Author Topic: BLUE CROSS BLUE SHIELD  (Read 11127 times)

Sportsmom

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Re: BLUE CROSS BLUE SHIELD
« Reply #15 on: April 12, 2013, 03:34:32 PM »
If you have a fax number I can fax you a great cross walk I got from a class I took from the American Academy of Child and Adolesecent Phsychiatry.

rdmoore2003

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Re: BLUE CROSS BLUE SHIELD
« Reply #16 on: April 17, 2013, 04:17:22 PM »
I AM NOT HAVING ANYMORE ISSUES WITH BC, HOWEVER, EMAIL ME WITH YOUR CROSSWALK INFORMATION.  I WOULD APPRECIATE THAT
Regina

Sophrosyne

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Re: BLUE CROSS BLUE SHIELD
« Reply #17 on: November 05, 2013, 10:20:28 AM »
I'd love to get some clarification on this thread. I just (like, yesterday) started at a practice with licensed medical psychologists who have been billing either 90834/90837 with the 90863 add on code. BCBS has been paying just for the psychotherapy codes, but not the 90863. Is there a way to get BCBS to pay for it? Other insurance companies HAVE paid for both.

Sophrosyne

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Re: BLUE CROSS BLUE SHIELD
« Reply #18 on: November 05, 2013, 10:21:15 AM »
And we are in Louisiana  :)

rdmoore2003

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Re: BLUE CROSS BLUE SHIELD
« Reply #19 on: November 05, 2013, 04:42:02 PM »
And we are in Louisiana  :)

So am I.  What part?    BCBS will pay the following examples until Jan. 1, 2014.

For a med check it must be billed with e/m code and 90833, 90836, or 90838.  BcBS will not pay for the e/m code but will pay for med check code. 
Regina

rdmoore2003

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Re: BLUE CROSS BLUE SHIELD
« Reply #20 on: November 05, 2013, 04:45:46 PM »
bcbs is not covering 90863
Regina

PMRNC

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Re: BLUE CROSS BLUE SHIELD
« Reply #21 on: November 06, 2013, 08:32:30 AM »
Because med management code 90862 was deleted prescribing providers instead needed to use the E/M code. IN Your situation(s) your prescribing provider is a psychologist in one of the two states that allow them to prescribe, however they cannot bill E/M codes..   With that in mind what if you billed your psychotherapy code along with HCPCS M0064. M0064 is used by those provider's performing a quick med check, it cannot be billed with any E/M service and is meant to just be a code used when only a small portion (general rule is 15 min or less) of the visit is for medication management/prescription.

Just a thought. I have psychiatrists who use this code since Medicare began cracking down on Nursing home visits for 90862.

 
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

rdmoore2003

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Re: BLUE CROSS BLUE SHIELD
« Reply #22 on: November 06, 2013, 09:23:19 AM »
Because med management code 90862 was deleted prescribing providers instead needed to use the E/M code. IN Your situation(s) your prescribing provider is a psychologist in one of the two states that allow them to prescribe, however they cannot bill E/M codes..   With that in mind what if you billed your psychotherapy code along with HCPCS M0064. M0064 is used by those provider's performing a quick med check, it cannot be billed with any E/M service and is meant to just be a code used when only a small portion (general rule is 15 min or less) of the visit is for medication management/prescription.

Just a thought. I have psychiatrists who use this code since Medicare began cracking down on Nursing home visits for 90862.

Medical psychologists can bill E/M codes.  Medical psychologists cannot use the M code
Regina

rdmoore2003

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Re: BLUE CROSS BLUE SHIELD
« Reply #23 on: November 06, 2013, 09:25:17 AM »
bcbs is not covering 90863

for medical psychologists that is
Regina

PMRNC

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Re: BLUE CROSS BLUE SHIELD
« Reply #24 on: November 06, 2013, 10:51:34 AM »
I should have clarified.. Medical psychologists cannot bill E/M codes to MEDICARE. Remember MOST carriers follow Medicare, hence BCBS won't allow you to bill the E/M for this provider. Their licensure requirements for prescribing does not include evaluation and management..

