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Billing Psych visit 90834 to Medicare for denial - confused about GY modifier
debfini:
Hello everyone - have been billing psych for 20 years and just now finding out information regarding billing Medicare for an Licensed Professional Counselor (LPC) - which is NOT covered my Medicare in Virginia. I always send these via paper with letter stating that Medicare does not pay for services rendered by LPC - please deny and highlight on bottom of claim "This claim is for denial purposes only" (which is what Medicare told me to do years ago)... :-\ Then I submit denied EOB to secondary.
Think I have been doing this wrong all along? Should I be sending the HCFA to Medicare without letter, etc? And, instead send the HCFA with just a "GY" modifier? With Psych - I have never used a modifier.
Please advise.. :-[. Also I just saw that Medicare will not take the OLD HCFA's after 4/1/14.
Thanks to anyone that can guide me....
Debbie
rdmoore2003:
Medicare does not cover LPC's. Why are you using a modifier? If I have a patient that has medicare primary, I file to medicare electronically so that they can send crossover.
Merry:
It only will cross over for Medigap plans. Many secondaries are supplementals, which dont always cross over.
More so.. If the specialty is not a covered benefit for Medicare how can one even attempt to bill Medicare? I am confused. The provider would not be in the Medicare system at all. Ok, missing part of my brain here.
debfini:
Merry and Rdmoore - This provider is not set up electronically because she is (opt-out) and because Medicare does not pay for LPC....so I do it all by paper. I read this information on Medicare website and started second guessing myself as Medicare billing is not my forte'. Most of my clients are fee for service or straight CareFirst/Anthem, so I feel inept billing Medicare. Typically, I bill Medicare with my letter and such, then client sends me the denial. I take denial and create paper claim to CareFirst attaching Medicare denial. Provider eventually gets paid.
However, after reading the Medicare website I thought I was doing this all wrong and thought I was supposed to be using the GY modifier. Should not have second guessed myself because my system gets the provider paid and that is all that matters.
I apologize for the confusion and I am not going on that website again!!! :-[
Thanks again....will leave well enough alone...
Regards,
Debbie
Merry:
Please.. Nothing to apologize about. I just wanted to be sure that we understood you. Please do hang out here. There are lots of people here that bill mental health so stay in touch please.
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