instance, Cigna stipulates that the provider must bill the patient’s insurance unless the provider is included in a ‘group’ contract. With a Cigna group contract, which necessitates a minimum of three providers, the provider can have a separate practice and receive cash payment for services provided in the cash-based practice. It is crucial to conduct thorough research in such cases. Contacting the insurance network and asking relevant questions is highly recommended. This proactive approach can potentially save a significant amount of money and prevent unnecessary complications.

For additional details, Metro NeuroHealth is a specialized credentialing and contracting firm that can provide support. They provide consulting services , along with contracting, credentialing, rate negotiations, specialty billing services , and various other offerings. To contact a representative, please click HERE .

Schedule a Complimentary Consultation

1-833-TMS-HELP (867-4357)

Info@TMSStartitup.com

Psychiatry Medical Billing Services By Metro NeuroHealth

Fri, 01 Jul 2022 20:22:04 GMT

Reduce Overhead. Increasing Collections. Stay Compliant.

The psychiatry and TMS therapy medical billing cycle can be a costly nightmare for psychiatrists and TMS Therapy clinics. At Metro NeuroHealth, we make it easy.

What Sets Us Apart?

At MNH, your practice's billing system is in the hands of experts. Our team has over eight years of experience in TMS therapy and psychiatry billing and we’ve owned and operated our own TMS therapy clinics. As a mental health billing specialist, when we say we understand what you’re going through, we genuinely mean it.

Our shared experience in the field sets us apart from other medical billing companies because we know firsthand how complicated the TMS billing process can be. From patient intake to prior authorization, we understand how critical each step in the process is when it concern claims getting paid.

MNH TMS Billing Services Quick Read:

96% TMS Billing Collections Rate in 2021
TMS Billing Services Available in All 50 States
Led by TMS experts with over 8 years of experience
TMS Billing Services Done For You
Patient Intake & TMS Prior Authorization Services
Complete Understanding of the TMS Billing Cycle
Free 30-Minute Consultation

Reduce Overhead

If you hire an in-house biller, you pay salary, benefits, payroll taxes, time off, and maybe even workers' compensation. And when your biller takes time off, who's left to finish the task? Even worse, should your biller resign or not work out, it can wreak havoc on your practice. The monthly cost climbs even higher when you add in the cost of bill-paying software.

Hiring the right psychiatry medical billing company can result in enormous savings – especially when the fee is on a sliding scale.

Increase Collections

Sick of claims going unpaid? Our team of experts gets the job done. We file claims within 48 hours of receiving your superbill and provide aggressive follow-up on outstanding claims. The result? MNH clients report a 30-50% increase in collections and improved cash flow.

Improve Management

Managing the billing cycle leaving you frustrated? By leveraging MNH's “done for you” billing systems, you can make sure you receive funds for services on time. Your TMS clinic or psychiatry practice will access time and money-saving solutions like an online EHR, easy-to-use credit card processing, eligibility verification, and more.

Streamline Web Access

The world is going remote, so secure online access has never been more essential to a successful business. Our unique online billing system allows you to safely send data, upload documents, and view patient accounts anywhere. Sending your superbill has never been easier.

Ensure HIPAA Compliance

At MNH, we know HIPAA compliance is a top priority for all our clients. We pride ourselves on a demonstrated commitment to protecting the privacy of individually identifiable health information. MNH, and its affiliates, partner with you to provide streamlined billing services that are up to date in all things related to compliance and security. We sweat the details, so you don't have to.

Let MNH manage your billing system, so you can focus on what matters most: your patients.

Schedule a Complimentary Consultation

1-833-TMS-HELP (867-4357)

Info@TMSStartitup.com

What is aTMS Therapy or Stanford Theta Burst Treatment?

Mon, 25 Apr 2022 14:26:23 GMT

SAINT Depression Treatment

Transcranial magnetic stimulation has now been an FDA-approved treatment for depression for 14 years. It’s no longer the new kid on the block in alternative mental health therapy. The most popular type of TMS for depression treatment has historically been rTMS, which simply means repeated magnetic pulses rather than a single pulse (sTMS). However, there are newer forms of TMS on the rise. Intermittent theta-burst stimulation, or iTBS, was FDA-approved in 2018. This method allows for different frequencies of magnetic pulses, which actually mimics neuroplasticity frequencies in the brain and makes the treatment much more efficient. iTBS reduces treatment time from 30-45 minutes to just 3 minutes with the same levels of depression remission. Many TMS clinics already offer intermittent theta-burst stimulation.

Additionally, there have now been attempts to make iTBS more efficient by accelerating the process; this is known as Accelerated TMS . Consider the typical TMS treatment program of treatment once a day, 5 days a week, for a course of 4-6 weeks. These timelines have not been scientifically determined as the most effective; rather they are schedules that have been proven effective from the limited research available and prove to be convenient based on most work schedules. Researchers are studying different protocols and schedules with the goal to shorten the treatment time while remaining safe and effective. Accelerated TMS shortens the treatment process to just 5 days. One accelerated TMS protocol in particular is proving to be extremely effective: the SAINT protocol.

What is SAINT?

The Sanford Accelerated Intelligent Neuromodulation Therapy (SAINT) protocol identifies specific procedures and regulations for accelerated TMS to develop a standard treatment process that maintains the efficacy of TMS treatment. These procedures include:

Five consecutive days of treatment with 10 iTBS sessions administered per day
1800 magnetic pulses administered per session with 50-minute intervals between sessions, more than typical TMS treatments
Pulses administered to the left dorsolateral prefrontal cortex (DLPFC), just as with other forms of TMS

Is SAINT effective?

Clinical trials reveal that accelerated TMS following the SAINT protocol is extremely effective in reducing depression symptoms. Cole et al. conducted a randomized clinical trial in 2020 as a follow-up to a previous investigation on SAINT, this time with a larger, more generalizable cohort of participants, in order to examine safety, efficacy, and feasibility. The results: 90.48% of participants showed a treatment response immediately following treatment, which was defined as a reduction in depression scores by more than 50%. Nineteen of the 22 participants (86.4%) met the criteria for remission. Additionally, 70% of participants continued to show treatment response one month after SAINT. The mean number of days of treatment until treatment response was 2.3, meaning on average, participants showed a significant response on the third day of treatment, or after just 23 sessions. There were no adverse side effects, and neurocognitive abilities were not impaired on any measures.

