Author Topic: Behavioral health billing  (Read 1575 times)

Tameka79

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Behavioral health billing
« on: August 29, 2016, 07:35:32 AM »
Good Morning,

I need some guidance if posible.  I was approached about doing some Pediatric Behavioral Health billing. I have never done this speciality before, but I was told by the Pediatrican that she, along with a social worker, need to have some billing done. She stated that there are only about 8 cpt codes that they use and they are just starting up so she doesn't think it would take me more then 2 to 3 hours a week to do the billing.

I am not familar with the codes used, but I did some research and I wanted to know if the codes from 90832-90899 would be the only codes that are used?

Also she is stating that they are just starting up, but she doesn't think they would have any more then 45 patients, twice a week, so that's about 90 encounters a week. I would also be doing patient billing. She wanted to pay me by a percentage of the insurance, but I let her know that I would prefer a flat fee, so she said she woudl consider that.

I really am unsure as to how much to charge them.  Right now they are not making any money because they just started, but what about in the future?  I feel I should make room for that too.

I am also in the process of starting my medical billing service so I want to keep that in mind as well.

Any suggestions would be greatly appreciated.

Michele

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Re: Behavioral health billing
« Reply #1 on: August 29, 2016, 09:10:31 AM »
Are they doing counseling or testing?  I'm thinking counseling based on the information.  If so then the codes would be mostly 90791 (initial), 90832, 90834 and possibly 90837.  Those would be the most common.  They may do others such as family therapy (90846, 90847). 

As far as charging you will want to allow for growth.  Maybe have a sliding flat fee based on number of patients/claims.
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Michele

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Re: Behavioral health billing
« Reply #2 on: August 29, 2016, 09:13:23 AM »
I forgot to mention, when the provider is estimating that it will only take three hours a week, what are they basing that on?  Are they including time to run aging reports, check on unpaid claims, file appeals?  Don't go based on what the provider thinks it will take.  Make sure you do your own calculations and then remind the provider that there is more to billing than submitting the claim.  :)
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PMRNC

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Re: Behavioral health billing
« Reply #3 on: August 29, 2016, 01:11:51 PM »
You mention the pediatrician, so your codes may differ if the pediatrician does services and there are the add-on codes. And like Michele asked, will there be testing done? Reimbursement is going to vary by the provider as well.. if the pediatrician (MD) does services then your codes will be different. your social worker depending on her licensure will also have different codes.

I agree with Michele, don't go by what they tell you for how long it will take.. with mental health and dealing with pediatric and social worker you will spend a LOT of time on benefit verifications. There is also contracts to take into consideration that they may or may  not hold.

I would suggest you ask for the following information to help you better price your services or provide them with a reasonable quote:

1. all provider contracts and fee schedules
2. Are they Medicare and Medicaid?
3. Do they hold any contract for EAP?

Find those out first.. again you will be doing a lot of benefit verifications and eligibility checks and most often you can obtain the initial authorizations. With mental health it is critical to provide this service so that you have all of the benefit information as well as the authorizations setup. You will also want to review each carriers' requirement on testing if you will be billing for testing as well.
Linda Walker
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Tameka79

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Re: Behavioral health billing
« Reply #4 on: August 29, 2016, 02:59:09 PM »
Are they doing counseling or testing?  I'm thinking counseling based on the information.  If so then the codes would be mostly 90791 (initial), 90832, 90834 and possibly 90837.  Those would be the most common.  They may do others such as family therapy (90846, 90847). 

As far as charging you will want to allow for growth.  Maybe have a sliding flat fee based on number of patients/claims.

Thank you for your response. I believe it is just counseling, but I will checking to see if they would also be doing testing.
What exactly is a sliding flat fee? I know it is used just in case the practice expands and they get more patients, but is it that I would give them a range? (ie. if you see x amount of patients it's say $1,000 a month, but if you see x amount more it's $1500?

Tameka79

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Re: Behavioral health billing
« Reply #5 on: August 29, 2016, 03:01:55 PM »
I forgot to mention, when the provider is estimating that it will only take three hours a week, what are they basing that on?  Are they including time to run aging reports, check on unpaid claims, file appeals?  Don't go based on what the provider thinks it will take.  Make sure you do your own calculations and then remind the provider that there is more to billing than submitting the claim.  :)

She is basing it on just submitting claims.  I did have to explain to her that billing is much more then just submitting claims and she also wants me to do patient billing. She's also saying that they will not have much patients, maybe 45 between the two of them when the practice is established. 

I would really like to thank you for this forum.  I have learned so much :-)

Tameka79

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Re: Behavioral health billing
« Reply #6 on: August 29, 2016, 03:12:05 PM »
You mention the pediatrician, so your codes may differ if the pediatrician does services and there are the add-on codes. And like Michele asked, will there be testing done? Reimbursement is going to vary by the provider as well.. if the pediatrician (MD) does services then your codes will be different. your social worker depending on her licensure will also have different codes.

