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Mental Health Billing Nightmare!!
PsychBiller:
Came across this article today, I work completely in mental health billing and it is an absolute nightmare at the moment, just wanted to share:
http://vitals.nbcnews.com/_news/2013/02/07/16842490-glitch-in-medical-code-threatens-mental-health-care-therapists-warn?lite&ocid=msnhp&pos=5
RichardP:
From the link:
“We are ethically bound not to leave patients hanging,” Perlow said. “I will personally see people for a sliding scale … there have been situations where I’ve seen people for free.”
Charging a different fee to different patients. That is because he is allowed to, except where constrained by state, Federal, or insurance carrier regulations.
rdmoore2003:
--- Quote from: RichardP on February 07, 2013, 04:49:23 PM ---From the link:
“We are ethically bound not to leave patients hanging,” Perlow said. “I will personally see people for a sliding scale … there have been situations where I’ve seen people for free.”
Charging a different fee to different patients. That is because he is allowed to, except where constrained by state, Federal, or insurance carrier regulations.
--- End quote ---
These regulations are to be upheld by the insurance companies as well.
PMRNC:
--- Quote ---These regulations are to be upheld by the insurance companies as well.
--- End quote ---
Sort of.. Both sides have to RESEARCH legality... doctors side/patient side/ Insurance company side. The patient's POLICY does also determine a cost sharing provision to which a patient MUST pay that portion as their OOP. That's not a state or federal law, that's a POLICY provision to which the insured is bound to in that policy . For example, if a doctor charges $100 office visit and gives patient $20 discount, the insurance must show that discount, either by billing ONLY the $80 or showing the $20 discount (either is acceptable) So really the patient cannot get out of their cost sharing responsibility. They are still responsible for their coinsurance/copay/deductibles, no matter what discount is, so neither doctor nor patient win in this instance. For providers that participate they have to follow their contracts and patients still have their policys to abide by. All kinds of do's and don'ts from all 3 sides.
Sportsmom:
It's more than a Nightmare, with the mental health billing. Our claims are being denied left and right saying the new codes are not covered benefits. We have clients that are stopping care because they are worried they are going to have to pay. How is it that we providers had to be ready and told we could get a fine if we did not bill with the right codes, but the insurances companies are not ready?
We have been told by BCBS we will have to call on each claim that is denied and ask to have it fixed once they have the system fixed, that is a lot of time and extra money we have to pay out because they are not up to date.
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