Author Topic: Mental Health Billing Nightmare!!  (Read 3353 times)

PsychBiller

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Mental Health Billing Nightmare!!
« on: February 07, 2013, 12:24:08 PM »

Came across this article today, I work completely in mental health billing and it is an absolute nightmare at the moment, just wanted to share:

http://vitals.nbcnews.com/_news/2013/02/07/16842490-glitch-in-medical-code-threatens-mental-health-care-therapists-warn?lite&ocid=msnhp&pos=5

RichardP

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Re: Mental Health Billing Nightmare!!
« Reply #1 on: February 07, 2013, 01:49:23 PM »
From the link:

We are ethically bound not to leave patients hanging, Perlow said. I will personally see people for a sliding scale there have been situations where Ive seen people for free.

Charging a different fee to different patients.  That is because he is allowed to, except where constrained by state, Federal, or insurance carrier regulations.

rdmoore2003

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Re: Mental Health Billing Nightmare!!
« Reply #2 on: February 07, 2013, 01:59:35 PM »
From the link:

We are ethically bound not to leave patients hanging, Perlow said. I will personally see people for a sliding scale there have been situations where Ive seen people for free.

Charging a different fee to different patients.  That is because he is allowed to, except where constrained by state, Federal, or insurance carrier regulations.

These regulations are to be upheld by the insurance companies as well. 
Regina

PMRNC

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Re: Mental Health Billing Nightmare!!
« Reply #3 on: February 08, 2013, 10:11:27 AM »
Quote
These regulations are to be upheld by the insurance companies as well. 

Sort of.. Both sides have to RESEARCH legality... doctors side/patient side/ Insurance company side.    The patient's POLICY does also determine a cost sharing provision to which a patient MUST pay that portion as their OOP. That's not a state or federal law, that's a POLICY provision to which the insured is bound to in that policy . For example, if a doctor charges $100 office visit and gives patient $20 discount, the insurance must show that discount, either by billing ONLY the $80 or showing the $20 discount (either is acceptable) So really the patient cannot get out of their cost sharing responsibility. They are still responsible for their coinsurance/copay/deductibles, no matter what discount is, so neither doctor nor patient win in this instance.   For providers that participate they have to follow their contracts and patients still have their policys to abide by.    All kinds of do's and don'ts from all 3 sides.
Linda Walker
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Sportsmom

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Re: Mental Health Billing Nightmare!!
« Reply #4 on: February 14, 2013, 04:50:53 PM »
It's more than a Nightmare, with the mental health billing. Our claims are being denied left and right saying the new codes are not covered benefits. We have clients that are stopping care because they are worried they are going to have to pay. How is it that we providers had to be ready and told we could get a fine if we did not bill with the right codes, but the insurances companies are not ready?
We have been told by BCBS we will have to call on each claim that is denied and ask to have it fixed once they have the system fixed, that is a lot of time and extra money we have to pay out because they are not up to date.

rdmoore2003

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Re: Mental Health Billing Nightmare!!
« Reply #5 on: February 14, 2013, 04:54:42 PM »
sportsmom,  this is a nightmare!  so far, Tricare South is the only one that is going through and reprocessing claims that are denying for this reason.   Yes it does take up alot of time to contact these carriers and have them reprocess claims correctly.  Not sure what type of provider you bill/code for?  Some are having more issues than others.
Regina

PMRNC

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Re: Mental Health Billing Nightmare!!
« Reply #6 on: February 15, 2013, 04:35:58 PM »
What carriers specifically? I'm not having any problems at all so far.. KNOCK WOOD.
Linda Walker
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barb2512

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Re: Mental Health Billing Nightmare!!
« Reply #7 on: February 15, 2013, 05:35:56 PM »
I am only having problems with Aetna Medicaid and Tricare in Texas. All my other insurance companies are processing. And so far, only BCBS of Texas has lowered the rate for the shorter appointment duration. They were paying 84.95 for 90806 and 80.53 for 90834.

PsychBiller

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Re: Mental Health Billing Nightmare!!
« Reply #8 on: February 18, 2013, 07:46:42 AM »
In GA - Medicaid are denying ALL claims and say that it may be June before they have their system updated, on top of that their system threw a glitch and terminated all contracts for Psychologists!!

Other insurers denying for the new 90834 code are BCBS (GA) and Tricare.  I have not been able to get anything to process yet for Medicare... but this may just because they are being super slow! (I hope!!).

PMRNC

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Re: Mental Health Billing Nightmare!!
« Reply #9 on: February 18, 2013, 09:16:18 AM »
I HAVE one Tricare patient but it's an EAP case we had auth and services were paid. From what I understand MHN rates right now are the same as last year for the new codes.   If your provider is authorized to use the E/M codes (prescriber) total reimbursement is going to be a little higher.   Here's what I have for MHN.  I had a client in NJ who billed them quite a lot and they can be a bit of a pain <g>  https://www.mhn.com/static/pdfs/CPT_FAQ_12062012_FINAL.pdf

I am so glad I don't bill Tricare because their information for providers on their website is so out of date!! They had a great fee schedule look up but when I revisited (after a long time NOT visiting) all the codes are so outdated!!  And this is for our military????   :o :o :o :o :o >:( >:( >:(
Linda Walker
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