Author Topic: Billing Services  (Read 5553 times)

Michele

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Re: Billing Services
« Reply #15 on: October 13, 2011, 06:43:19 AM »
Type of bill 0842 probably would be fine, because as we've been stating all along, it probably won't be reimbursed.  I wouldn't change it to outpatient even when billing the therapy sessions.  The patient was inpatient when the sessions took place.  As for the rev code for room and board, I would use the regular room & board rev codes, whether is is private, semi-private etc.  The room & board is room & board.  The type of bill indicates where the room & board is, and the facility name as well. 

As for the book, I'd have to put it in line......we have so many projects we are trying to get to!

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PMRNC

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Re: Billing Services
« Reply #16 on: October 25, 2011, 09:00:34 AM »
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My question is it legal for that company to take our superbill and prepare it onto a UB04 or 1500 without our knowledge and submit it to the insurance company?

No, it's not illegal at all. In fact many Union's and other self-funded policies still require the patient to submit the claim form. My plan up until just last year gave me forms to complete and submit. Also there are still companies providing CAP services for patient's and they need only obtain the proper forms for patient consent.. as for record's your only obligated to release them to the patient and I wouldn't do anything for anyone but the patient and then let them go from there (self-disclosure)  My dental plan still requires me to send in the stupid handwritten form so I give it to my dentist. Many self-funded plans have not caught up to the times due to cost restraints. 

Another thing I'm wondering is that could it be an A/R Factoring company?  I had a provider one time go out to dinner with some guy and next thing I know the guy is contacting me for the AR because the doctor signed the A/R over.. without even looking into all the ramifications and consequences.. I bowed out of that client fast because he was planning on retirement and I knew this was going to cause a lot of headaches when patient's called about bills they knew nothing about!  He didn't even tell me until AFTER the fact and expected me to just turn over the A/R!
Linda Walker
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Angie

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Re: Billing Services
« Reply #17 on: October 25, 2011, 11:51:57 AM »
Linda has your company ever done any billing for a therapeutic wilderness program or I should say have you had an experience with it? If so I would LOVE some advise!
And I agree with a comment on another topic posted today; with you and Michele's combine 50 years experience! This forum has been a breath of fresh air and I am so grateful for all of your knowledge you ladies are willing share! Just to put that out there   ;)

PMRNC

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Re: Billing Services
« Reply #18 on: October 25, 2011, 12:21:01 PM »
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Linda has your company ever done any billing for a therapeutic wilderness program or I should say have you had an experience with it? If so I would LOVE some advise!

No actually I am a bit flushed to ask..but what kind of therapy is that? I had a provider who specialized in pet therapy and that was different but very straight forward since the carriers did not cover it. 

Linda Walker
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Angie

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Re: Billing Services
« Reply #19 on: October 25, 2011, 12:46:15 PM »
Sorry I was not more clear.....
The students (ages 12-17) live in the wilderness for 6-8 weeks with the field staff (who are not licensed therapists) and our licensed therapist (LCSW, Psychologist, Ph.D., ect) go to the field 2 days a week and provide individual (face to face) therapy sessions and group therapy sessions, hand out therapeutic assignments for the week ectů also they do a family therapy session over the phone weekly . It is kind of like Residential Treatment but in the wilderness (without four walls). The diagnosis of the students are typically dealing with Major Depression, Oppositional Defiance, ADHD, PTSD ect..more of a mental health diagnosis. Typically after our program they go to Residential Treatment for a more long term care.
I hope that helps....

PMRNC

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Re: Billing Services
« Reply #20 on: October 25, 2011, 03:29:37 PM »
Thank you for the clarification, and no I really have not dealt with those circumstances at all. I have clients of course that treat patient's for those conditions, but not in the "wilderness" type setting. I'm sorry :(  Do the insurance carriers cover it? if not are they denying it because of "place" of service or provider type?
Linda Walker
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Angie

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Re: Billing Services
« Reply #21 on: October 25, 2011, 03:56:37 PM »
I have yet to find an insurance that will cover the program. Most of the insurance companies will reimburse their members for the face to face therapy sessions with the licensed therapist. If they request we will provide them with an itemized statement of those sessions for the families to submit for reimbursement. I just have student's families asking all the time if we can prepare a claim so they can submit to their insurance for the program and there is no rev code for "Wilderness Program" and we are not licensed as residential treatment so we cannot put that either......I know of another billing company that says that they bill for the full program and then if it gets denied they appeal it (don't know how but that's a whole other issue) They have actually taken an invoice from one of our families that have hired them and they have prepared a UB04 and submitted it to the insurance which makes me nervous because we will not bill the insurance directly and on the type of bill they are putting it as 0863 which is residential treatment......I also see alot of itemized statements from other wilderness programs and it looks as though they are just doing a running invoice and coding a group session everyday, when i know for a fact that the therapist did not provide the group directly because they are not in the field 7 days a week..... and I am not sure how that works.....I have families asking why we cannot do that but I wont do anything without the therapist notes; correct.......You cannot prepare an itemized statement or superbill without the proper notes from the licensed therapist is that how you view it? Just looking for someone else's view from this......

PMRNC

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Re: Billing Services
« Reply #22 on: October 25, 2011, 04:21:13 PM »
Well, again, it's not a rule that a patient or even someone on behalf of a patient sending in a claim form, but I too would be leary if there is any false information being sent in. A good idea might be to be sure your office is completing them and then in your office policy make it something they are aware of that they should NOT be filing anything aside from the superbill/invoice.  By law all heatlhcare providers are obligated to provide the exact billing information they would to an insurance company to the patient upon request, be it on a superbill or invoice or the Billing form, which is why I think it would be a good idea for you guys to have prepared to avoid any of this problems. As for the coding, I really can't help with that as I don't do UB04 billing at all. I've never billed therapy in that setting before but just from your description it sounds like insurance carriers have a hard time with the "setting" and the license of the provider?  or is it because you don't have a "facility" per se TO license as a residential treatment center?
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Angie

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Re: Billing Services
« Reply #23 on: October 25, 2011, 04:39:23 PM »
It is the licensing, "Wilderness Program". They don't have a problem with the LCSW or psychologist but the "setting".....Some insurance companies look at the sessions as an outpatient service 90806, 90853 ect..even though they are being provided within the wilderness program, they reimburse their members that way but there are some that will not even reimburse for the sessions because they are being provided within the program.....I know how to prepare a UB claim form, I am just unclear on the coding.....(since we are not inpatient, or outpatient.....) I don't know what to put for the type of service so it is not misleading to the insurance and nobody has an answer. (I am an overworrier!) And I am unclear how the other programs are providing a superbill with a group session 90853 on there everyday when the licensed therapist is not providing the service...... We have parents asking us to do this all of the time but it is my understanding that we cannot unless we have a therapy note with the therapist signature, is that correct?
I really appreciate all your input!