I am working in a psychiatric practice and have run into an interesting situation. We have patient's with an Emblem HIP plan which covers medical benefits under Emblem Health and behavioral health benefits under Value Options. We have always billed our E&M and Psychotherapy codes to value options. As of recently we have accidentally billed our codes to Emblem Health medical. It paid on the E&M but not the psychotherapy. It said on the EOB "bill to Value Options" for the psychotherapy codes. I just want to make sure since this is a psychiatric nurse practitioner boarded in psychiatry that this is kosher. Intact all the diagnoses on the claim were DSM-5 psych codes, not medical. Can I bill the E&M and add on codes separately? So that E&M goes to medical insurance and psychotherapy add ons go to behavioral health insurance. The reason we want to bill separately is the reimbursement is significantly greater for HIPP than Value Options on the E&M; more than double in fact. Any advise would be most appreciated on how to precede without getting myself into trouble with the payers involved. I would hate to get audited, give the money back, and then get nailed for timely filing.
