Medical Billing Forum

Billing => Billing => Topic started by: Lisa@srts-inc.com on February 16, 2011, 12:03:54 PM

Title: 3 visits same day
Post by: Lisa@srts-inc.com on February 16, 2011, 12:03:54 PM
Hello,

I have 3 providers who are just starting out and I am wondering if they can each see the same patient on the same day.

These are for autistic patients and the insurance on most will be Medicare, the patients will be seen by a PhD for therapy-90806, then a psychiatrist(MD) for a 90862 and then an occupational therapist for a 97530 on the same day........will Medicare reimburse all three services?

Any info or anything else you think I may need to know for this billing would be greatly appreciated.
Lisa
Title: Re: 3 visits same day
Post by: Michele on February 16, 2011, 01:08:20 PM
Are all 3 providers in the same group?

Title: Re: 3 visits same day
Post by: Lisa@srts-inc.com on February 16, 2011, 01:31:52 PM
Well they haven't decided yet if they will form a group or each bill individually.
Title: Re: 3 visits same day
Post by: PMRNC on February 16, 2011, 02:37:46 PM
Carriers will generally ONLY allow for ONE visit per day.  I've had groups with therapists and psychiatrists and we just explain that to the patient and schedule their visits on different days. The carriers, in general, will also not authorize for more than one visit per day. Medicare also will not.
Title: Re: 3 visits same day
Post by: Michele on February 16, 2011, 05:39:14 PM
But if they are all individual, billing separately, and the services are all different, wouldn't that be ok?  I would think a patient could go for psychotherapy, and an OT appt, and even a med check, all in one day, if it were three separate offices, so if they bill separately it might fly.  But if they are in a group, then I don't think it will fly.

Curious to see what others think.

Michele
Title: Re: 3 visits same day
Post by: Lisa@srts-inc.com on February 16, 2011, 06:10:27 PM
I actually bill for another group and we can bill for a therapy visit (90806) and a med visit (90862) on the same day and the carriers do pay, so I was hoping just adding an OT visit for these new providers that all 3 would pay.

Lisa
Title: Re: 3 visits same day
Post by: PMRNC on February 16, 2011, 06:31:46 PM
Hmm.. what carrier is reimbursing that? I know Medicare doesn't. 90862 is actually a med check with minimal therapy. Only my psychiatrist gets reimbursed for his quick med checks using the HCPCS code M0064  It doesn't matter if they are seeing another provider.  For example, just the other day we tried to get authorization for a patient coming in for 1 hour therapy session after she had not been seen in a month. When we called to get the authorization they told us another authorization already existed for another provider. We contacted the patient and let them know she could do both visits but her carrier was only going to pay for one and that she would need to pay in full.  turns out she was actually "torn between two therapists" LOL
Title: Re: 3 visits same day
Post by: Lisa@srts-inc.com on February 17, 2011, 07:01:52 AM
I am in Massachusetts and we do get paid for a 90806 and a 90862, same day, different clinicians by BC/BS, United Beh(& Pacificare), and Tufts.........and United Beh/Pacificare will only charge a co-pay for one of the services, not both.

They were just credentialed by Medicare so I haven't seen if they will pay both yet but I am assuming they won't from what you have told me here.

Thanks for the info, this site is so helpful!
Lisa
Title: Re: 3 visits same day
Post by: PMRNC on February 17, 2011, 07:28:25 AM
I do a lot of BCBS but they farm it out to TPA's and they won't cover two visits. YOU can have the psychiatrist bill out the M0064 for a quick med check on same day as a therapy visit. Medicare is actually watching psychiatrists and their overuse of the 90862 for quick med checks.
Title: Re: 3 visits same day
Post by: camedbill on February 17, 2011, 10:43:41 AM
I thought M0064 is only used to bill Medicaid? Can this be used instead of 90862? Is reimbursement more or less?
Title: Re: 3 visits same day
Post by: Michele on February 17, 2011, 11:06:13 AM
  turns out she was actually "torn between two therapists" LOL

Is that like cheating?

Just wondering.  :D
Title: Re: 3 visits same day
Post by: Michele on February 17, 2011, 11:07:59 AM
The M0064 is a lower reimbursement than the 90862 because it is a minimal medical check only, no therapy.  The 90862 is a more complex visit.

Michele
Title: Re: 3 visits same day
Post by: PMRNC on February 17, 2011, 11:44:43 AM
I started using it back when Medicare announced they were going to start flagging overuse of 90862. Many times a patient comes in, doctor say's how's it going, patient says eh, it's ok, but not great.. doctor says.. let's adjust dosage, and your outta there. 15 min or less usually.  90862 SHOULD only be used when the provider IS ACTUALLY providing at least minimal therapy with the med check.  Good example of overuse is the docs that make the nursing home rounds, those are ones Medicare really scrutinizes for overusing the 90862.
Title: Re: 3 visits same day
Post by: rdmoore2003 on February 18, 2011, 08:35:04 AM
As long as the services are billed as separate rendering providers, I have never had an issue with authorizations or reimbursements.  A 90862 is a quick visit but 90805 is med check with therapy.   We do not use the M code at all.