Psychologists cannot bill Evaluation and Management (E&M) codes when treating Medicare beneficiaries because the Center for Medicare and Medicaid Services (CMS) currently restricts the use of these codes. CMS has taken the position that E & M codes involve services unique to medical management, such as medical diagnostic evaluation, drug management, and interpreting laboratory or other medical diagnostic studies.
Although there are some similarities among the services, the health and behavior codes should not be viewed as a substitute for E&M codes. APA is continuing its advocacy with CMS to permit psychologists to be reimbursed for providing E&M services to Medicare beneficiaries.
Psychologists treating patients with private insurance may be able to bill for E&M services because not all insurers impose the same restrictions as Medicare. Psychologists should check with the private carrier to determine its policy on E&M services.
    -- Source APA

M0064 can be used in lieu of the old 90862, however  it is for the "soul purpose of monitoring....." and you wouldn't be able to bill it with psychotherapy.

I think it's important to remember there are ONLY two states right now that allow specialty licenses to psychologists for the purpose of prescribing So this is one of those things those two states have to deal with. There won't be allowances for med management on same day with separate reimbursement.  Since BCBS follows Medicare guidelines that is why you will receive the denials and I can't see a way around it because you can't bill the E/M. If you could your problem is solved as you would use the medical evaluation mgmt code with your add on therapy code, but again, you can't do that due to the type of provider.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

rdmoore2003

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Re: BLUE CROSS BLUE SHIELD
« Reply #25 on: November 06, 2013, 11:21:47 AM »
Here is my clarification on this:  my medical psychologist can bill e/m codes, with and without add on codes, for every insurance that we are paneled with except medicare and tricare.  tricare requires 90863 with therapy add on.  (example: 90863 & 90832).
None of our paneled insurance will except the M0064, this is only for  psychiatrists. (per our paneled insurances here)
Now, this is per our contracts, fee schedules, etc. It is all in writing and I have not had any issues all year with payments or denied claims.  It was nerve racking at first because there is only 2 states that have this type of provider.  It is simple and the APA and State board does have guidelines for this that you can get.
Regina

rdmoore2003

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Re: BLUE CROSS BLUE SHIELD
« Reply #26 on: November 06, 2013, 11:25:41 AM »
including blue cross blue shield
Regina

PMRNC

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Re: BLUE CROSS BLUE SHIELD
« Reply #27 on: November 06, 2013, 02:51:47 PM »
If you look at some of your contracts.. let's take Value Options for example, they actually sent providers clarification on using M0064 and their allowance was for "prescribers".  HOWEVER this still wouldn't help you even if you could bil lit UNLESS the patient was coming in ONLY for a med check.   Your issue is that BCBS is following Medicare rules and many DO that using Medicare as the base guideline. In any other state your provider wouldn't be doing E/M or medication mgmt at all. The issue is that the scope of license is recognized, but the carriers still can determine if they want to pay a med mgmt code WITH therapy on same date. If you were in any other state OR if your provider was a psychiatrist you would have no problems with the E/M and add on's.   JMHO but if I was in your position I'd have my provider / client refer out for med checks as they are losing reimbursement due to the restrictions and coverage guidelines.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Sophrosyne

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Re: BLUE CROSS BLUE SHIELD
« Reply #28 on: November 07, 2013, 04:50:45 PM »
Thanks for all the advice! I just recently received an email from BCBS saying: "Effective January 1, 2014, BCBSLA will allow payment for E&M codes and the following psychotherapy codes when billed on the same claim: CPT codes 90833, 90836, 90838." They don't say anything about same date of service, but we'll see how it goes!

PMRNC

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Re: BLUE CROSS BLUE SHIELD
« Reply #29 on: November 07, 2013, 04:52:51 PM »
Thanks for all the advice! I just recently received an email from BCBS saying: "Effective January 1, 2014, BCBSLA will allow payment for E&M codes and the following psychotherapy codes when billed on the same claim: CPT codes 90833, 90836, 90838." They don't say anything about same date of service, but we'll see how it goes!

Is that for LA medical psychologists? That is basically your problem. For my psychiatrists we are getting paid for the E/M and therapy codes.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com