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Behavioral health billing

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Tameka79:
Good Morning,

I need some guidance if posible.  I was approached about doing some Pediatric Behavioral Health billing. I have never done this speciality before, but I was told by the Pediatrican that she, along with a social worker, need to have some billing done. She stated that there are only about 8 cpt codes that they use and they are just starting up so she doesn't think it would take me more then 2 to 3 hours a week to do the billing.

I am not familar with the codes used, but I did some research and I wanted to know if the codes from 90832-90899 would be the only codes that are used?

Also she is stating that they are just starting up, but she doesn't think they would have any more then 45 patients, twice a week, so that's about 90 encounters a week. I would also be doing patient billing. She wanted to pay me by a percentage of the insurance, but I let her know that I would prefer a flat fee, so she said she woudl consider that.

I really am unsure as to how much to charge them.  Right now they are not making any money because they just started, but what about in the future?  I feel I should make room for that too.

I am also in the process of starting my medical billing service so I want to keep that in mind as well.

Any suggestions would be greatly appreciated.

Michele:
Are they doing counseling or testing?  I'm thinking counseling based on the information.  If so then the codes would be mostly 90791 (initial), 90832, 90834 and possibly 90837.  Those would be the most common.  They may do others such as family therapy (90846, 90847). 

As far as charging you will want to allow for growth.  Maybe have a sliding flat fee based on number of patients/claims.

Michele:
I forgot to mention, when the provider is estimating that it will only take three hours a week, what are they basing that on?  Are they including time to run aging reports, check on unpaid claims, file appeals?  Don't go based on what the provider thinks it will take.  Make sure you do your own calculations and then remind the provider that there is more to billing than submitting the claim.  :)

PMRNC:
You mention the pediatrician, so your codes may differ if the pediatrician does services and there are the add-on codes. And like Michele asked, will there be testing done? Reimbursement is going to vary by the provider as well.. if the pediatrician (MD) does services then your codes will be different. your social worker depending on her licensure will also have different codes.

I agree with Michele, don't go by what they tell you for how long it will take.. with mental health and dealing with pediatric and social worker you will spend a LOT of time on benefit verifications. There is also contracts to take into consideration that they may or may  not hold.

I would suggest you ask for the following information to help you better price your services or provide them with a reasonable quote:

1. all provider contracts and fee schedules
2. Are they Medicare and Medicaid?
3. Do they hold any contract for EAP?

Find those out first.. again you will be doing a lot of benefit verifications and eligibility checks and most often you can obtain the initial authorizations. With mental health it is critical to provide this service so that you have all of the benefit information as well as the authorizations setup. You will also want to review each carriers' requirement on testing if you will be billing for testing as well.

Tameka79:

--- Quote from: Michele on August 29, 2016, 12:10:31 PM ---Are they doing counseling or testing?  I'm thinking counseling based on the information.  If so then the codes would be mostly 90791 (initial), 90832, 90834 and possibly 90837.  Those would be the most common.  They may do others such as family therapy (90846, 90847). 

As far as charging you will want to allow for growth.  Maybe have a sliding flat fee based on number of patients/claims.

--- End quote ---

Thank you for your response. I believe it is just counseling, but I will checking to see if they would also be doing testing.
What exactly is a sliding flat fee? I know it is used just in case the practice expands and they get more patients, but is it that I would give them a range? (ie. if you see x amount of patients it's say $1,000 a month, but if you see x amount more it's $1500?

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