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Need Coding Help - Substanse Abuse Coding Help
bvikash:
I need some help for one of my facility for mental health & Substance abuse treatment. I am looking for some codes which can pay us higher reimbursement. And my facility can get more payment. Please suggest some codes for PHP and IOP services.
Please also see if someone can let me know the medicare fee schedule for mental health & Substance abuse treatment and Usual & Customary rates.
Michele:
--- Quote from: bvikash on March 21, 2018, 09:51:52 PM ---I need some help for one of my facility for mental health & Substance abuse treatment. I am looking for some codes which can pay us higher reimbursement. And my facility can get more payment. Please suggest some codes for PHP and IOP services.
--- End quote ---
The way you are asking your question suggests fraud. I am not implying that you are intentionally asking it that way but I wanted to make you aware of that. It is fraudulent to code a claim strictly to get higher reimbursement. With that being said, people cannot suggest codes for you without all of the information necessary to code. Are you looking for rev codes or HCPCS? Are you billing on a UB04 or a CMS 1500? Claims should be coded with the most accurate codes for the services that were provided, not so that the provider can get more money. Billers want to make sure their providers are getting reimbursed for all that they are entitled to, but you have to be careful that the coding is done based on the services that were performed.
--- Quote from: bvikash on March 21, 2018, 09:51:52 PM ---Please also see if someone can let me know the medicare fee schedule for mental health & Substance abuse treatment and Usual & Customary rates.
--- End quote ---
Medicare fee schedules are online. You don't mention what state you are in so we cannot provide the link. Just Google "Medicare fee schedule *state*"
bvikash:
Thanks for your response -
Let me rephrase my question may be i have not conveyed it correctly :) - we are facing issue with UHC when we are billing rev code 0915 and they are denying it and asking us to bill the claims on HCFA 1500 form, however we are facility, so I was asking if we have any replacable code for OP Behavioral Health Treatment.
Even if you bill them with HCFA 1500 form then they will pay it according to physican fee schedule not as per facility.
Please let me know if anyone is facing same kind of issue and we can have a resolution.
Michele:
That makes much more sense! It sounds like a credentialing issue. Are you in network with UHC? If so, are you credentialed as a facility? We have billed for providers who were credentialed with some groups as a facility, but not with others. We billed the ones that had them as a facility on UB04s and the others on CMS 1500s. You are right, billed on a CMS 1500 will be paid as a professional claim, not a facility claim. But if UHC doesn't have you credentialed as a facility then that is the issue.
bvikash:
I mean we are out of network providers.
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