June 2026: Protect Your Revenue — The R.I.S.E. Series (Standards & Coding)
Part 3 of a 4-Part Series for Behavioral Health Facility Owners | April–July 2026
R.I.S.E Series: Impact & Exposure
Payment Is Not Proof: How to Know Whether You’re Billing Appropriately
Thank you to everyone who joined Part 3 of the R.I.S.E. Series. After Part 2’s deep dive into the forces driving today’s surge in audit activity, this session moved from why audits happen to how to prevent them — starting with the codes on your claims.
In this session, Erin Burke (CEO & Founder, Hansei), Jenna Joneikis, CCS, CRCR, CSPR (Senior Revenue Integrity Analyst at Hansei), and Jessica Daugherty (Director of Revenue Cycle Management at Hansei), walked us through real-world coding scenarios across the full behavioral health continuum of care — and showed how the right code choices protect both reimbursement and compliance.
If you missed it, the coding document referenced can be found here:
DISCLAIMER: This document is a mockup created for training and illustrative purposes only. It is NOT a coding guide and should not be used to determine code selection. Appropriate coding must always be based on the clinical documentation for each individual patient, in accordance with payer requirements, federal and state regulations, and applicable coding guidelines.
Specificity Is Your Best Defense
The session’s central theme: specific codes beat generic codes, every time. Generic and unspecified codes are among the most common audit triggers in behavioral health, and they frequently lead to denials and payment delays.
The team worked through the level-of-care coding map, including:
Mental Health IOP — HCPCS S9480 paired with revenue code 0905
Mental Health PHP — H0035 with revenue codes 0912/0913, where it’s explained that the choice between 0912 and 0913 depends on program hours (0913 for 6+ hours)
Substance Use Disorder IOP and PHP — H0015 with 0906, and S0201 with 0912/0913
Residential, detox, and routine outpatient services — including the distinctions between H0017, H0018, and H0019 for residential levels of care, and proper coding for individual and group therapy
It was also clarified how H2001 rehabilitation programs can encompass multiple therapy types beyond behavioral health — but only when documentation captures all services actually performed.
Documentation and Diagnosis Alignment
Coding accuracy doesn’t stop at the procedure code. The team emphasized that:
Diagnosis codes must align with the primary diagnosis and the services billed. Unspecified diagnosis codes can trigger audits and denials; more specific codes are always preferred.
Documentation must match what was authorized. If the claim says it, the chart needs to support it.
Partial attendance matters. Only days the patient was present should be billed, with absences properly documented when required.
State Rules and Payer Nuances
No two payers — and no two states — treat behavioral health claims the same way. The discussion covered state-specific requirements for provider credentials and co-signatures, payer-specific expectations for out-of-network claims, and how contract terms shape which codes apply. The session wrapped with a Q&A on coding for adolescent services and routine outpatient therapy.
The Bottom Line
Coding is where revenue integrity becomes real. Specific, well-documented, properly aligned codes don’t just get claims paid — they keep auditors at bay. As Erin put it, revenue integrity isn’t a back-office function; it’s a frontline protection for your facility’s financial health.
Join us in July for the final meeting of the R.I.S.E. Series: Enforcement & Rights.
Tuesday, July 14th
11:00 am - 12:00 pm PST I On Zoom