Putting SAINT into Practice

What are the implications of putting this protocol into practice? We have incorporated SAINT protocol into our clinics for certain candidates. The 5 day schedule dictates that someone wouldn’t be able to work full time, which makes it a lesser option for some situations. However, many patients find it easier to take a week off work instead of daily treatments for weeks. Additionally, travelling to a nearby city for a week is a possibility for sooner results than a 6-8 week course.

While more research is still needed, these and other similar results show that SAINT accelerated TMS is a safe, feasible, and effective TMS treatment for depression. Just as with other forms of TMS, symptom relief can last for a significant period of time even after the treatment period ends.

How We Can Help

Let today be a new day. If that choice is to finally Saying "NO" to depression, anxiety, or obsessive compulsive disorder (OCD), then MNH TMS & Psychiatry Services can help. Visit us a www.TMSstartitup.com or to find a TMS clinic near you visit TMS Directory.

Guest Written Article by Nima Fahimian M.D.

2022 TMS Therapy & Psychiatry Billing Clarified

tmswebsites@tmsstartitup.com (Kimberly Mercille) — Sun, 03 Apr 2022 14:44:32 GMT

TMS Therapy Billing - The Art and Science of Effective TMS Billing

There is no doubt there is an art and science to TMS therapy billing . If you are reading this article you are likely having issues with TMS therapy billing or are thinking of starting a TMS clinic and just doing your due diligence before getting started. Perhaps you offer TMS billing services and are struggling with overturning denied claims.

The most important thing in TMS billing is having an astute knowledge of the entire patient intake process. This starts with the benefits and eligibility check. Unfortunately, without this knowledge it would be quite difficult to determine the reason for denial or overturn a denied claim. There are a few articles online that discuss TMS billing. Unfortunately, regardless of how modern the technique for billing may be, if you don’t fully understand all of the intricate details of the patient intake process, your will have difficulty with collecting on denied claims.

Metro NeuroHealth TMS & Psychiatry Services (MNH) is the only TMS therapy billing service provider in the U.S. that has hands-on experience in the TMS clinic setting. This is an absolute must to fully understand the entire process and effectively overturn denied claims. Missing any of the steps during the patient intake process can wreak havoc on your billing and can leave your patient footing the bill for their entire treatment. MNH specializes in TMS billing, credentialing , patient intake, and start up training for providers all across the U.S. Our team of TMS billing specialist fully understands every intricate step of the patient intake process and the impact it

has on billing and claims denials. In 2021, our rate of collections for all billed claims was 96%, and for TMS therapy billing, this speaks volumes regarding the experience and training of our staff.

Our team of collections specialists have encountered 100’s of reasons for denials. So, while it would be impossible to address all of the reasons for denied TMS claims, we can certainly share some insight on how to avoid some of the most common errors as they relate to the patient intake process.

The TMS Patient Intake Process

The TMS patient intake process plays a vital role in TMS therapy billing . The process begins with the TMS consultation visit. For some clinics the consultation visit is performed by the technician or other staff, and in other clinics it is done by the provider. Either way, this visit should include the following:

1 - A thorough history of the patient’s history as it relates to depression with the following minimum information collected from the patient:

Initial diagnosis
History of medication trials, including doses and approximate start and stop dates
History of psychotherapy, including duration, frequency, and provider details
Evaluation for any contraindications to TMS therapy

2 - Completion of a Request for Medical Records that should include:

The patient’s pharmacy
Any previous provider who has prescribed psychiatric medications for the past 5 years
Any therapist, counselor, psychologist the patient has seen in the last 5 years

3 - A medication checklist to assist the patient in recalling previous medication trials

In addition to the above, the patient would likely complete a TMS Registration Form, as well as other documents required for HIPAA purposes or otherwise. However, collecting the above bullet list of items will streamline the prior authorization process and assist with a timely submission to the payer network.

Verification of TMS Benefits and Eligibility

Verification of TMS benefits and eligibility can be a daunting process, as it must be done via phone. This process is very different than checking benefits for a regular patient visit for medication management, which can be performed through your billing system. Often times, deductible amounts for TMS treatment may not be applicable, and there are a number of things you will want to verify before ever starting treatment to ensure your claims are paid.

Metro NeuroHealth recommends verifying the following with every benefits and eligibility call.

Ensure the patient’s policy has benefits for TMS therapy treatment.

Request the patient (and family if applicable) deductible amount, copay or coinsurance, annual max out-of-pocket, and accumulations. All of this information will be necessary to determine the required Good Faith Estimate that you will need to provide to the patient.

If you are told the deductible is not applicable or a TMS prior authorization is not required, never assume this information is correct. Metro NeuroHealth recommends that you call back a second time and reverify this information, and always keep good records of the date of your call, the name of the individual providing you the information, and a call reference number. This is your ammunition when a claim is denied.

Obtain the plan name and payer ID for the specific TMS codes (90867, 90868, and 90869).

Ensure the provider who will perform the mapping session is in-network with the EIN the claim will be billed under.

Inquire about the process for submitting the prior authorization.

Obtain the plan effective date, as this is important to know. If a patient’s plan will be changing before or during treatment, the prior authorization doesn’t automatically transfer to the new payer network. So, it would be wise to be sure and communicate this with your patient before starting treatment. Be sure to ask them to notify you if they anticipate any insurance plan changes during the course of treatment or before starting treatment and be proactive.

Requests for Medical Records

While a request for medical records may seem trivial, it is vitally important to the billing process. Oftentimes patients treated in TMS therapy clinics are not patients of the practice. Therefore, you don’t have any information on this patient other than your initial evaluation for TMS therapy. If a payer network requests for records before they pay a claim, you will likely not have any information to send. Further, these records are often needed to successfully submit a prior authorization. While it may slow the intake process down by a few days, it can also prove to be a vital step in the billing process and help to overturn denied claims in the long run. Thus, saving you the loss of thousands of dollars in the long run.