I agree with Michele, don't go by what they tell you for how long it will take.. with mental health and dealing with pediatric and social worker you will spend a LOT of time on benefit verifications. There is also contracts to take into consideration that they may or may  not hold.

I would suggest you ask for the following information to help you better price your services or provide them with a reasonable quote:

1. all provider contracts and fee schedules
2. Are they Medicare and Medicaid?
3. Do they hold any contract for EAP?

Find those out first.. again you will be doing a lot of benefit verifications and eligibility checks and most often you can obtain the initial authorizations. With mental health it is critical to provide this service so that you have all of the benefit information as well as the authorizations setup. You will also want to review each carriers' requirement on testing if you will be billing for testing as well.

Yes I noticed there were codes like 90833, 90836, and 90838 that were add on codes when performed with evaluation and management services. I am assuming only the MD would be able to use these (if done) and the social worker would use the others 90832, 90834, and 90837.  Would there be different code for pediatric behavioral billing? I thought they would be the same ones.

Also, what testing are you speaking about?  Do you know the codes that may be used? I will ask about this.

I have access to the provider contract and fee schedules already because where I live each provider does not negotiate fees, we have an entity that does that for us so I have be looking at the codes to see what the reimbursement rates are.

Thank you for the tip about benefit verification  and authorization because I think they are trying to keep the staff a small as possible, so I don't know if they have someone doing that or I would need me to, so I will definitely ask.

Michele

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Re: Behavioral health billing
« Reply #7 on: August 30, 2016, 07:46:58 AM »

Thank you for your response. I believe it is just counseling, but I will checking to see if they would also be doing testing.
What exactly is a sliding flat fee? I know it is used just in case the practice expands and they get more patients, but is it that I would give them a range? (ie. if you see x amount of patients it's say $1,000 a month, but if you see x amount more it's $1500?

We have a large mental health group that we bill for.  We charge them a sliding flat fee based on the number of claims created.  They have 10 to 15 social workers that see patients in their homes.  The number of claims varies but mostly grows.  We have a sliding flat fee that goes up based on the number of claims.  For example 1000 to 1250 claims is one fee, 1251-1500 is another, etc.  Then at the end of each month we bill them based on the number of claims we submitted.  It's similar to a per claim fee, but we have it bunched into groups.  We have been doing this with them for several years.  Works great on both ends.
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PMRNC

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Re: Behavioral health billing
« Reply #8 on: September 03, 2016, 09:52:56 AM »
So they are only wanting you to bill the therapy? I have to ask what are the doing for the rest of the billing? will they be utilizing two different systems? One system and having you work just the behavioral claims? What about the other billing.. I do ped's and my pediatricians will do initial testing and then refer to a specialist for a diagnosis in many instances. Sometimes it's just early intervention screenings. But again, I think it's important to find out if you'll be working in the same system they have the rest of their practice using or are they looking to segregate the behavioral billing? That would be a red flag for me as having two sets of books/2 systems is a formula for disaster.
Linda Walker
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Tameka79

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Re: Behavioral health billing
« Reply #9 on: September 08, 2016, 12:09:10 PM »

Thank you for your response. I believe it is just counseling, but I will checking to see if they would also be doing testing.
What exactly is a sliding flat fee? I know it is used just in case the practice expands and they get more patients, but is it that I would give them a range? (ie. if you see x amount of patients it's say $1,000 a month, but if you see x amount more it's $1500?

We have a large mental health group that we bill for.  We charge them a sliding flat fee based on the number of claims created.  They have 10 to 15 social workers that see patients in their homes.  The number of claims varies but mostly grows.  We have a sliding flat fee that goes up based on the number of claims.  For example 1000 to 1250 claims is one fee, 1251-1500 is another, etc.  Then at the end of each month we bill them based on the number of claims we submitted.  It's similar to a per claim fee, but we have it bunched into groups.  We have been doing this with them for several years.  Works great on both ends.

Michelle, I was wondering how the sliding scale would work if you based your flat fee on time?

Tameka79

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Re: Behavioral health billing
« Reply #10 on: September 08, 2016, 12:12:27 PM »
So they are only wanting you to bill the therapy? I have to ask what are the doing for the rest of the billing? will they be utilizing two different systems? One system and having you work just the behavioral claims? What about the other billing.. I do ped's and my pediatricians will do initial testing and then refer to a specialist for a diagnosis in many instances. Sometimes it's just early intervention screenings. But again, I think it's important to find out if you'll be working in the same system they have the rest of their practice using or are they looking to segregate the behavioral billing? That would be a red flag for me as having two sets of books/2 systems is a formula for disaster.

Yes, It would just be for the therapy.  Their Pediatric office is completely seperate and I would not be dealing with that.

Michele

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Re: Behavioral health billing
« Reply #11 on: September 09, 2016, 07:55:15 AM »

Michelle, I was wondering how the sliding scale would work if you based your flat fee on time?

I've never done a sliding scale based on time.  I have done it based on claims and patients.
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