Psychiatric Partial Hospitalization Programs 101

Frequently asked questions about mental health Psychiatric Partial Hospitalization Programs. Confused? Contact our mental health billing team and improve your revenues.

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What is a Psychiatric partial hospitalization program

A PHP is used for intensive psychiatric outpatient treatment of less than 24 hours of daily care
It was designed for patients with disabling / debilitating mental health conditions.
The goal is to provide such patients care that is
individualized yet comprehensive 
Intensive and coordinated
multidisciplinary approach
Such treatments are generally not available in a regular outpatient setting, hence the need for Partial hospital programs.

Who delivers a psychiatric partial hospitalization program

Typically, a hospital or community mental health center (CMHC) delivers a psychiatric partial hospitalization program. These organizations can provide ambulatory care and avoid costs associated with inpatient care.

Who is psychiatric partial hospitalization program available to

Generally PHP is available to patients with acute mental illness. However, these patients have to be certified for need by a psychiatrist or physician with credentials (ie MD/DO that’s trained to diagnose + treat psychiatric illness)
You have to have documented consent of the patient or their guardian for admission to the program.
Your patient must require comprehensive, multimodal treatment.
The patient must require medical supervision and coordination.
Your patient must have an adequate support system to sustain/maintain themselves outside the PHP
Your patient must not be a danger to themselves or others. It’s ok if they have had recent episodes of self-mutilation, serious risk taking, or self-endangerment.
Your patient must have been diagnosed with a mental disorder that significantly interferes with multiple areas of daily life.
Such dysfunction of social, vocational, or educational nature must be acute – not chronic. 
Due to the acute nature of the disorder, the patient will qualify for PHP as long as the acute condition requires active treatment

How is psychiatric partial hospitalization program different from hospitalization 

There’s no 24-hour observation as it’s a day program. 
The intensity of the treatment programs is different.
The frequency of patients’ participation is different 
The program of services provided to a patient (comprehensive, structured)

Does Medicare cover partial hospitalization program

Yes it does cover partial hospitalization of patients in 2 scenarios 

– patients discharged from an inpatient hospital treatment program. You are allowed to use the partial hospitalization program in lieu of continued inpatient treatment (ie cost reduction)
– For patients who would cost more by being under inpatient hospitalization partial hospitalization wasn’t available (ie cost avoidance)

Your documentation should support the fact that an active program would improve the patient’s disorder and level of functioning. 

What comprises active treatment in partial hospitalization program

Treatments that include individual, group, and family psychotherapies

Treatments that include occupational, activity, and psycho-educational groups 

Medical and psychiatric diagnostic evaluation

Treatments that support medication management

The patient must have the capacity for active participation in all phases of the multidisciplinary and multimodal program. 

Treatments that include treatment of a co-morbid substance abuse disorder (if present)

What is not considered active treatment in partial hospitalization program

If your treatment is primarily centered around activity, social, or recreational therapy. Medicare does not pay for psychosocial programs that provide socialization or vocational rehabilitation