Author Topic: Billing/Rendering  (Read 257 times)

mlr5005

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Billing/Rendering
« on: June 15, 2021, 01:10:11 PM »
Hi all! I have tried to search through the wealth of knowledge here (and on the great and powerful Google) but I feel like I'm not quite nailing what I'm asking.

I took over managing an outpatient mental health group a while back and we do in-house billing. I have been doing it the way I was taught, but I have some nagging concerns that things aren't right.

Scenario: LPC billing incident-to under LICSW (I understand all the clinical parameters- be in building, see LICSW for treatment plans, etc etc) but what does THE CLAIM look like?

I was told to leave the LICSW as both the billing and rendering. We do have a group PTAN and group NPI, but obviously the LPC is not credentialed with Medicare.

Currently the 1500 form looks like this:
24J: LICSW NPI
25: group TIN
31: LICSW NPI
32/32a: group/group NPI
33/33a: group/group NPI

Specific guidance on those lines would be super appreciated. Thank you!

Michele

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Re: Billing/Rendering
« Reply #1 on: June 16, 2021, 04:50:54 PM »
I was never really sure on the incident to billing.  I've always seen conflicting info on whether it was ok for an LPC to see the patient but to bill under the LCSW.  So I'm going to respond to your question but I'm not confirming that it's ok to bill for the LPC services under the LCSW.  (You seem to know the guidelines so I'm assuming you are good with that portion.)

So in answer to the question on what info goes where, the way you described it below is exactly how it should be.  I'm not sure who told you to put the LICSW as both the rendering and the billing.  You would definitely want the group info in box 32 & 33.
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mlr5005

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Re: Billing/Rendering
« Reply #2 on: June 17, 2021, 02:18:33 PM »
Thank you for your response!

Yes the incident-to makes me question things regularly. My Director (the LICSW in question, in fact) said she consulted her lawyer about it. Not that I'd advise others to move forward without consulting their own as well :)

Medical Billing Forum

Re: Billing/Rendering
« Reply #2 on: June 17, 2021, 02:18:33 PM »