Author Topic: LCSW  (Read 3623 times)

ruthie72

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LCSW
« on: February 18, 2013, 08:57:36 AM »
Hi Everyone!!
I got my first client. She is a LCSW..I have been doing my homework and know we can only bill 4 codes. I was wondering does anyone have any advice for me. I know she takes EAP, BCBS, Medicare, and Tricare..I would really appreciate any tips, or help with billing in anyway..Thanks so much. Have a great day. SOOO EXCITED.

PMRNC

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Re: LCSW
« Reply #1 on: February 18, 2013, 09:22:11 AM »
They are pretty straight forward and easier than psychologists and psychiatrists. If you have billed other mental health providers you won't have a problem. LCSW's usually get most of the EAP cases. One thing you MUST know about EAP is that it is a COMPLETELY separate benefit outside the patient's plan benefits. The biggest mistake that could cost your provider their enrollment status and even sanctions is mistakenly billing a major medical carrier instead of the EAP!!  This is a HUGE HUGE no-no.  VERIFY, VERIFY and then VERIFY again.  NEVER disclose EAP info to the major med carrier.. EVER. They will and should not know about each other.   In general with LCSW's (at least in my experience) you have to make sure benefit verifications are done. In many cases patients might be seeing a psychiatrist or other prescriber in addition and you want to make sure you have authorization for your visits.  I seem to have the MOST trouble with LCSW's and their OTR's.  I have to stay on top of mine with a report every week of which patient's are using up their last 2 visits in an auth series. If I don't do this, they will forget or simply get lazy, not sure why. My LCSW's seem to be MUCH busier than my psychologists and even my psychiatrists. They work longer hours for lesser pay of course.
Linda Walker
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www.billerswebsite.com

ruthie72

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Re: LCSW
« Reply #2 on: February 18, 2013, 10:11:11 AM »
Thank you so much for your reply. So when you say Verify..you mean with the insurance companies? It was my understanding that it is after the insurance companies pay for their visits, then the EAP can kick in. is that correct? You advice is to make sure the insurance company does not know about the EAP and vice versa? Thank you so much. I just want to be clear. Also, what should I do when I see the patient only has two more visits left, get more authorization from the insurance company or see when the EAP will start to pay? Sorry IF I am asking too many questions, I really appreciate the help.  :)

PMRNC

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Re: LCSW
« Reply #3 on: February 18, 2013, 10:29:29 AM »
EAP comes first. When patient has an EAP they have already gone through the EAP procedures, it's contracted OUT. Once EAP is exhausted their major medical benefits take over. EAP stands for Employee Assistance Programs. Employers that have the EAP's have a dedicated hotline where patients call in to open this benefit. No copay, no fuss, no muss. <g>  The EAP will usually even set up the appointments so when patient comes in you already have established the EAP case and the clinical information is the providers responsibility.   The reason the visits are confidential is to provide the patient and their family with a safe avenue with full confidentiality aside from their normal mental health benefits, the two do not coincide at all. The EAP visits bear no importance at all to the major medical benefits. They do not get applied to max benefits nor do their diagnosis, clinical information get carried over to the major medical.  Some patients will continue care beyond the EAP but NOT with their insurance company.  On my clients patient screening sheets we ask them if they have an EAP because in some instances patients are NOT aware of it, we then do our best to see if they have EAP benefits and where to get the case opened. 98% of the time though, the EAP is already established.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

ruthie72

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Re: LCSW
« Reply #4 on: February 18, 2013, 10:55:32 AM »
Wow,
Thank you so much. I am really learning a lot. So do I bill the EAP or the EAP just send the provider a check for the amount of visits that the patient is authorized for? My question is..I guess do I have to do anything with the EAP except find out how many visits the patient is entitled to? Thank you again.

PMRNC

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Re: LCSW
« Reply #5 on: February 18, 2013, 11:23:56 AM »
You still have to bill, only diff is you are billing the EAP, they will usually tell you what they want when you verify benefits. Some even will send the auth and directions for billing. They are easy, only important thing to remember is that they are separate benefits and major medical should not be billed until the EAP is exhausted. 
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

ruthie72

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Re: LCSW
« Reply #6 on: February 18, 2013, 12:20:39 PM »
One more question. What is an OTR?

PMRNC

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Re: LCSW
« Reply #7 on: February 18, 2013, 01:40:21 PM »
OTR is Outpatient Treatment Report   This is the clinical report your LCSW will use to obtain authorizations. Usually carriers will give you the first visit and an auth for a few more before requiring the clinician sending in the OTR. I usually remind my clients when the patient has 2 visits remaining in an authorization series.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

ruthie72

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Re: LCSW
« Reply #8 on: February 18, 2013, 04:53:32 PM »
Thank you so much....!!!

QueenAlicia

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Re: LCSW
« Reply #9 on: February 20, 2013, 01:29:31 PM »
Yes, verify the insurance benefits especially for EAP.  Often EAP patients will have their own billing forms. Some will fax them to the provider, others you can get off the website. Be careful with Value Options, the pay the least and are a pain in the ass.

QueenAlicia

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Re: LCSW
« Reply #10 on: February 20, 2013, 01:30:53 PM »
I forgot to say.. CONGRATS Ruthie!I am happy for you, persistence pays off.

ruthie72

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Re: LCSW
« Reply #11 on: February 21, 2013, 06:40:10 AM »
Aliciaaaaa
I  have been looking for you..thank you so much..I hope you are well..I am trying, I am slowly getting there. They are using Medisoft..not really liking it too much, I would prefer them to use Office Mate/ALLy like you suggested. Medisoft does not seem user friendly to me..what do you think?

JenniferPT

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Re: LCSW
« Reply #12 on: February 26, 2013, 01:55:47 PM »
I know nothing about Medicare, as my practice did not want to get involved, nor get paid their low rates. 

Aetna's version of EAP mails the provider a form to fill in by hand.  You fax it to the number on their form when they are done.   You'll want to make sure each part of that form is completed by the provider.

BCBS uses MHN now, I believe...I honestly can't remember, I'm tired today, sorry.  MHN sends a few forms and you'll see the ID number they want you to use for their claim and they have a KIT# they want in box 10d, where the insureds information goes.     

MHN, I just found out today, wants a special procedure code when billing to them for EAP.  99404.  We have always used the Psych eval code for the initial visit, the indv. and family codes (90801, 90806, 90847).   After 8 denials received this week for January claims, I find this out.