CMH Billing

09/08/2015

Mental Health Billing and ICD-10
Listening to this podcast will help you:
1. Summarize the basic tenets of the Mental Health Billing and ICD-10 podcast
2. Discuss mental health billing, credentialing, the claim process, and additional services
3. Provide helpful tips to prepare and assist in the transition to the new ICD-10 codes/DSM-5

Hear the podcast here--
goo.gl/PNB9TJ

Podcast transcript available by clicking here. Description: Barbara Carter brings more than a decade experience as a mental health biller. In this podcast, Barbara explains how a biller can provide support to help a counseling practice thrive. She explains how a counselor can interview a biller and…

08/12/2015

Received a good question today. Can you start using the new diagnosis codes right now?

No, please don't. They will not become effective in the insurance systems until October 1st.

All claims before October 1st have to have the ICD 9 codes that we have been using. Even if after October if you send in a claim for a September or August Date of Service you have to use the old codes because the date of service is before October 1st.

Point number 2- if the diagnosis you have for a client was made by a primary care physician and you feel the primary care physician should choose the new diagnosis code make a point to get in touch with the PCP's office for the new code. Put it on the calendar!

08/03/2015

As I continue to read up on the ICD10 diagnosis code change coming there is one thing that has come up on more than one website, and therefore, I felt I should pass along. I'll have more details on the diagnosis code changes as the time approaches.

Articles repeatedly warn providers that payment of claims may be interrupted or delayed and that providers should plan for this by saving money in the bank in the months preceding the change.

When I read it once I thought it was an interesting take on the change. I thought perhaps it would be like the whole Y2K scare. You may remember the computer world was going to end, and then it did not.

But these articles suggest that even if only 1/4 to 1/3 of claims are delayed either because of provider error, provider program errors, clearinghouse errors or insurance companies not being ready, then providers are asked to imagine how much money would be delayed in their individual practice.

You take your monthly insurance payments and divide by 4. What if that amount failed to come in for October? What if it also failed to come in November?

See, that is scary. That is the scariest part of the whole process of the change. There are just so many pieces that have to get it right.

Some providers are working only with large insurance companies and so their income is a bit more protected. But if you have claims going to smaller companies, like EAP companies or third party administrators, then there may be a chance of a delay.

Here are some articles on the progress of the change as it pertains to your bank account.

http://www.cnbc.com/2015/04/07/could-icd-10-hurt-your-doctors-practice.html
http://www.healthcareitnews.com/icd10-2013/how-much-emergency-cash-should-providers-keep-icd-10

On Oct. 1, all U.S. medical and billing codes will migrate to a new global standard, but is the health-care system ready for the change?

03/10/2015

Way to go John Duggan!! Getting the word out there.

An effort is underway to be included in system meant to cut paperwork and increase efficiency.

12/06/2014

December is hectic!

But January will be hectic as well. There is always the question of whether your clients' insurance has changed or if their deductible starts over. Do you want your clients' to reconfirm their insurance details? Or, do you want to keep rolling with the info you have and wait till the claims are processed to pick up on any changes in coverage?

You make the call!

Let me know how we can help.

11/06/2014

Telemental Health, once an industry that faced considerable financial hurdles, has become considerably more cost effective leading to organizations reporting “major gains in quality and lower costs since adopting telemedicine.” A recent article published by HealthLeaders Media discusses why telehealth has the right foundation to take-off.

With hospitals and clinics now having broadband connection and expensive equipment now being replaced by tablets and laptops, the cost of telemental health has fallen considerably. Technology has allowed mental health professionals to treat their patients remotely while saving time and money for the patient

"Mobile monitoring devices continue to also shrink in size," the article says, "For that all-important physical exam, sensitive auscultation devices permit doctors/ mental health professionals at remote locations to hear heart, lung, and bowel sounds as if they were in the same room as the patient." This is an important factor for Telepsychiarty as doctors feel it is important to monitor vital signs as this bio feedback helps the doctor determine a patients treatment options.

This technology also enables providers to streamline scheduling and reduces the patient’s combined travel and waiting time. The technology allows people to be treated in the comfort of their own homes and studies have shown that people that are being seen by a mental health professional online are returning at higher rate than "traditional" treatment methods.

Telehealth is set on the path to streamline the medical industry.

11/06/2014

Therapy Appointment has changed servers and their counselor practice management websites are zipping right along!! Thank you Therapy Appointment for the upgrades!

10/29/2014

CLIENT'S WHO USE THEIR INSURANCE THROUGH THE AFFORDABLE CARE ACT- may have claims paid that will ultimately be recouped by the insurance company. We have seen this in one practice that we serve here at CMH Billing. The claims were filed, processed and paid to the provider in a timely manner.

However, three months later the insurance company sent a letter asking for the claims payments amounts to be returned. The client had stopped coming to therapy and the counselor did not have a credit card on file to charge the amounts she was returning to Cigna.

The insurance company will keep payments meant for other client's until they have recouped the money for the patient who did not make up their premiums. We are sending the client statements but have little hope of receiving payment. Note: the client would have known when she was being seen that she was not making her premium payments but did not inform the office.

Since the insurance company has a right to recoup the money from the provider when premiums are not paid, what is a practice to do? The Affordable Care Act is slanted very strongly in the patient's favor in this instance. There are bills before congress to try to change this and make the law protect providers. We'll see if they pass one.

I suggest knowing which patients' policies are purchased using Advance Premium Tax Credits. This can be accomplished by calling for an eligibility check before each of the patient's appointments and asking customer service specifically if the client is in a 'grace period.'

Additionally you can put this statement on the new client paperwork and require a signature.
- I (the patient) also understand and acknowledge that I am personally responsible to pay (the name of the practice) in full for services that my health insurer will not cover due to non-payment of my health insurance premiums.

I have attached a document form the AMA which outlines a collection policy for grace period patients.


Affordable Care Act "grace period"



Under the Affordable Care Act (ACA), if a patient who receives an advance premium tax credit does not pay his or her health insurance premiums in full, he or she enters a 90-day "grace period." During the first month of the grace period, the patient continues to have health insurance coverage, and the patient's health insurer will pay claims for health care services provided to the patient during that time. However, if the patient enters the second or third month of the grace period, the health insurer may pend claims for services provided to the patient during that time. If the patient pays his or her premiums in full before the end of the grace period, the patient retains health insurance coverage for the second and third months of the grace period, and the insurer will pay the pended claims. But if the patient does not pay his or her health insurance premiums in full before the end of the grace period, the health insurer will not extend coverage for the second or third months of the grace period and will deny claims for services provided during that time. In this case, a patient is then responsible for paying the entire bill for services rendered during the second and third months.

Health insurers are required to notify physicians of patients' grace period status. Still, a number of questions concerning the specifics of notification, as well as other issues of concern to physicians, have yet to be addressed. It is, therefore, important that you find out how your patients' contracted health insurance issuers will provide notice and handle other grace period issues. It is also vital that your practice proactively take steps to minimize any potential non-payments from health insurers that are due to cancellation of coverage at the end of the grace period.



(This advice does not create an attorney-client relationship between CMH Billing and the reader. The reader should receive legal advice from retained legal counsel concerning any issues raised in this email.)

11/08/2013

You’re time is more valuably spent treating your patients. I’ve worked in administration in the mental health field since 1995, and I’ve been specializing in claims filing and payment since 2006. We've helped counselors navigate the CPT code changes this year and we are ready to help you transition to the ICD-10 conversion.