To avoid delays in getting medical records, try these handy tips:

On your cover sheet let the provider you are requesting records from know why you need the records in a couple days. For example, “ We are requesting medical records in an effort to obtain a prior authorization for TMS therapy treatment so that the patient can begin treatment next week. If you could please fax the patients records in the next couple of days to prevent delays in treatment, we would sincerely appreciate it. Please don’t hesitate to contact us with any questions. ”

If you don’t have the records within three days, Metro NeuroHealth recommends calling the provider to notify them of the sense of urgency. During this call, if you are needing specific information to submit a prior authorization, ask them to provide you the information over the phone to keep the process moving

Always call the patients pharmacy to obtain the medication information needed for the TMS prior authorization rather than waiting on medical records.

Gathering Information and TMS Prior Auth Submission

It’s a good practice to have a TMS prior authorization template to use when collecting information to submit a prior authorization for TMS therapy treatment. While each payer network has their own set of basic or core criteria, each also has many branches that stem from that basic criteria that is not mentioned in the medical guidelines but may land you a denial. It’s important to know and understand each payer networks guidelines medical guidelines for transcranial magnetic stimulation.

The minimum information you will want to document includes all of the following:

Diagnosis code (make sure it is a covered diagnosis, such as F33.2 or F32.2). Some insurances will reimburse for F33.1, and there are a few insurances that are now reimbursing for OCD, as well as the theta burst treatment protocol. But it’s important to know that the TMS system you are using is FDA-approved for OCD and theta burst, as well as the treatment protocol outlined in the medical policy guidelines

Document any secondary diagnosis’ – understand that certain secondary diagnoses’ may disqualify your patient for TMS treatment (i.e., Bipolar disorder, SUD, Eating disorder, OCD, PTSD, seizure disorder, etc.). Every payer network is different. If a prior authorization for MDD treatment is denied due to a secondary diagnosis of OCD or PTSD, this can typically be overturned during the peer-to-peer with a clear explanation that the treatment is specifically being done for major depressive disorder with a thorough an explanation of medical necessity.

Detailed information about the history of antidepressant medications (dose, dates of the trial, side effects, etc.)
Detailed information about any augmentative medications (dose, dates of the trial, side effects, etc.)
History of psychotherapy (who, where, duration, and frequency)
Age of first diagnosis

Conclusion and Wrap Up

In addition to the above list, you will want to be sure your patient does not have anything in their medical records that contradicts the insurance medical guidelines for transcranial magnetic stimulation. If your request for a TMS prior authorization is denied, always ask why it was denied and schedule a peer-to-peer immediately. Some payer networks will give you a very short window of time to schedule the peer-to-peer.

There are a number of other things to consider when completing and submitting a prior authorization to help prevent denials. Metro NeuroHealth offers a TMS prior authorization training course that details the entire patient intake and prior authorization process. Ready to learn more? Contact team MNH today

Minding Your Mental Health During COVID-19

Wed, 01 Jul 2020 02:50:00 GMT

A time for prayer, hope, and a new normal

COVID-19 has brought about a time for prayer, hope, and a new normal. Managing symptoms of stress, anxiety, and depression is critical. The coronavirus places people at a higher risk for mental health challenges due to social distancing, financial concerns, loss of health insurance, and access to health care. Learn how to overcome obstacles, maintain compliance, and remain mentally well during an ever-changing landscape.

The 21st century has brought about much change in our world today. The first few years of this century marked the rise of our global economy. Good or bad, we've witnessed many advances in technology, such as the creation of social media in 2003, China genetically modifying children in 2018, multi-use rockets thanks to Elan Musk in 2017, the creation of the endoscopy capsule in 2001, the bitcoin and cryptocurrencies, the 5th generation mobile network, and the list goes on and on. With the rise of the world population to over 6 billion people, more than half of the world's population is now with access to the internet.

In addition to the many creations and inventions, the 21st century has also brought about sustained and new concerns for our world as a whole. On September 11, 2001 we pulled together after one of the deadliest attacks on our country since Pearl Harbor. In 2019, our world faces a horrific pandemic that threatened the lives of every human being. More than ever before, with the outbreak of COVID-19 (coronavirus), we are being called to pay attention to our physical, emotional, spiritual, and probably most importantly, our mental health. People across every nation are thinking about many things they've never thought of or perhaps all they've taken for granted for many years. Loved ones, both young and old, are being taken away from us with no warning or time to anticipate. Others are realizing for the first time, just how important their health is. Now, we're not only worried about our own health, but many of us find ourselves worrying about the health and wellbeing of family members, friends, neighbors, and coworkers. Unfortunately, this adds to an already strained mental health system.

We've found people helping and giving in ways we've never seen. Neighbors helping neighbors, strangers delivering groceries to the elderly, retired nurses headed back into the hospital to help, hospital staff working countless and tireless hours, the transformation of distilleries and breweries now becoming hand sanitizer manufacturers, and people coming together online and on television in ways we've never seen before. It's refreshing to see how far people are willing to extend themselves to help others.

Since the outbreak of COVID-19 American's have immersed themselves in the news and media. The major news outlets hand-pick some of the most traumatizing stories and deliver it to the nation in the most dramatic way. Unfortunately, this has created much anxiety and stress across our nation. While COVID-19 is most certainly real, and precautionary measures and social distancing are necessary, many people have suffered symptoms of prolonged stress, anxiety, and worsening depression as a result of all the changes occurring due to this horrific pandemic.

Over 30 million people have lost their jobs and filed for unemployment as a result of COVID-19. This means that many people who had health insurance through their employer lost their coverage. There are millions of people who continue to suffer, both mentally and physically. People with existing mental health conditions should continue with their treatment regimens, and be sure to maintain compliance with their medications. Thankfully, due to the passed legislation, testing for the coronavirus is free for all Americans. However, financial challenges due to job loss, lack of insurance, or new expenses resulting from the pandemic may make it tough to afford medications. To continue with your medications, it is important to know that there are programs available that can help you maintain compliance.

