Author Topic: Out patient facility billing for substance abuse and Mental health  (Read 8308 times)

billinggirl

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I have a client that offers only Out patient substance abuse and mental health services.   They are billing for Out pt treatment using the CPT codes starting with 9.  I've always used rev codes like 0912 or 0906 etc.  If an ins asked us to bill with HCPCS would use the H0035
or H00015.  Does anyone know which is correct.  I have only seen the H codes along with Rev Codes.   If its the H codes how can I go about asking the facility to use them on the superbill without offending anyone? 

Thank you

Michele

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Re: Out patient facility billing for substance abuse and Mental health
« Reply #1 on: January 01, 2012, 01:46:29 PM »
Do you mean they report the services to you using cpt codes that begin with 9 and you are only familiar with billing rev codes and/or hcpcs codes?  Sorry just not sure of the question.  If they are billing using cpt codes such as 90801-90853 then they are billing on CMS forms instead of UB04's.  Just not sure I understand completely to answer.
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billinggirl

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Re: Out patient facility billing for substance abuse and Mental health
« Reply #2 on: January 01, 2012, 09:00:27 PM »
they are billing using the 9 codes for professional services on the ub04, which is incorrect.   my question is, if they are providing out patient treatment can we bill for daily rates just as if they were a residential facility.  Can i bill for separate charges for using the facility just like we do for residential services.   See the difference with this facility is that the patients do not live there but they come in as out patient treatment.  I am used to billing for residential treatment where they live there for 3 to 6 months.  I am used to billing professional charges on the cms 1500 and the ub04 is for facility charges.  Out patient is new to me.   hope it makes sense

PMRNC

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Re: Out patient facility billing for substance abuse and Mental health
« Reply #3 on: January 02, 2012, 10:14:53 AM »
No, they can't.. if that were the case therapists could charge for the use of their office.  The professional components of the therapy visits for the outpatient care are inclusive. Billing daily rates would only be appropriate for inpatient.
Linda Walker
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Angie

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Re: Out patient facility billing for substance abuse and Mental health
« Reply #4 on: January 02, 2012, 11:00:30 AM »
If it is Residential Treatment (inpatient) we can put the professional fees on the UB04  even if it is all inclusive and show the room and board am I correct?
Using the 0914-0916 Individual, Group and Family and the Residentail Procedure codes 90818 Individual ect.....?

PMRNC

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Re: Out patient facility billing for substance abuse and Mental health
« Reply #5 on: January 02, 2012, 12:39:37 PM »
No the revenue codes/facility charges cannot be on same claim form. Professional charges are done on CMS 1500 and facility is billed on UB form. You can't charge for room and board/facility for outpatient therapy.
Linda Walker
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Angie

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Re: Out patient facility billing for substance abuse and Mental health
« Reply #6 on: January 02, 2012, 01:02:24 PM »
So if it is all inclusive Residentail Treatment (inpatient) $300 a day, we cannot bill the inpatient professional fees on a UB04? We just itemize them out per the therapy notes. They are inpatient, not outpatient sessions; and the insurance is the one who said they would not pay for the room and board but the therapy sessions that being provided by the therapist even though it is all inclusive. Does that not sound right?
I'm not questioning you Linda I just want to make sure I understand because it is inpatient, not outpatient.

PMRNC

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Re: Out patient facility billing for substance abuse and Mental health
« Reply #7 on: January 03, 2012, 07:12:34 AM »
I'm confused because your first post indicates the services are not inpatient:
Quote
  they are billing using the 9 codes for professional services on the ub04, which is incorrect.   my question is, if they are providing out patient treatment can we bill for daily rates just as if they were a residential facility.  Can i bill for separate charges for using the facility just like we do for residential services.   See the difference with this facility is that the patients do not live there but they come in as out patient treatment

If there are inpatient R&B fees they cannot be on the CMS1500.  If they are outpatient then the outpatient therapy codes are used on the CMS 1500 fee but there won't be R&B fees.. so I'm confused.. is this inpatient or outpatient? Are you trying to get $300 R&B for outpatient therapy?  Either way facility fees / R&B can NOT be billed with the CPT codes on the CMS 1500 form.
Linda Walker
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Angie

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Re: Out patient facility billing for substance abuse and Mental health
« Reply #8 on: January 03, 2012, 07:36:35 AM »
That was from the very first post which was not from me and I guess I was a little bit confused and misread it myself when they started talking about the 9 codes, I'm sorry.
I was asking a different question and was unclear because our facility is RTC inpatient and the insurance company will not authorize or pay for the room and board charges but they will pay for the inpatient therapy so with that said; we bill those inpatient therapy charges on a UB04.
I guess my question was;
1. Is that correct for us to bill the inpatient therapy on the UB04? and
2. Since we are Inpatient RTC and we have a $300/day rate, can we "unbundle the services" more less and bill the insurance for the Therapy $150/per day and the patient for the Room and Board $150 per day to equal the $300 daily rate? I know there has been some confusion on the forum about unbundling services but the insurance authorized it like that, is that unheard of?
« Last Edit: January 03, 2012, 07:41:07 AM by Angie »

PMRNC

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Re: Out patient facility billing for substance abuse and Mental health
« Reply #9 on: January 03, 2012, 11:30:27 AM »
Ah ok, my bad.. I rarely look at "who" posts what.. I think that keeps me objective but I shouldn't do that.. I apologize. 


Quote
1. Is that correct for us to bill the inpatient therapy on the UB04?

No, again, professional services are billed on A CMS1500  regardless of what carrier pays or doesn't pay. There are plans/carriers that will pay inpatient mental health facility fees of course so they must be broken out.. R&B on the UB04 and professional services (Therapy services, CPT Codes) on the CMS 1500.


Quote
2. Since we are Inpatient RTC and we have a $300/day rate, can we "unbundle the services" more less and bill the insurance for the Therapy $150/per day and the patient for the Room and Board $150 per day to equal the $300 daily rate? I know there has been some confusion on the forum about unbundling services but the insurance authorized it like that, is that unheard of?


I can't really say yes/no on this except to say that you should bill the appropriate claim forms to the appropriate carriers and then bill patient after you receive remittances. IF YOU KNOW the plan isn't going to reimburse, you should have a clear office/financial policy each patient should be signing to receive reimbursement on those fees, you can then file the claims appropriately according to plan guidelines as a courtesy or if you are a par provider as required.  Certainly the best way to handle this is to collect all non covered out of pocket expenses at time of service.. in a perfect world <g>  IMHO I think you would be playing with fire if you began to fiddle with the services for patient billing.. cover yourself and bill the appropriate claim forms to the appropriate plans. 
Linda Walker
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Angie

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Re: Out patient facility billing for substance abuse and Mental health
« Reply #10 on: January 03, 2012, 11:34:59 AM »
Thank you Linda!