Author Topic: Residential Treatment  (Read 2687 times)

Angie

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Residential Treatment
« on: January 17, 2013, 12:14:28 PM »
At our Residential Treatment Center we have a psychiatrist that is contracted with us and does monthly visits to our patients. He bills us and then we bill the patient to pay us. Since his service is not part of the daily rate of the RTC can he bill it as Office/Outpatient or does he have to bill it as Inpatient since he See's the patients in the RTC? The only inpatient we can find is hopsital or PHP the 99221, 222, 223 codes but it does not define RTC.
My question is should we be billing it as Office or Other 99201, 202, 203 with place of service 56 (RTC) on CMS for professional?
Or billing it with the inpatient codes?
(The patient pays us and we provide them with a courtesy claim that they can submit to their insurance for possible reimbursement. We have a it clearly in our contract also and are OON with all insurance carriers.)

PMRNC

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Re: Residential Treatment
« Reply #1 on: January 17, 2013, 01:38:09 PM »
Quote
Since his service is not part of the daily rate of the RTC can he bill it as Office/Outpatient or does he have to bill it as Inpatient since he See's the patients in the RTC? The only inpatient we can find is hospital or PHP the 99221, 222, 223 codes but it does not define RTC.

Who is he billing? What is the arrangement and entity structure of the facility? In other words.. what is the arrangement they have?
Linda Walker
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Angie

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Re: Residential Treatment
« Reply #2 on: January 17, 2013, 01:47:59 PM »
He is providing services to our patients in the RTC. He is not an employee but is contracted with us for us to pay him and then we send statements out to the parents for his services and collect the monies. But we also provide a courtesy 1500 claim form for his services so they can seek reimbursement from their insurance. (all OON)
The RTC has a daily rate of $350/ day but that does not include the M.D. visits. So we were questioning on the claim form if we should use inpatient codes since he comes to the RTC and provides the service there (Which is an E/M) or if we can use the outpatient codes since his fee is not part of the daily rate.
« Last Edit: January 18, 2013, 10:11:56 AM by Angie »

PMRNC

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Re: Residential Treatment
« Reply #3 on: January 18, 2013, 10:51:38 AM »
I'm not sure I can answer this at all because it sounds like, since there is NO insurance billing here this comes down to agreements between the doctor and the RTC. I am just guessing but I would think you would bill the professional services separately and then again, how you compensate the physician really depends on the legal structure setup, I'm not really comfortable answering this one, I'm sorry.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

ElroyQuin

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Re: Residential Treatment
« Reply #4 on: March 02, 2014, 09:06:56 AM »
At our Residential solar panel Treatment Center we have a psychiatrist that is contracted with us and does monthly visits to our patients. He bills us and then we bill the patient to pay us. Since his service is not part of the daily rate of the RTC can he bill it as Office/Outpatient or does he have to bill it as Inpatient since he See's the patients in the RTC? The only inpatient we can find is hopsital or PHP the 99221, 222, 223 codes but it does not define RTC.
My question is should we be billing it as Office or Other 99201, 202, 203 with place of service 56 (RTC) on CMS for professional?
Or billing it with the inpatient codes?
(The patient pays us and we provide them with a courtesy claim that they can submit to their insurance for possible reimbursement. We have a it clearly in our contract also and are OON with all insurance carriers.)

To whom he has billed? I am facing similar question so can you help me out? Waiting for reply thanks in advance:)
« Last Edit: March 03, 2014, 11:05:25 AM by ElroyQuin »