Most drug manufacturers offer Patient Assistance Programs (PAPs), which allow people taking brand-name medications to get them at a discount or for free. There are many generic medications that cost less than $10 for a month supply through certain pharmacies, such as Walmart. Other medications offer Savings Cards where a 30-day supply can be purchased for as little as $4. For instance, the Zoloft Savings Card can be used to continue your prescription for only $4 per month. If you are on Medicare and have an income below $19,380 (single), or $26,100 (married), you may be able to get Extra Help , a program that lowers prescription costs. Some states offer State Pharmaceutical Assistance Programs (SPAPs) that help older adults pay for their Medicare prescription drug plan and/or medications.

Maintaining your mental and physical health should be a priority. If watching the news creates undue stress and anxiety, then perhaps it is best to stay informed by checking the Center for Disease Control (CDC) website for COVID-19 updates. If social isolation and distancing is causing worsening mental health symptoms, including anxiety, depression, and loneliness, thankfully the 21st century has also brought about new ways to stay virtually connected, such as Facetime , Zoom , and Skype .

As life continues to change across the globe, we must learn to find effective ways to cope and adapt in an effort to preserve our fragile mental health. Be sure to discuss any ongoing or unrelieved symptoms with your psychiatrist or primary care doctor. Most doctors are continuing to see patients through telehealth methods (virtual visits), and some have reopened their offices with strict safety measures in place. When medications are not effective in relieving certain mental health symptoms related to depression and anxiety, visit TMS Directory to learn about the most advanced depression treatment of the early 21st century, transcranial magnetic stimulation (TMS). To learn more about TMS, contact a TMS therapy specialist by calling 1-833-TMS-HELP.

Stay safe, keep your faith, remain positive, and mind your mental health.

Just Do It! And I'm Not Talking About Buying a Pair of Nike's

Tue, 19 May 2020 01:32:00 GMT

Anything is possible but you are responsible for making it happen.

Are you stuck in a comfort zone that you find is no longer satisfying? Perhaps you've desired a change in your life for a long time - only to find a year later you're still hoping for change. Well, it's time to get off your duff and Just Do It!

There's no better time than now to do what your heart desires, what your life needs, and what you're soul longs for. Why, because life's too short to procrastinate. While having a comfort zone can be satisfying for many, ask yourself if it brings joy to your life. If so, great - than you can stop reading now. But if you're life doesn't spell joy, than keep reading and learn how to bring joy to your life - for a much healthier, happier brand new you.

Remaining in a comfort zone is easy, and I would wager that the majority of people would agree. But, more often than not, success, complete inner peace, and true joy are not derived from a life sustained in a comfort zone. So, I encourage each of you to walk the boundaries of your comfort zone, and take a look outside to see all the wonderful things that life has waiting for you. Then, I challenge you to step outside your boundary of comfort and make a change. For many, fear inhibits change. Yet others don't embrace change for the mere fact that it takes work...and change.

Let's rewind and take a deeper look at your comfort zone

One's comfort zone is technically a psychological state of mind where we live each day knowing what to expect. It allows for control of our environment, and lessens episodes of anxiety and stress. Our comfort zone feels safe, comfortable, content, and inhibits fear. Our comfort zone is predictable. In fact, having a comfort zone is not a bad thing unless it become mundane. Mundane is when our imagination no longer plays a role in our lives, we become stale, stagnant without joy - in a sense, a mundane person is merely existing. Mundane lifestyles often bring about depression, health problems, and can cut years off of one's life. In fact, long-term use of certain psychiatric medications can rob people of their ability to feel joy and the opportunity to have a soaring imagination and sense of livelihood - leading to a mundane lifestyle.

Let's think of our life as a pet fish. For example, guppies, goldfish, and pufferfish can sustain a decent quality of life in a clean fish bowl with pretty rocks and tunnels to flow through. Yet they live in the confinement of the bowl. How about the polar bear? The polar bear takes responsibilities seriously, is loyal and a good listener, and very nurturing. But, they have great difficulty stepping outside of their comfort zones and they dislike change. The average polar bear only lives about 15 years. However, the oldest known polar bear in the Arctic lived to be 32 years old. Well, I'm certainly no zoologists, but for me, this gives rise to the question of "What was different in this polar bears life that all the others did not not possess?".

On the other hand, the dolphin possesses enthusiasm, friendliness, good communication skills, and is warm and affectionate - even toward humans. Dolphins are considered one of the world's most intelligent animals, and they have several cognitive abilities that set them apart. In fact, researchers consider their intelligence to be a combination of perception, communication, and problem-solving. What I love about dolphins is their altruism. Their compassion extends beyond their own species and they are known for helping individuals in danger to shore. What's so cool about the dolphin is they tend to live their life outside of their comfort zones, and use their intelligence as a protective mechanism. Their intelligence inhibits fear.

Take a moment to reflect on your own life. Is it like the dolphin, or is it more like the guppy or polar bear? Do you have dreams, desire more for your life, or feel as if something is missing or needs to change in your life? If so, there's no better time than now to just do it!

What's the downside of remaining in our comfort zones?

Life is short, this is a fact. And, for those of us that are no longer considered 'youth' or a 'young adult', the year's seem to go by even faster. When we choose to remain in our comfort zone, essentially we are choosing to continue to only do what is safe and easy - maybe even effortless. This doesn't challenge our minds or teach us anything new. Furthermore, If there's no challenge or risk, then there's likely no reward. Think of how great you feel when you accomplish something. When you procrastinate and only dream of what you want, days go by, and before you know it another year has passed and you're still sitting in the same spot. Most importantly, when you never step outside your lines of boundaries, you limit your ability to learn and grow.

So, what's the upside to stepping outside my comfort zone?

The big thing that so many people miss is the fact that by achieving new things and stepping outside your boundaries, your comfort zone just becomes bigger -expanding your boundary line. Taking healthy risk to achieve your dreams brings about self confidence and a sense of achievement. Reaching goals is rejuvenating. Pushing yourself to do something you've always desired to do, whether it be going back to school, applying for that position you've always wanted, starting a work-up out routine, or whatever it may be, you're encouraged to just do it.

