Are they doing counseling or testing? I'm thinking counseling based on the information. If so then the codes would be mostly 90791 (initial), 90832, 90834 and possibly 90837. Those would be the most common. They may do others such as family therapy (90846, 90847). As far as charging you will want to allow for growth. Maybe have a sliding flat fee based on number of patients/claims.
I forgot to mention, when the provider is estimating that it will only take three hours a week, what are they basing that on? Are they including time to run aging reports, check on unpaid claims, file appeals? Don't go based on what the provider thinks it will take. Make sure you do your own calculations and then remind the provider that there is more to billing than submitting the claim.
You mention the pediatrician, so your codes may differ if the pediatrician does services and there are the add-on codes. And like Michele asked, will there be testing done? Reimbursement is going to vary by the provider as well.. if the pediatrician (MD) does services then your codes will be different. your social worker depending on her licensure will also have different codes. I agree with Michele, don't go by what they tell you for how long it will take.. with mental health and dealing with pediatric and social worker you will spend a LOT of time on benefit verifications. There is also contracts to take into consideration that they may or may not hold. I would suggest you ask for the following information to help you better price your services or provide them with a reasonable quote:1. all provider contracts and fee schedules2. Are they Medicare and Medicaid?3. Do they hold any contract for EAP?Find those out first.. again you will be doing a lot of benefit verifications and eligibility checks and most often you can obtain the initial authorizations. With mental health it is critical to provide this service so that you have all of the benefit information as well as the authorizations setup. You will also want to review each carriers' requirement on testing if you will be billing for testing as well.
Thank you for your response. I believe it is just counseling, but I will checking to see if they would also be doing testing. What exactly is a sliding flat fee? I know it is used just in case the practice expands and they get more patients, but is it that I would give them a range? (ie. if you see x amount of patients it's say $1,000 a month, but if you see x amount more it's $1500?
Quote from: Tameka79 on August 29, 2016, 05:59:09 PMThank you for your response. I believe it is just counseling, but I will checking to see if they would also be doing testing. What exactly is a sliding flat fee? I know it is used just in case the practice expands and they get more patients, but is it that I would give them a range? (ie. if you see x amount of patients it's say $1,000 a month, but if you see x amount more it's $1500?We have a large mental health group that we bill for. We charge them a sliding flat fee based on the number of claims created. They have 10 to 15 social workers that see patients in their homes. The number of claims varies but mostly grows. We have a sliding flat fee that goes up based on the number of claims. For example 1000 to 1250 claims is one fee, 1251-1500 is another, etc. Then at the end of each month we bill them based on the number of claims we submitted. It's similar to a per claim fee, but we have it bunched into groups. We have been doing this with them for several years. Works great on both ends.
So they are only wanting you to bill the therapy? I have to ask what are the doing for the rest of the billing? will they be utilizing two different systems? One system and having you work just the behavioral claims? What about the other billing.. I do ped's and my pediatricians will do initial testing and then refer to a specialist for a diagnosis in many instances. Sometimes it's just early intervention screenings. But again, I think it's important to find out if you'll be working in the same system they have the rest of their practice using or are they looking to segregate the behavioral billing? That would be a red flag for me as having two sets of books/2 systems is a formula for disaster.
Michelle, I was wondering how the sliding scale would work if you based your flat fee on time?