Medical Billing Forum
Starting a Medical Billing Business => Starting Your Own Medical Billing Business => : bethcanare January 20, 2009, 05:19:31 PM
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I recently purchased the Mental Health Big Book. I noticed on the CMS case study samples most of the claims don't have modifiers. Is that common in mental health billing? Do you also bill Worker's Comp in mental health?
Thank you very much in advance for helping a newbie like me. :)
Beth
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Mental health claims hardly ever require the use of a modifier.
There are some times that workers comp may be billed for a mental health claim but it is not common. We had a situation once where an employee of a grocery store was robbed at knife point. They weren't injured physically but they did need counseling to be able to return to work. The claim was billed out to the comp carrier on the CMS form as it would be billed to the patient's regular insurance, just with the comp info.
Michele
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Thank you, Michele. That will help me a lot.
Beth C
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One case that I know of where a modifier is required for Mental Health and that is when you are billing Medicare for a LCSW. You must submit a AJ modifier. I have been billing for a LCSW for over 4 years and that is the only one I have ever used. :)
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We bill for 17 LCSW's and I have not heard of that before! Interesting. Since our claims are being paid I'm going to leave it as is. Just curious, where are you in the country. I'm thinking it must be a carrier specific requirement.
Michele
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Its that way for NC...where are you Michele?
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https://www.magellanprovider.com/MHS/MGL/getpaid/HIPAA/degree-level-modifiers.pdf
http://www.cignagovernmentservices.com/partb/pubs/mb/2009/01_09/PDFs/NC_01_09.pdf (page 50)
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Upstate (Central) NY. But we bill for LCSW's all over NY State, Florida, and PA.
Thanks for the links, I will check them out.
Michele
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You are more than welcome.
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We bill for 17 LCSW's and I have not heard of that before! Interesting. Since our claims are being paid I'm going to leave it as is. Just curious, where are you in the country. I'm thinking it must be a carrier specific requirement.
Michele
Michele,
I am in Indiana.
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Well thanks for sharing the info. It's always good to know what is done in other areas.
Michele
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Michele, I have been researching some information, and it seems that the fee schedule for a LCSW and a clinical psychologist are different (never done mental health billing). Leaving off the modifer, your claims could still get paid (obviously) but be reimbursed at a higher rate than allowed.
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http://www.cignagovernmentservices.com/partb/pubs/news/2007/0707/cope5991.pdf
I meant to post this with my comment, sorry.
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michele,
I am trying to take your advice and target mental health at first, I read that in one of your posts.
When I try to look this up in the yellow pages I come up with very few.
Is child and youth service fall into the same area can you bill for this.
Please give me some tips on looking this up in the yellow pages. what are the key words?
margemib
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Hi,
There are many listings you can look under. Some will refer you to others. Try counselors, marriage counseling, psychiatrists, psychologists and see what you find.
Alice
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Thanks Alice,
what do you think about the child and youth services.
can you bill for them, some are private practices I see?
I'm not sure but it comes up alot when I type in counseling.
margemib
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I recently purchased the Mental Health Big Book. I noticed on the CMS case study samples most of the claims don't have modifiers. Is that common in mental health billing? Do you also bill Worker's Comp in mental health?
Thank you very much in advance for helping a newbie like me. :)
Beth
Here is a great link for Mental Health billing.........Medicare
http://www.medicarenhic.com/providers/pubs/Mental_Health1208.pdf
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Not using the modifier shouldn't result in a higher reimbursement. (Of course I must tell you I am an extremely optimistic person who lives in a very happy world. :) ) If they require the modifier they should deny the claim without it. The reimbursement should be based on the rendering provider's NPI number and how Medicare has them credentialed. I certainly would hope it would work that way or else it could get quite messy. I know the fee schedule for the psychologist is higher than a social worker but I hope there is more to the system than relying on the modifier.
Can you imagine the mess if they paid higher, then went back to request the overpayment? Ughhh.
Anyway, since I don't bill in any regions that require the AJ modifier I am not sure. But I appreciate the link, it really has some great info!
Michele
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You are welcome.....but I would re-read page 24. They don't reimburse by the NPI, they use the modifier for reimbursement. A LCSW and a Clinical psychologist use the same cpt, the modifier determines how its reimbursed. the NPI is going to reflect the group. Within that group you can be seen by either or. I'm not proclaiming to be the expert, I am just cautious when it comes to Medicare/Medicaid/Tricare billing. I wouldn't just continue to bill that way, just because its getting it paid until I contacted Medicare to determine if the modifier was required. I also don't think it varies from one state to another since Medicare is a federally funded program. The only difference is your FI.
Good blessings.
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Thanks. Currently our local Medicare switched carriers on 9/1/08 and it is such a mess Congressman Arcuri is involved. But I will reread that and look into it further.
Michele
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They could be either private and interested or government sponsored. I don't think you could tell without calling.
Alice