Increased Risk of Depression & Anxiety in the Midst of COVID-19

Tue, 24 Mar 2020 01:23:00 GMT

Debunk panic during COVID-19 and stay mentally healthy too!

With so much uncertainty taking place across the globe, people have a tendency to panic. Those already suffering from mental illness, such as depression and anxiety are at risk for worsening symptoms. Conversely, those without a mental health condition are now at risk for developing stress, anxiety, and depression. TMS therapy can be one of the most effective treatments for those with exacerbated symptoms.

Conversely, those without a mental health condition are now at risk for developing stress, anxiety, and depression. Frontline health care professionals - those working in emergency rooms and directly taking care of those hospitalized with COVID-19 face high risk everyday. First responders who already encounter traumatic situations are also at a heightened risk for acquiring COVID-19, which brings about worry, as well as symptoms associated with anxiety and depression.

COVID-19 has evoked fear across the nations amidst a season where colds, allergies, and other respiratory symptoms tend to be very common. The mere absence of people within the community, businesses with closed signs hanging in the window, highways bare, grocery stores without food on the shelf or milk in the coolers, and the scarcity of necessary items for survival all bring about feelings of fear, despondency, stress, worry, and depression. Community lockdowns and stay-at-home mandates inhibits social events, decreases the ability to exercise, and can put people at risk for worsening physical and mental health symptoms.

Symptoms of depression, stress, and anxiety are quite normal during such a pandemic as COVID-19. Those most vulnerable to an exacerbation of symptoms includes people with existing mental illness, health care workers, first responders, and those with existing chronic or terminal illness. This is a time of great challenge for everyone across the globe. It is critical that we take it seriously, but refrain from panic.

Fear is the expected reaction to a known threat, such as the influenza virus, whereas anxiety is a response to a lesser type of threat, such as speaking in front of a large audience. Fear related to COVID-19 brings about more than just concern for acquiring the virus. Some of these concerns includes, loss of jobs and income, inability to finish school, lack of ability to obtain necessary items to prevent the spread the virus, loss of loved ones due to the virus, and so many other effects from this global phenomenon. The financial effects of COVID-19 are difficult to swallow, especially for those families and small businesses who've already been impacted.

With all the fear, panic, worry, and anxiety that this horrific pandemic has brought about, it is important to know and understand that panic only brings about worsening symptoms. Instead, it is important to be mindful of your actions and thoughts, and to remain positive in the midst of COVID-19.

Minimize your chance of worsening mental health symptoms

It's normal to feel anxious, fearful, stressed, and to exhibit worry about our world's current state of chaos. However, it's important to remember that we can manipulate the situation and level the playing field by following the rules set forth by the Centers for Disease Control (CDC). Alternatively, having faith, wisdom, and a positive attitude (even in the midst of illness) can make a significant difference in your overall health. Recognizing that we are not in control of what the future holds, but we are in control of ourselves, our actions, and our own health.

For those already suffering from mental health conditions, such as depression and anxiety, COVID-19 can quickly bring about worsening symptoms. Refuse to allow it to consume you. Utilize your time spending time in your home engaged in activities to calm your mind and spirit, and generate moments of laughter playing games and watching comedies with your immediate family members. This can help to deter your worry, stress, and feelings of despondency.

It's also important to remain compliant with your medications and maintain contact with your doctor when necessary. While many physician offices are closed, most doctors continue to see and treat patients remotely via telehealth or by phone. For those that continue to struggle despite efforts to minimize worsening symptoms, transcranial magnetic stimulation (TMS) can help. TMS consultations can be done via telephone, and the process for obtaining prior authorization from your insurance can be done remotely.

Most importantly, remember that your mental and physical health work synergistically. Maintaining your mental health is a critical component to promoting good physical health and vice versa.

For more information about TMS therapy, visit TMS Director y or call the a TMS therapy specialists at 1-833-TMS-HELP or 314-226-1997.

When Medications Don't Relieve Anxiety

Thu, 30 Jan 2020 05:45:00 GMT

The world doesn't have to feel like a constant threat

You don't have to continue to suffer from the symptoms of anxiety and depression. Transcranial magnetic stimulation (TMS) can be an effective treatment option for both depression and anxiety. When traditional forms of treatment have not provided significant symptom relief, then TMS can offer long-term remission without the undesired side effects of medications. Learn more about the causes, symptoms, etiology, and treatment for anxiety and depression.

As controversial as it may sound, it seems as if anxiety is the thing to have these days. Many people will talk about it as if it’s a popular thing to have – like it’s a badge of honor in a sense. Take a gander across social media and you’ll find so many posts related to tapping in on the anxiety trend and making comments as if this serious condition is something to be proud of.

I bring this up because I understand, that for those who truly suffer from anxiety or panic attacks, it's not something to be taken lightly, nor something to be ashamed of. Anxiety is a serious condition and involves much more than just being nervous or anxious about something – I want people to understand there is a big difference. People who truly suffer from anxiety don’t enjoy it. It can be quite debilitating and causes many people the inability to live a good quality of life.

On the other hand, feelings of anxiousness or nervousness are a normal part of life in certain situations. It's certainly normal to experience feelings of fear or worry when having to speak in a public setting, performing in front of others, or trying out for a sports team. However, generalized anxiety disorder involves much more than just episodic symptoms of anxiety. People suffering from an anxiety disorder frequently experience excessive worrying, feelings of uncontrolled anxiousness, and fear about everyday situations. Often times, these symptoms become so severe that they create panic attacks. Unfortunately, panic attacks often mimic the symptoms of a heart attack where the person experiences severe chest pain, and shortness of breath or difficulty breathing.

Clinical anxiety (often called 'generalized anxiety disorder') can include a combination of any of the following symptoms:

There are several different types of anxiety disorders, with the most common being generalized anxiety disorder (GAD). The cause for the variety of anxiety disorders is not fully understood by doctors or researchers, but it's believed to be related to a history of a traumatic life event or hereditary factors. There could also be medical causes, such as chronic lung or heart disease, hyperthyroidism, or asthma that can trigger anxiety.

GAD is a serious condition that often leads to other mental health illnesses, such as depression. Conversely, depression can lead to worsening anxiety - as both conditions often go hand-in-hand. Both can lead to a very poor quality of life, as well as complicate medical conditions, and often lead to behaviors such as substance abuse, suicidal thoughts, and even suicide.

