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LCSW

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ruthie72:
Hi Everyone!!
I got my first client. She is a LCSW..I have been doing my homework and know we can only bill 4 codes. I was wondering does anyone have any advice for me. I know she takes EAP, BCBS, Medicare, and Tricare..I would really appreciate any tips, or help with billing in anyway..Thanks so much. Have a great day. SOOO EXCITED.

PMRNC:
They are pretty straight forward and easier than psychologists and psychiatrists. If you have billed other mental health providers you won't have a problem. LCSW's usually get most of the EAP cases. One thing you MUST know about EAP is that it is a COMPLETELY separate benefit outside the patient's plan benefits. The biggest mistake that could cost your provider their enrollment status and even sanctions is mistakenly billing a major medical carrier instead of the EAP!!  This is a HUGE HUGE no-no.  VERIFY, VERIFY and then VERIFY again.  NEVER disclose EAP info to the major med carrier.. EVER. They will and should not know about each other.   In general with LCSW's (at least in my experience) you have to make sure benefit verifications are done. In many cases patients might be seeing a psychiatrist or other prescriber in addition and you want to make sure you have authorization for your visits.  I seem to have the MOST trouble with LCSW's and their OTR's.  I have to stay on top of mine with a report every week of which patient's are using up their last 2 visits in an auth series. If I don't do this, they will forget or simply get lazy, not sure why. My LCSW's seem to be MUCH busier than my psychologists and even my psychiatrists. They work longer hours for lesser pay of course.

ruthie72:
Thank you so much for your reply. So when you say Verify..you mean with the insurance companies? It was my understanding that it is after the insurance companies pay for their visits, then the EAP can kick in. is that correct? You advice is to make sure the insurance company does not know about the EAP and vice versa? Thank you so much. I just want to be clear. Also, what should I do when I see the patient only has two more visits left, get more authorization from the insurance company or see when the EAP will start to pay? Sorry IF I am asking too many questions, I really appreciate the help.  :)

PMRNC:
EAP comes first. When patient has an EAP they have already gone through the EAP procedures, it's contracted OUT. Once EAP is exhausted their major medical benefits take over. EAP stands for Employee Assistance Programs. Employers that have the EAP's have a dedicated hotline where patients call in to open this benefit. No copay, no fuss, no muss. <g>  The EAP will usually even set up the appointments so when patient comes in you already have established the EAP case and the clinical information is the providers responsibility.   The reason the visits are confidential is to provide the patient and their family with a safe avenue with full confidentiality aside from their normal mental health benefits, the two do not coincide at all. The EAP visits bear no importance at all to the major medical benefits. They do not get applied to max benefits nor do their diagnosis, clinical information get carried over to the major medical.  Some patients will continue care beyond the EAP but NOT with their insurance company.  On my clients patient screening sheets we ask them if they have an EAP because in some instances patients are NOT aware of it, we then do our best to see if they have EAP benefits and where to get the case opened. 98% of the time though, the EAP is already established.

ruthie72:
Wow,
Thank you so much. I am really learning a lot. So do I bill the EAP or the EAP just send the provider a check for the amount of visits that the patient is authorized for? My question is..I guess do I have to do anything with the EAP except find out how many visits the patient is entitled to? Thank you again.

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