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Any therapy conducted via telephone is not covered by insurance, unless of course the phone is being used as a platform for video using an app.

90837 is a "timed code" it does not signify that the visit took place in person.  It absolutely cannot be used for phone therapy.

When submitting claims to insurance for teletherapy, you would use the appropriate timed code (90832, 90834, 90837), place of service 02 (telehealth) and a GT modifer. 
Starting Your Own Medical Billing Business / Re: Medicare Primary question
« Last post by PMRNC on Today at 09:51:56 AM »
I've had so many opportunities to bill for LMT's out here but I always refer them out because of that.
Exactly, that's why they should definitely contact the secondary BEFORE seeing the patient!   ;D
Starting Your Own Medical Billing Business / Re: Medicare Primary question
« Last post by PMRNC on Today at 07:53:19 AM »
I missed that it was an LMT.. sorry!!  I've heard of others getting a letter from Medicare since they don't cover LMT's the problem however is that most secondaries follow Medicare rules.
Agree with Michele on this but this needs to be addressed:

but I have been billing them under 90837

Not good.

I totally missed that statement!  Linda is right, that is not good.  90837 is a "face to face" code.  It should not be used for telephone sessions. 
Hi all! We are a brand new billing company that is just getting started. We have yet to land our first client, but have some promising leads. In the meantime Iím wondering about billing software. We decided on Healhpac for our billing software, anyone have experience with that? And Navicure for our clearinghouse, experiences? Good/ bad?!?

Are we better off waiting to see who our clients use, and maybe just use their software? I hate to incur costs that we donít need to. Thanks so much!

I have never heard of either the software company or the clearinghouse so I can't comment on that.  Like Linda said, many of us wish we had a way to ask this question when we started.  In 1994 there wasn't any place to get the information available today.  We started with a bad company, then switched blindly to Lytec.  Fortunately Lytec has been a good product for us.   Like Linda, we also utilize other softwares that our clients use.  We have clients that don't have any system (some don't even have a computer, or a fax machine!) and we use ours for them.  Some have systems but they want us to use ours.  And others want us to work out of theirs.  Honestly I can't even say one works better than the other.  It really depends on the individual situation and needs of the provider.  The important thing is to be open.  We are flexible when we meet with a provider.  That doesn't mean we do whatever they want or bend over backwards!  But we consider what they need and what we can do.  It may be something different than we currently do but if it makes sense we will consider it.
Since Medicare does not credential LMTs you cannot submit the claim to Medicare.  They won't process it.  So there is no way to get an EOB from Medicare.   So you are right, you can't submit it to Medicare to get an EOB.  And you can't submit to the secondary stating you submitted to Medicare. 

However, IF the secondary does allow LMTs to submit claims you can contact them to ask them if they will cover it in this situation with Medicare prime.  The reason I say this is because we bill for an Acupuncturist.  Medicare does not credential them either.  We do have patients with secondary plans that allow acupuncture and the claims are billed with the GY modifier and they pay.  The claims are not submitted to Medicare since the secondary insurance carrier (UHC - Empire Plan) knows that Medicare doesn't cover acupuncture and doesn't credential acupuncturists.  But Linda is right, you have to be careful.  You cannot do anything to 'trick' the secondary into paying.  Prior to seeing the patient a call should be made to see if the secondary will allow and how they handle it.
Coding / Re: CPT Codes for Mental Health Video chatting and phone/text sessions
« Last post by PMRNC on March 18, 2018, 02:37:58 PM »
Agree with Michele on this but this needs to be addressed:

but I have been billing them under 90837

Not good.
Starting Your Own Medical Billing Business / Re: Medicare Primary question
« Last post by PMRNC on March 18, 2018, 02:36:55 PM »
This provider told me to submit claims to Medicare, then simply bill the secondary insurance (Blue Cross) stating Medicare has not paid anything on this claim.

Nope, your right it doesn't "sound" right because it is not right. In fact I wouldn't even call this abuse but rather borderline blantant fraud..add a few years in jail more if they want you to submit phony Medicare EOB's with primary payment. HOW do they expect the secondary to consider the primary by you just saying "Oh hey, Medicare didn't pay this so will you please pay it?"

You ask a question that many of us wish we had an avenue way back when to I would have made an entirely different decision than I did back in 1997. I would have avoided 4 changes due to software companies that couldn't hack it in keeping up, 2 companies that just decided to leave customers high and dry and about 9 data conversions that were messy, unnecessary and caused a delay in revenue for clients that could have been avoided.

I ONLY utilize clients systems and those that don't have one, I'm happy to pass on contacts and demo's based on my many years in the industry of companies THEY can trust. I'm able to also pass on the savings by not charging an exhorborant setup fee, by not making them wait for revenue while I setup and by letting them maintain full control over their system therefore showing them all of my expertise and paying me based on the work I provide.

I'd NEVER go back to maintaining "one" system or any system and cost ever again. It's easier to market this model as well as the client has full control and there is no delay in reimbursement.

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