Treatment involves a combination of psychiatric medications and psychotherapy or cognitive behavioral therapy. However, many people do not benefit from these traditional forms of treatment. Newer treatment modalities, such as transcranial magnetic stimulation (TMS) have shown to be effective in relieving the symptoms of both depression and anxiety.

Transcranial magnetic stimulation, or TMS therapy, is an FDA-approved, outpatient treatment for major depressive disorder (MDD) and obsessive compulsive disorder (OCD) using magnetic pulses targeted at a specific location within the brain. TMS is a brief, noninvasive therapy that doesn't require any sedation or medications, and is considered very safe and effective. Unlike medications, TMS doesn't cause any undesired systemic side effects. Further, TMS can offer long-term remission from debilitating symptoms. While TMS is covered by insurance for MDD and OCD, it offers many patients suffering from anxiety long-term relief as well.

How TMS works to treat an anxiety-riddled brain?

I'm sure you've been asked the common riddle question, "Which came first, the chicken or the egg?". Well, the same goes for depression and anxiety. The two mental health disorders as interconnected and go hand-in-hand in most cases. This interconnectedness is a result of dysregulation of the same neurocircuitry in the brain - which is likely the reason why many patients receiving TMS for depression also experience relief from their anxiety symptoms.

Mood disorders, such as depression and anxiety, are thought to be triggered by a disruption in the balance of neurochemical activity in the areas of the brain that regulate mood. In a traditional TMS treatment, rapid, high-frequency, stimulatory pulses are precisely targeted to treat the areas of the brain that regulate mood. This area is just above the left eyebrow in the prefrontal area of the brain. The magnetic field produced in TMS therapy passes through the skull and creates a current that affects the action of neurons in the area of the brain responsible for facilitating mood. Therefore, since depression and anxiety are interrelated, it only makes sense that TMS would improve one's symptoms of anxiety. To explain further, TMS works by improving the underactive neuronal activity in the brain by restoring normal activity levels of neurochemicals, such as, serotonin, dopamine, and norepinephrine.

However, in some cases, anxiety often has a mind of its own. While the exact etiology is not known, it is believed that anxiety results from the misfiring of electrochemical signals that stems from hyper and hypoactive areas of the brain, which in turn triggers symptoms of excessive worry and/or fear, racing heart, shortness of breath, muscle tension, and stomach upset. So, when treating anxiety that has a mind of its own with TMS, it is typically done on the right side of the brain, just opposite of the depression treatment area. Why? Well, the simple theory is based on the understanding that the right side of our brain sends inhibitory signals to the left side of the brain (meaning they tend to depress activity in neurons). The opposite of inhibitory is excitatory, which refers to a 'boost in brain activity'. So, when we treat stubborn anxiety with TMS, we do so on the right side of the brain with repeated slow, inhibitory, low-frequency magnetic pulses - which slows the targeted areas on the right side of the brain that are overactive. In turn, we tame or calm an anxiety-riddled brain.

The world doesn't have to feel like a constant threat.

The bottom line, is that, for those suffering from severe anxiety, the world doesn't have to feel like a constant threat. Patients suffering from untamed anxiety (and depression) where traditional forms of medications and therapy have not helped - transcranial magnetic stimulation (TMS) can be a safe and effective treatment option. TMS offers hope and long-term relief from life-robbing symptoms when trials of multiple medications have not provided satisfactory relief.

So, if you've tried all the traditional methods of treatment with no real relief, then it's time to Say "No" to Anxiety and Depression, and "Yes" to TMS. To find a TMS therapy near you, visit TMS Directory .

Say "NO" to Depression this Holiday Season

Fri, 06 Dec 2019 02:55:00 GMT

You don't have to suffer from depression and anxiety, especially during the holiday season. Make your holidays magical and sparkle like a snowflake!

For those battling depression, it often worsens during the holiday season. For others, depression seems to creep into their lives during whats meant to be the jolliest time of year. Don't let it rob you of the joy that holidays should bring. There is an alternative that offers long-lasting relief from debilitating symptoms. Give yourself the gift of TMS therapy this holiday season, and celebrate your holiday like you never have before.

Depression often has a way of creeping into our lives during the holiday season. It tends to bring about a certain degree of sadness, pulls us away from family and friends, forces negativity upon us, and takes away our energy, motivation, and livelihood.

How dare depression to be so unkind! Say "NO" to depression this holiday season and allow yourself to sparkle like a snowflake.

The good news is, depression doesn't have to sabotage the magic you deserve to experience. That blank canvas you feel can be transformed to a rainbow of holiday colors. Gift yourself this holiday season and invite magic into your life.

Every year we're repeatedly reminded of the joy to be experienced during the holiday season - from the colorful lights outlining every home we pass, the red kettles and Salvation Army bells ringing as we enter the grocery store, the traditional songs heard on every radio station, the beautiful poinsettias adorning the lamp posts downtown on main, and the season greetings from family and friends that frequent our mailbox. For many, instead of bringing joy, these constant reminders bring about sadness and feelings of anxiety. While the exact cause may not be known, worsening depression around the holidays is real, and is no fun for those suffering.

Depression often includes a myriad of symptoms that can become worse as we move into the winter months. This includes irritability, social withdrawal, appetite changes, sleeping issues, absenteeism from work or school, and worsening feelings of sadness. What many don't know, is that persistent and unrelieved depression disrupts the body's stress response, contributes to an autonomic imbalance (hyperactive sympathetic system and a hypoactive parasympathetic system) that's associated with various pathological disease processes. Unfortunately, over time, this excessive energy demand on bodily systems can lead to premature aging and diseases, and even increases blood clotting. All the more reason to say "no" to depression and seek relief and change.

Let me help you find peace this holiday season

Change can be difficult, especially when you're experiencing symptoms associated with depression. However, everyone has hope somewhere within them. So, muster up that smidge of hope and let's make things happen. You won't regret it, I promise!

Let's start with the small things that can make a big difference in your mood. Hover over each of the images below and check out a few things you can to positively impact your mood.

