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Billing Services

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PMRNC:
Thank you for the clarification, and no I really have not dealt with those circumstances at all. I have clients of course that treat patient's for those conditions, but not in the "wilderness" type setting. I'm sorry :(  Do the insurance carriers cover it? if not are they denying it because of "place" of service or provider type?

Angie:
I have yet to find an insurance that will cover the program. Most of the insurance companies will reimburse their members for the face to face therapy sessions with the licensed therapist. If they request we will provide them with an itemized statement of those sessions for the families to submit for reimbursement. I just have student's families asking all the time if we can prepare a claim so they can submit to their insurance for the program and there is no rev code for "Wilderness Program" and we are not licensed as residential treatment so we cannot put that either......I know of another billing company that says that they bill for the full program and then if it gets denied they appeal it (don't know how but that's a whole other issue) They have actually taken an invoice from one of our families that have hired them and they have prepared a UB04 and submitted it to the insurance which makes me nervous because we will not bill the insurance directly and on the type of bill they are putting it as 0863 which is residential treatment......I also see alot of itemized statements from other wilderness programs and it looks as though they are just doing a running invoice and coding a group session everyday, when i know for a fact that the therapist did not provide the group directly because they are not in the field 7 days a week..... and I am not sure how that works.....I have families asking why we cannot do that but I wont do anything without the therapist notes; correct.......You cannot prepare an itemized statement or superbill without the proper notes from the licensed therapist is that how you view it? Just looking for someone else's view from this......

PMRNC:
Well, again, it's not a rule that a patient or even someone on behalf of a patient sending in a claim form, but I too would be leary if there is any false information being sent in. A good idea might be to be sure your office is completing them and then in your office policy make it something they are aware of that they should NOT be filing anything aside from the superbill/invoice.  By law all heatlhcare providers are obligated to provide the exact billing information they would to an insurance company to the patient upon request, be it on a superbill or invoice or the Billing form, which is why I think it would be a good idea for you guys to have prepared to avoid any of this problems. As for the coding, I really can't help with that as I don't do UB04 billing at all. I've never billed therapy in that setting before but just from your description it sounds like insurance carriers have a hard time with the "setting" and the license of the provider?  or is it because you don't have a "facility" per se TO license as a residential treatment center?

Angie:
It is the licensing, "Wilderness Program". They don't have a problem with the LCSW or psychologist but the "setting".....Some insurance companies look at the sessions as an outpatient service 90806, 90853 ect..even though they are being provided within the wilderness program, they reimburse their members that way but there are some that will not even reimburse for the sessions because they are being provided within the program.....I know how to prepare a UB claim form, I am just unclear on the coding.....(since we are not inpatient, or outpatient.....) I don't know what to put for the type of service so it is not misleading to the insurance and nobody has an answer. (I am an overworrier!) And I am unclear how the other programs are providing a superbill with a group session 90853 on there everyday when the licensed therapist is not providing the service...... We have parents asking us to do this all of the time but it is my understanding that we cannot unless we have a therapy note with the therapist signature, is that correct?
I really appreciate all your input!

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