Medical Billing Forum

Starting a Medical Billing Business => Starting Your Own Medical Billing Business => Topic started by: bethcanare on January 20, 2009, 02:19:31 PM

Title: Mental Health Billing
Post by: bethcanare on January 20, 2009, 02:19:31 PM
I recently purchased the Mental Health Big Book.  I noticed on the CMS case study samples most of the claims don't have modifiers.  Is that common in mental health billing?  Do you also bill Worker's Comp in mental health?

Thank you very much in advance for helping a newbie like me.   :)

Beth
Title: Re: Mental Health Billing
Post by: Michele on January 20, 2009, 05:46:28 PM
Mental health claims hardly ever require the use of a modifier. 

There are some times that workers comp may be billed for a mental health claim but it is not common.  We had a situation once where an employee of a grocery store was robbed at knife point.  They weren't injured physically but they did need counseling to be able to return to work.  The claim was billed out to the comp carrier on the CMS form as it would be billed to the patient's regular insurance, just with the comp info.

Michele
Title: Re: Mental Health Billing
Post by: bethcanare on January 20, 2009, 06:51:58 PM
Thank you, Michele.  That will help me a lot.

Beth C
Title: Re: Mental Health Billing
Post by: billingfromhome428 on February 18, 2009, 09:10:29 AM
One case that I know of where a modifier is required for Mental Health and that is when you are billing Medicare for a LCSW.  You must submit a AJ modifier.  I have been billing for a LCSW for over 4 years and that is the only one I have ever used. :)
Title: Re: Mental Health Billing
Post by: Michele on February 18, 2009, 12:38:06 PM
We bill for 17 LCSW's and I have not heard of that before!  Interesting.  Since our claims are being paid I'm going to leave it as is.  Just curious, where are you in the country.  I'm thinking it must be a carrier specific requirement.

Michele
Title: Re: Mental Health Billing
Post by: Pay_My_Claims on February 18, 2009, 09:58:03 PM
Its that way for NC...where are you Michele?
Title: Re: Mental Health Billing
Post by: Pay_My_Claims on February 18, 2009, 10:00:59 PM
https://www.magellanprovider.com/MHS/MGL/getpaid/HIPAA/degree-level-modifiers.pdf

http://www.cignagovernmentservices.com/partb/pubs/mb/2009/01_09/PDFs/NC_01_09.pdf   (page 50)
Title: Re: Mental Health Billing
Post by: Michele on February 19, 2009, 08:43:44 AM
Upstate (Central) NY.  But we bill for LCSW's all over NY State, Florida, and PA.

Thanks for the links, I will check them out.

Michele
Title: Re: Mental Health Billing
Post by: Pay_My_Claims on February 19, 2009, 10:22:17 AM
You are more than welcome.
Title: Re: Mental Health Billing
Post by: billingfromhome428 on February 20, 2009, 08:16:00 AM
We bill for 17 LCSW's and I have not heard of that before!  Interesting.  Since our claims are being paid I'm going to leave it as is.  Just curious, where are you in the country.  I'm thinking it must be a carrier specific requirement.

Michele


Michele,

I am in Indiana.
Title: Re: Mental Health Billing
Post by: Michele on February 21, 2009, 09:53:12 PM
Well thanks for sharing the info.  It's always good to know what is done in other areas.

Michele
Title: Re: Mental Health Billing
Post by: Pay_My_Claims on February 21, 2009, 11:16:02 PM
Michele, I have been researching some information, and it seems that the fee schedule for a LCSW and a clinical psychologist are different (never done mental health billing). Leaving off the modifer, your claims could still get paid (obviously) but be reimbursed at a higher rate than allowed.
Title: Re: Mental Health Billing
Post by: Pay_My_Claims on February 22, 2009, 08:29:38 AM
http://www.cignagovernmentservices.com/partb/pubs/news/2007/0707/cope5991.pdf

I meant to post this with my comment, sorry.
Title: Re: Mental Health Billing
Post by: margemib on February 22, 2009, 11:43:27 AM
michele,
I am trying to take your advice and target mental health at first, I read that in one of your posts.
When I try to look this up in the yellow pages I come up with very few.
Is child and youth service fall into the same area can you bill for this.
Please give me some tips on looking this up in the yellow pages. what are the key words?
margemib
Title: Re: Mental Health Billing
Post by: Alice Scott on February 22, 2009, 01:44:16 PM
Hi,
There are many listings you can look under.  Some will refer you to others.  Try counselors, marriage counseling, psychiatrists, psychologists and see what you find.
Alice
Title: Re: Mental Health Billing
Post by: margemib on February 22, 2009, 02:10:49 PM
Thanks Alice,
what do you think about the child and youth services.
can you bill for them, some are private practices I see?
I'm not sure but it comes up alot when I type in counseling.
margemib
Title: Re: Mental Health Billing
Post by: Pay_My_Claims on February 22, 2009, 05:16:27 PM
I recently purchased the Mental Health Big Book.  I noticed on the CMS case study samples most of the claims don't have modifiers.  Is that common in mental health billing?  Do you also bill Worker's Comp in mental health?

Thank you very much in advance for helping a newbie like me.   :)

Beth

Here is a great link for Mental Health billing.........Medicare

http://www.medicarenhic.com/providers/pubs/Mental_Health1208.pdf
Title: Re: Mental Health Billing
Post by: Michele on February 22, 2009, 07:32:38 PM
Not using the modifier shouldn't result in a higher reimbursement.  (Of course I must tell you I am an extremely optimistic person who lives in a very happy world.  :) )  If they require the modifier they should deny the claim without it.  The reimbursement should be based on the rendering provider's NPI number and how Medicare has them credentialed.  I certainly would hope it would work that way or else it could get quite messy.  I know the fee schedule for the psychologist is higher than a social worker but I hope there is more to the system than relying on the modifier. 

Can you imagine the mess if they paid higher, then went back to request the overpayment?  Ughhh. 

Anyway, since I don't bill in any regions that require the AJ modifier I am not sure.  But I appreciate the link, it really has some great info!

Michele
Title: Re: Mental Health Billing
Post by: Pay_My_Claims on February 22, 2009, 08:28:40 PM
You are welcome.....but I would re-read page 24. They don't reimburse by the NPI, they use the modifier for reimbursement. A LCSW and a Clinical psychologist use the same cpt, the modifier determines how its reimbursed. the NPI is going to reflect the group. Within that group you can be seen by either or. I'm not proclaiming to be the expert, I am just cautious when it comes to Medicare/Medicaid/Tricare billing. I wouldn't just continue to bill that way, just because its getting it paid until I contacted Medicare to determine if the modifier was required. I also don't think it varies from one state to another since Medicare is a federally funded program. The only difference is your FI.

Good blessings.
Title: Re: Mental Health Billing
Post by: Michele on February 23, 2009, 09:23:02 AM
Thanks.  Currently our local Medicare switched carriers on 9/1/08 and it is such a mess Congressman Arcuri is involved.  But I will reread that and look into it further.

Michele
Title: Re: Mental Health Billing
Post by: Alice Scott on February 23, 2009, 02:27:30 PM
They could be either private and interested or government sponsored.  I don't think you could tell without calling.
Alice