Finding your way out of depression may not always be easy, but it can be done. There are times in our lives when we all feel down, but clinical depression is not just something that disappears. It often requires medications and types of therapy and life changes in order to experience long-term relief or remission. Everyone responds differently to the multitude of treatments and therapies available. Research indicates that for those who suffer from various types of depression , treating your depression with multiple modalities is key. For example, in addition antidepressant medications, you might try any of the following:

The ultimate goal is to find the joy that lives within you. Turn your hope into reality and sparkle like a snowflake this holiday season...and every year yet to come.

Wishing you a joyful holiday season full of peace and freedom from your symptoms of depression!

Interested In Starting Your Own TMS Therapy Clinic?

Fri, 08 Nov 2019 03:41:00 GMT

Since 2008, the first FDA-approval of transcranial magnetic stimulation (TMS) for the treatment of depression, TMS is becoming a preferred method of treatment for a number of mental, behavioral, and neurological health conditions.

Thinking of starting a TMS therapy clinic? In 2018, the global TMS market was valued at $883.38 million . The market is anticipated to grow at a CAGR (compound annual growth rate) of 8.8% through 2026. According to WHO (World Health Organization), the U.S. is one of the most depressed countries globally . Depression affects as many as 16.1 million (6.7%) of the adult U.S. population every year. TMS is FDA-approved for major depressive disorder (MDD), obsessive compulsive disorder (OCD), and smoking cessation. There are a total of seven FDA-approved TMS therapy devices available on the U.S. market. However, it is important to note that not all TMS systems are FDA-approved to treat all approved conditions.

What inspires the growth?

There is increasing interest among researchers in using TMS to treat a variety of mental health and neurological conditions. Driving this interest is the increased prevalence of depression, substance use, and neurological disorders, such as Alzheimer’s, neuropathic pain, and Parkinson’s disease, along with increasing awareness about TMS. Transcranial magnetic stimulation (TMS) is becoming a preferred method of treatment for mental health disorders, such as depression, anxiety, and obsessive compulsive disorder (OCD). Psychiatrists, and even non-psychiatrists are opening clinics all across the nation in hopes of giving life back to many people suffering from these life-robbing conditions. However, there are a number of things to consider before jumping into purchasing a TMS therapy treatment system.

Considerations for aspiring TMS therapy clinic owners.

Before getting started with a TMS therapy clinic it is important to understand the industry, as well as the market in your geographic area. Since insurance began reimbursing for TMS in 2014, TMS therapy device sales have consistently grown year over year and the insurance landscape has changed significantly.

If you already have a private practice, you should think of your TMS clinic as a separate business. Sounds easy. But many TMS clinic owners have launched their clinics without knowing the nuts and bolts of running a thriving TMS therapy clinic. You may be a healthcare provider, business owner, or entrepreneur – but running a TMS therapy clinic is much different than running a private practice or any other business. Be sure to do your due diligence on available TMS therapy devices, billing and reimbursement, and TMS therapy guidelines before diving into purchasing a TMS system. Here’s a checklist of items to consider as you move forward with starting your own TMS therapy clinic.

Choose the right legal business structure (sole proprietorship, LLC, corporation, partnership)
Understand what FDA-approval means as it relates to the TMS therapy system you purchase, as well as reimbursement
What conditions will you treat in your TMS clinic
Know which TMS system is best for you – you can check out a quick reference guide of FDA-approved systems HERE .
How will you properly fund your business for growth and success
Know how best to market your TMS clinic in your geographic area
Understand that what you don’t know can hurt you the most. For example, if you don’t understand the credentialing and reimbursement process, then consult with a TMS industry expert .
Outsource areas of your business to those who specialize in the industry. The only TMS specialty consulting and comprehensive service provider in the U.S. is MNH TMS & Psychiatry Services .

Avoid making costly mistakes

I’ve worked with a number of psychiatrists and non-licensed professionals who have reached out for assistance either before or after starting their TMS therapy clinic. In speaking with my clients, I find that many share the same obstacles in getting started, as well as the frustrations with running the day-to-day business. So, I assume if you’re reading this article, then you are likely considering opening a TMS clinic or perhaps have already done so, and need further direction. My hope in writing this article is to help guide you in the process so that you can avoid common and costly mistakes.

Let’s start with the most common mistake that could potentially save you thousands of dollars

#1 Don’t talk to a TMS device rep or purchase a TMS therapy system before talking with the TMS consulting agency . Why? The best place to get unbiased TMS device information is from an expert who knows the industry and is not trying to ‘sell you the device‘. I’ve talked to many physicians and other TMS clinic owners after they’ve purchased a TMS device. Sadly, I learn that their TMS device has been sitting and collecting dust for months and even years because they didn’t realize all the facts about billing, reimbursement, the prior authorization process, or even how the high cost of treatments would negatively impact their business. For instance, certain TMS device manufacturers will promise to provide specific services, such as marketing and patient intake services in lieu of charging a fee for every TMS treatment administered. Unfortunately, those who purchase these fee-for-service TMS systems don’t realize the fee can be close to 40-50% of what insurance reimburses. This leaves very little for other operating costs and can significantly impact your profit margin. Additionally, I can’t tell you how critical it is to initiate the credentialing process prior to purchasing a TMS therapy device if your business will primarily be insurance-based. There are a number of steps that need to be implemented well before purchasing a device. In fact, the equipment should be one of the last steps in starting your TMS therapy clinic.

#2 Don’t assume you have the staff to run the back office or bill for TMS services. TMS is a whole different bird. If you plan to take insurance, then the majority of patients you treat will require a prior authorization before able to start treatment. Don’t be fooled in thinking that this prior authorization is similar to obtaining prior authorization for a medication. There is an art and science to submitting a successful prior authorization for TMS therapy. This will be one aspect of your business where you will want to consider outsourcing to an expert .

#3 If your billing provider has not previously billed for TMS therapy, they will likely not know how to bill for TMS services. Our agency receives calls every day from TMS clinics who have provided TMS treatment to many patients with no reimbursement. I’ve personally spoken with many TMS owners who have over $100 thousand in denied claims. You certainly don’t want to take risks or cut corners when it concerns astute billing procedures. It’s better to outsource one of the most critical aspects of your business to an expert .

