Author Topic: Type of Bill  (Read 3204 times)

Angie

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Type of Bill
« on: December 02, 2011, 03:01:01 PM »
We are a Therapeutic Wilderness Program for mental health/substance abuse. We do not participate with any of the insurance companies. The patient want us to prepare a claim for the program; even though it is not a covered benefit on their plan.  We are not licensed as Residential Treatment as we don't have a building with beds, our license specifically states we are Outdoor Youth Treatment. Can we use the 0861 for the type of bill even though we are not licensed as Residentail Treatment. A third party biller who this family has hired told me that we can bill it as residentail treatment even though we are not licensed as such or bill it as subacute care facility, which we are not licensed as either.....I worry this is misleading to the insurance company. Any advise would be most helpful...

PMRNC

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Re: Type of Bill
« Reply #1 on: December 02, 2011, 04:25:05 PM »
Best thing to do is give an itemized billing statement to the patient and let them file it. If you are not credentialed you are under no obligation to file, why jump through the hoops when you don't have to?
Linda Walker
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Angie

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Re: Type of Bill
« Reply #2 on: December 03, 2011, 01:29:15 PM »
But how do you code an itemized statement for boarding when there is no code for boarding in the wilderness? (sleeping in a tent)
Or for the group sessions that they have every day but the group sessions are not provided directly by the therapist because the therapist is only in the field 2 days a week and those are the only 2 days he directs the actual group session. The other group sessions they have are sessions within the group and held by the field staff who are not licensed therapists.......What code do you use for those???? I don't think you can code those so how do you itemize those on a itemized statement?


PMRNC

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Re: Type of Bill
« Reply #3 on: December 03, 2011, 06:50:03 PM »
Quote
But how do you code an itemized statement for boarding when there is no code for boarding in the wilderness? (sleeping in a tent)

That's probably going to be a POS of other.. but if there's no code, you have to just do what you do. if you do not participate and insurance billing is not something you offer, then BEST you can do is give the patient the itemized bill and let them fight with the insurance company, if the carrier needs or wants something else, have them contact you, there's no obligation on your part other than an itemized bill. HOPEFULLY you collected payment as with other clients, if you let the patient off the hook or with an assignment of benefits than to get paid you set yourself up to jump through the hoops.  My suggestion to avoid this in the future is to have one financial policy that addresses this and making NO exceptions aside from documented hardship cases. (JMO)
Linda Walker
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Angie

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Re: Type of Bill
« Reply #4 on: December 05, 2011, 09:30:25 AM »
Thank you for your advice. Another question... Would you use the 90818(Inpatient/Partial Hospital or Residential Treatment) or 90806 (Office or Other Outpatient facility) for the individual sessions? We are not licensed as Residential Treatment or Inpatient nor are we licensed as Outpatient.....What would be the most appropriate?
Anyone else do any wilderness program billing? or do you of someone who does?

Also Linda do you think it would be wrong when we do an itemized statement to use the 90853 Group procedure code everyday to show they had a group and just put *** by the Group sessions to indicate the group was provided directly by the licensed therapist? (The group sessions that we have notes from the licensed therapist) 
I have to have some kind of code to use for an itemized statement if the parents are wanting to submit to their insurance to see if they can get them to reimburse them for anything.
I have seen other programs statements and they are just using the 90853 group everyday but I know the therapist is not the one providing those sessions everyday; they are the field staff not licensed therapists. So it seems to me the best I can do is to indicate which ones are provided directly by the therapist, any thoughts?

Angie

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Re: Type of Bill
« Reply #5 on: December 13, 2011, 11:03:51 AM »
Thank you for your advice. Another question... Would you use the 90818(Inpatient/Partial Hospital or Residential Treatment) or 90806 (Office or Other Outpatient facility) for the individual sessions? We are not licensed as Residential Treatment or Inpatient nor are we licensed as Outpatient.....What would be the most appropriate?
Anyone else do any wilderness program billing? or do you of someone who does?

Also Linda do you think it would be wrong when we do an itemized statement to use the 90853 Group procedure code everyday to show they had a group and just put *** by the Group sessions to indicate the group was provided directly by the licensed therapist? (The group sessions that we have notes from the licensed therapist) 
I have to have some kind of code to use for an itemized statement if the parents are wanting to submit to their insurance to see if they can get them to reimburse them for anything.
I have seen other programs statements and they are just using the 90853 group everyday but I know the therapist is not the one providing those sessions everyday; they are the field staff not licensed therapists. So it seems to me the best I can do is to indicate which ones are provided directly by the therapist, any thoughts?
I have done so much research on this that my eyeballs are bouncing off the sides of my head! Nobody seems to know an answer to this so any advise at all would be of great help!

Michele

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Re: Type of Bill
« Reply #6 on: December 15, 2011, 06:46:05 AM »
I personally would go with the 90818 since the patient is in a residential treatment program.  It is not an outpatient situation. 
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Angie

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Re: Type of Bill
« Reply #7 on: December 15, 2011, 08:02:50 AM »
What do you think about the group sessions when we do an itemized statement for the family since we don't bill the insurance. We provide the families with an itemized statement and then they submit to their insurance for reimbursement only if requested.
The therapist is in the field two days a week, while he is in the field he will hold an individual and 2 group sessions. The other days of the week they have group sessions that are not provided directly by the licensed therapist and the staff that are doing the groups are not licensed at all, they are field staff that hold groups on topics of books they are reading assigned by the therapist or impact letter groups,etc.. the therapist is not on site 7 days a week. Can we code it as an 90853 and just indicate which ones were provided directly by the licensed therapist? I don't know of any other way to show they have a group everyday because there is no other code and I don't think we can code it if the therapist is not on site or licensed staff are not providing the service.....Thoughts? :-\

Michele

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Re: Type of Bill
« Reply #8 on: December 16, 2011, 08:24:45 AM »
I honestly don't know on this one.  If the staff is not certified or licensed in any way to perform psychotherapy (90853 is group psychotherapy) then I am not sure it can be indicated with that code.  Even if you flag the ones that are held with the licensed therapist.  It is really more of a legal question than a billing question and I am not qualified to give you advise on that.
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Angie

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Re: Type of Bill
« Reply #9 on: December 16, 2011, 09:02:43 AM »
I understand, Thank you Michele.

PMRNC

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Re: Type of Bill
« Reply #10 on: December 16, 2011, 12:28:46 PM »
I agree with Michele. I'm not sure the services should be coded at all with the CPT codes, since it's been mentioned before that you do not bill insurance carriers I feel it's better way all around to be sure patient's are made aware of the services, give them an itemized bill and let them deal with the insurance. What I might do is create internal codes for billing/invoicing (which you probably have already done) and then maybe give each person a "key" with a service description of charges and then again, they can deal with insurance companies which most likely are NOT going to pay.  JMHO
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com