Medical Billing Forum

Billing => Billing => Topic started by: Christy on January 22, 2014, 10:40:18 AM

Title: LCSW/Medicaid in NYS
Post by: Christy on January 22, 2014, 10:40:18 AM
I bill for a LCSW in NY. She is now a Medicaid provider. It is my understanding that an LCSW cannot bill straight Medicaid? What about when Medicaid is 2ndry to Medicare?

 
And if she cannot receive any payments from Medicaid, do we still have to fill out the EFT and E-remittance forms for them?  The reps at Medicaid are no help!!

Please help!
thanks :)
Title: Re: LCSW/Medicaid in NYS
Post by: Merry on January 22, 2014, 09:11:00 PM
Definitely a Linda question. I am sure that she will see it tomorrow. She is in NY and knows mental health backwards and forwards.
Title: Re: LCSW/Medicaid in NYS
Post by: Michele on January 23, 2014, 09:46:08 AM
They can only be reimbursed for patients who are QMBs (Qualified Medicaid Beneficiaries).  QMBs are persons who receive SSD because of age or long-term disability.  If she has patients who are QMBs or plans on seeing them then she needs to complete the EFT & other required paperwork.
Title: Re: LCSW/Medicaid in NYS
Post by: PMRNC on January 23, 2014, 09:53:25 AM
LCSW's are covered, and you can bill Medicaid. They do have some restrictions though I believe.. I don't think they can see patients not qualified under 21. I have not had a NY State Medicaid in a long time. Reimbursement is HORRIBLE on mental health claims

https://www.emedny.org/
Title: Re: LCSW/Medicaid in NYS
Post by: Michele on January 23, 2014, 10:11:16 AM
Actually they've revamped the system quite a bit.  They don't pay LCSW's unless the patient is QMB which is not a lot.  But the overall reimbursement for MH has gone up and it's really not that bad anymore.  It did used to be awful.  We bill NYS Medicaid currently for several LCSW's and they don't get reimbursed for straight Medicaid patients.  But the Medicaid HMO's do pay them and their reimbursement isn't bad either.
Title: Re: LCSW/Medicaid in NYS
Post by: Christy on January 23, 2014, 10:59:02 AM
THANK YOU!  THANK YOU! THANK YOU!

I am so grateful to each and everyone of you for sharing your knowledge and experience.

this was so helpful to me!!!! :)
Title: Re: LCSW/Medicaid in NYS
Post by: Christy on January 23, 2014, 11:06:54 AM
another question: if Medicare crosses their approved claim to a QMB, we can expect to get paid automatically, like any other insurer would, correct?

I wouldn't need to file anything, would I?

I am sort of Medicaid- phobic, lol....
Title: Re: LCSW/Medicaid in NYS
Post by: PMRNC on January 23, 2014, 11:22:03 AM
Quote
another question: if Medicare crosses their approved claim to a QMB, we can expect to get paid automatically, like any other insurer would, correct?

Not necessarily! This was yet another reason my clients that took Medicaid no longer take it. Are you a Medicare provider?
Title: Re: LCSW/Medicaid in NYS
Post by: Christy on January 23, 2014, 11:24:53 AM
ugh!!! yes we are a Medicare provider and a newly minted Medicaid provider....
Title: Re: LCSW/Medicaid in NYS
Post by: PMRNC on January 23, 2014, 11:30:26 AM
Then it SHOULD cross over from Medicare to Medicaid.. not the word "SHOULD".. it doesn't always happen. One of my providers did a lot of nursing home a few years ago and what a pain in butt if the crossover wasn't done.. try chasing down those ..

Michele, what are they paying on say a 90834? (LCSW level) Just curious.
Title: Re: LCSW/Medicaid in NYS
Post by: Christy on January 23, 2014, 11:34:17 AM
Quote
Michele, what are they paying on say a 90834? (LCSW level) Just curious.

Hudson Health Plan (managed Medicaid) pays $60
Title: Re: LCSW/Medicaid in NYS
Post by: PMRNC on January 23, 2014, 12:30:22 PM
Quote
Hudson Health Plan (managed Medicaid) pays $60

Oh they are part of MVP right?   hmm.. that's actually not bad.. I was just curious.. I think if I mentioned Medicaid to these two clients they would flat out tell me to go fly a kite. LOL   The reimbursement was only part of the problem.. they seem to be a pain in the neck.
Title: Re: LCSW/Medicaid in NYS
Post by: Christy on January 23, 2014, 12:34:02 PM
only the CHP and FHP has merged with MVP, I think....


anyhow, Hudson Health Plan behavioral hlth claims are processed by Beacon and they are a DREAM to work with....easy authorizations and payment in 2 weeks....I wish all payors were like them!
Title: Re: LCSW/Medicaid in NYS
Post by: Christy on January 23, 2014, 12:34:38 PM
curious what Fidelis pays for 90834?
Title: Re: LCSW/Medicaid in NYS
Post by: Michele on January 23, 2014, 06:35:40 PM
I will look up the Fidelis amount.  I believe it is just over $60 for a 90834. 

Linda,

They do pay the 90834.
Title: Re: LCSW/Medicaid in NYS
Post by: Christy on January 28, 2014, 12:17:27 PM
thanks, Michele! :)
Title: Re: LCSW/Medicaid in NYS
Post by: Christy on February 19, 2014, 12:18:07 PM
I have another question on this topic:

The LCSW is par with Medicare and NYS Medicaid. She billed 90834 (2013 claim.) Medicare allowed $61.83 and paid $39.39 with a patient resp of $21.64. Medicaid paid $4.33 on that claim (the patient is a QMB.) Can the provider balance bill the $17.31 to the patient???

Or is the $4.33 based on the Medicaid rate, which perhaps trumps the Medicare rate???

thanks!!! :)
Title: Re: LCSW/Medicaid in NYS
Post by: shanbull on February 19, 2014, 12:31:54 PM
I have another question on this topic:

The LCSW is par with Medicare and NYS Medicaid. She billed 90834 (2013 claim.) Medicare allowed $61.83 and paid $39.39 with a patient resp of $21.64. Medicaid paid $4.33 on that claim (the patient is a QMB.) Can the provider balance bill the $17.31 to the patient???

Or is the $4.33 based on the Medicaid rate, which perhaps trumps the Medicare rate???

thanks!!! :)

Medicaid has its own fee schedule, so it will only pay the remaining difference between its own rate and what Medicare paid. If its fee schedule rate is lower than what Medicare already paid, Medicaid pays nothing. We always have to write off any remaining balance once Medicaid makes its decision because it is a contractual obligation for us. I assume this is true for everyone who is par, but make sure you look at the wording of the Medicaid remittance and whether the adjustment codes say "CO" or "PR". QMB patients are rarely held responsible for a remaining balance.
Title: Re: LCSW/Medicaid in NYS
Post by: Christy on February 19, 2014, 12:33:58 PM
thank you, shanbull!
Title: Re: LCSW/Medicaid in NYS
Post by: Christy on February 26, 2015, 02:12:19 PM
Here's another question.

Patient has managed Medicare primary (Fidelis Dual Advantage) and straight Medicaid as 2ndry. Fidelis managed Medicare applies a service performed by a LCSW-R to the deductible. Will straight Medicaid over this deductible?

if not, can the patient be billed this amount?