#4 Do your research on how best to set up your TMS clinic. Decide if TMS will be an added service to your current practice or if starting a new business and tax ID would be a better route. The biggest mistake you can make is getting your information secondhand because laws vary from state to state. It’s always a good idea to speak to your accountant or an attorney, as well as an unbiased TMS industry consultant. A few things you might consider when making this decision are as follows:

Does your current practice have the necessary minimum space requirements available to add TMS services (treatment room, patient consultation room, reception space)?
Does the ownership structure of the TMS business differ from that of your private practice?
Is your current practice 100% cash pay? If so, will you accept insurance in your TMS clinic? Be sure to consider, that while a patient is inclined to pay a couple hundred dollars for a psychiatry visit, they may not be so inclined to pay several thousands for a course of TMS therapy. We receive calls in our agency every week from TMS clinic owners who want credentialing services because they are losing a significant amount of business by not accepting insurance.
If you intend on your TMS daily census to be sustained at greater than four or five patients, it may be challenging to effectively integrate and streamline TMS into your existing practice. In many ways, TMS is a business that works best when ran separate from a private practice. While the business may be located within the same office, it seems the most successful clinics run TMS as a separate business with its own tax ID. While this option may require a bit more effort up front, sometimes the payoff is much better in the long run, and the cost to start set up a new EIN is minimal.

#5: Consider decreasing your operating cost by outsourcing to a TMS support management provider that offers expertise in TMS reimbursement and billing, prior authorization submission, TMS business management or consulting services. This allows you to focus on what you do best – helping your patients to feel better and live a much better quality of life. TMS patients require a consultation, benefits check, medical records request, and a prior authorization before they can even start therapy. While there is much more to the process, it requires a great deal of knowledge in order to run the business effectively, efficiently, and profitably. Metro NeuroHealth (MNH) TMS & Psychiatry Services is the nation’s only TMS industry specialty service provider.

#6: Most importantly, don’t have all your eggs in one basket when it concerns keeping the chair busy. Implement a business plan and marketing budget. A thriving TMS clinic keeps their chair(s) full from a number of different referral sources, with about 50 percent of their business relying on self referrals from online marketing and website traffic. The most successful clinics are those who have a great responsive website and online presence. This includes digital media, Blogs, and community engagement.

#7 Be opened-minded and offer your patients a comprehensive program in which to engage. There’s plenty of research to support the fact that engaging your patients in multiple treatment modalities only serves to improve outcomes. Therefore, I recommend incorporating some type of weekly therapy into your TMS program in an effort to improve patient outcomes and add an additional stream of revenue to your clinic. MNH TMS & Psychiatry Services developed a program called Mind Your Mental Health , which provides your clinic therapist or TMS technician all the tools they need to lead your patients from negative thoughts and behaviors to a road of mindful awareness and positive thinking. This program is being used in TMS clinics and psychiatry practices all across the U.S.

TMS is not something that is easy to ‘just add to an existing practice’. It truly is a whole new beast that can have great financial benefit if set-up and ran properly. However, too often, chairs get purchased and then end up sitting in a room within a private practice rarely used. This happens when things like performing due diligence and gaining knowledge of the prior authorization and billing process were never taken into consideration prior to purchasing a TMS system.

For more information about starting a TMS therapy clinic or if your current clinic is struggling, consider outsourcing those services where you lack experience or need assistance to an expert. MNH TMS & Psychiatry Services can help. To schedule a 30-minute consultation call MNH at 1-833-TMS-HELP or send an email to request more information at Info@TMSstartitup.com .

Simple, sensible, smart, solutions for a thriving TMS therapy clinic

Fri, 09 Aug 2019 04:26:00 GMT

Avoid costly mistakes and false assumptions when starting your own TMS therapy clinic. Learn how to start a thriving, patient-focused, profitable TMS business. MNH TMS & Psychiatry Services offers physicians winning solutions that are simple, sensible, and smart . Our TMS expert team offers TMS consulting services, credentialing, training programs, psychiatric billing, responsive TMS website development, and effective marketing solutions.

Since 2008, the first FDA-approval of transcranial magnetic stimulation (TMS) for the treatment of depression, TMS is becoming a preferred method of treatment for a number of mental, behavioral, and neurological health conditions.

Thinking of starting a TMS therapy clinic? In 2018, the global TMS market was valued at $883.38 million . The market is anticipated to grow at a CAGR (compound annual growth rate) of 8.8% through 2026. According to WHO (World Health Organization), the U.S. is one of the most depressed countries globally. Depression affects as many as 16.1 million (6.7%) of the adult U.S. population every year. TMS is FDA-approved for major depressive disorder (MDD), obsessive compulsive disorder (OCD), and smoking cessation. There are a total of seven FDA-approved TMS therapy devices available on the U.S. market. However, it is important to note that not all TMS systems are FDA-approved to treat all approved conditions.

What inspires the growth?

Considerations for aspiring TMS therapy clinic owners.

Avoid making costly mistakes

Let’s start with the most common mistake that could potentially save you thousands of dollars

Does your current practice have the necessary minimum space requirements available to add TMS services (treatment room, patient consultation room, reception space)?

Does the ownership structure of the TMS business differ from that of your private practice?

Is your current practice 100% cash pay? If so, will you accept insurance in your TMS clinic? Be sure to consider, that while a patient is inclined to pay a couple hundred dollars for a psychiatry visit, they may not be so inclined to pay several thousands for a course of TMS therapy. We receive calls in our agency every week from TMS clinic owners who want credentialing services because they are losing a significant amount of business by not accepting insurance.

If you intend on your TMS daily census to be sustained at greater than four or five patients, it may be challenging to effectively integrate and streamline TMS into your existing practice. In many ways, TMS is a business that works best when ran separate from a private practice. While the business may be located within the same office, it seems the most successful clinics run TMS as a separate business with its own tax ID. While this option may require a bit more effort up front, sometimes the payoff is much better in the long run, and the cost to start set up a new EIN is minimal.

References