Author Topic: Residential Treatment UB  (Read 2945 times)

Angie

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Residential Treatment UB
« on: March 05, 2013, 11:38:25 AM »
Is it okay to provide your patient with a claim on a UB for the therapy sessions that are provided with a licenced therapist while they are in the Residential Treatment Program?
They pay a daily rate and the sessions are included in that daily rate but the patient is requesting a claim for the therapy sessions so he can submit it to his insurance to try to seek reimbursement for a portion of those. We do have in our contract a breakdown of the costs in the program; Boarding, Education, Therapy and how that totals the daily rate.
A couple of insurance companies have said it was ok; and others say it is not if the sessions are included in the daily rate. I have seen several facility claims come through like this so I just wanted some input......
OR
Is there anywhere on the UB that you could list the daily rate and then list the therapy sessions Example: in Box 39 value code: put the daily rate and then list the therapy sessions with the rev code etc. and put the type of bill as RTC?
I don't want it to look misleading to the insurance as if we were billing the patient separately for the therapy sessions and room and board?
We are an OON provider with all insurance companies.

PMRNC

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Re: Residential Treatment UB
« Reply #1 on: March 05, 2013, 12:55:18 PM »
You don't even have to worry about a UB form or CMS 1500 form at all if you are non par/cash up front practice and patients are responsible for sending in their own claims. Your only libel to produce a billing statement with the required elements the carrier will need so if you need to break out the therapy charges you can do so. Let the carrier worry about what or what isn't covered, that's not really your responsibility for your situation.   ONE itemized bill to the patient with a full itemization and breakdown of charges... NO hoops ..that's why you are a cash practice no? ;)
Linda Walker
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Angie

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Re: Residential Treatment UB
« Reply #2 on: March 05, 2013, 02:01:55 PM »
Yes that is why we are private pay.....
Say if we did become in network with an insurance comany; would we be able to break out the therapy sessions only on a UB with the RTC type of bill or do we need to show every charge since they are included in the daily rate? That is more my question.
The reason I ask is because I see a lot of RTC facilities doing this; just submitting a claim for the therapies only and they are OON and the patient gets reimbursed.
I have been told several different things so your knowledge would be the most helpful.

PMRNC

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Re: Residential Treatment UB
« Reply #3 on: March 05, 2013, 03:02:04 PM »
Quote
Yes that is why we are private pay.....
Say if we did become in network with an insurance comany; would we be able to break out the therapy sessions only on a UB with the RTC type of bill or do we need to show every charge since they are included in the daily rate? That is more my question.
The reason I ask is because I see a lot of RTC facilities doing this; just submitting a claim for the therapies only and they are OON and the patient gets reimbursed.
I have been told several different things so your knowledge would be the most helpful.

Each carrier you par with will guide you on their billing guidelines and you will have to follow them, most likely you will need to bill separately the professional charges on the CMS 1500, and facility on UB forms.   YOU will submit charges on a PARTICIPATING status, the contract is between you and the provider. Patient will not submit charges.
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Angie

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Re: Residential Treatment UB
« Reply #4 on: March 05, 2013, 03:40:06 PM »
So if the therapy sessions are being provided in the Residential Treatment Center (facility) by a licensed therapist and they are included in the daily rate; we can put those on a UB correct? example: using Rev codes 0914-0916
And if so do we have to show all charges since the insurance will not cover the room and board portion or can we just show the therapy sessions (they are included in the daily rate)?
I am trying to help out one of our patients to seek some reimbursement from the insurance.
My problem is that I see a lot claims come around from RTC facilities that are OON and that only put the therapy sessions on a UB and do not list the room and board when the therapy sessions are included.
Just for my own sanity and knowledge is this considered unbundling or is this ethical to do? Or is it ok to prepare a claim as such.
Thanks Linda I know this is a lot but I appreciate your input.

PMRNC

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Re: Residential Treatment UB
« Reply #5 on: March 05, 2013, 03:48:18 PM »
So if the therapy sessions are being provided in the Residential Treatment Center (facility) by a licensed therapist and they are included in the daily rate; we can put those on a UB correct? example: using Rev codes 0914-0916
And if so do we have to show all charges since the insurance will not cover the room and board portion or can we just show the therapy sessions (they are included in the daily rate)?
I am trying to help out one of our patients to seek some reimbursement from the insurance.

I was giving you info because you said "what if we were participating"  Since you are trying to help out a patient in the here and now, as NON par, again, YOU are only obligated to give them a breakdown of all charges and itemized with codes/diagnosis. 

IF..you become par then you will have to break out "facility" charges on UB and "Professional" charges on CMS 1500.   

While I can appreciate you trying to help a patient in your current situation, since you are non par the only thing I can say is that you provide them with a full breakdown of charges on an itemized bill that breaks out professional services and facility services. WHETHER they get reimbursement again, is really not something you can control on you end ASIDE from just giving them itemized bills.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com