Fee Schedules

Medicare Regional Reimbursement Schedules are normally made available every year towards the end of January when all the fee issue shake out.  Every year since I have been doing this there is always a change and a rollback on the Medicare fee schedules.  As soon as those fees are available we update our fee schedules and make these available for you.

You can go and get your fee schedules on the internet yourself or you can subscribe to obtain them from us.  We go a few steps further in figuring out what you should be expecting Medicare to pay and what you should be expecting from your client or their secondary.  Our fee schedules also compute the allowable amount for LCSW’s because that is not published on the internet.  This is a service that you do not have to be a contracted customer with DBMA in order to obtain these schedule.

In addition, we also have other insurance fee schedules available and we have recently added Tricare to our list of companies that we calculate how the coverage will play out according to the Tricare plan the individual is on.   If you are interested in any of this, please feel free to send us an email or contact our office.  We are always happy to serve this community.

Who’s Who?

Who’s on first?  This is my new saying as I try to work with the different insurances only to find out they have been bought by one entity or another.  Recently I was invited to go to a meeting in Houston and the speakers were going to be Beacon Health Strategies.  When asked who they were I remarked I think they bought PsychCare.  I was right but they also bought Value Options and although I think the two will maintain their names for awhile they pretty much have shut down the PsychCare website where I used to check eligibility on Humana clients.  We were having to call which is a big hassle trying to get through to the right place at PsychCare because you have to be intuitive to know which number to choose to get to Eligibility and Benefits because it is not an option.  Pet peave.  Always has been for me that the choices with the IVR do not include Benefits and Eligibility.  But I digress.  In addition Coventry bought MH Net last year or maybe the year before and Aetna bought Coventry so they are all operating with the different names but when you dig deeper you find that the credentialing is all done by Aetna.  Payments still come from the different entities. We keep trying to stay ahead of that ball to make sure our claims and credentialing information go to the correct place.  It is always a challenge.

Transition from ICD9-ICD10

This was in a newsletter from ValueOptions and I believe it responds to an age old question I have received for many years as to why Clinicians are taught in school to diagnose with DSM when the standard for billing has always been ICD.

Both DSM and ICD codes are used for diagnosis, but per HIPAA, ICD must be used for billing purposes. DSM-5 utilizes ICD-9-CM and ICD-10-CM coding depending on the date of service. The move from ICD-9 to ICD-10 is a rather large change. Some highlights include:

  • · The number of characters are increasing from 3 to 5 characters to 7 characters
  • · Codes can be alpha or numeric on any character
  • · The number of codes is growing from approximately 14,000 to 69,000 codes
  • · The concept of one to many is introduced with the possibility of a single ICD-9 code now having multiple ICD-10 codes and descriptions
  • · Some concepts will be retired – an example is substance dependency where dependency is replaced by use and specific substances are documented vs. polysubstance

Overall, by using ICD-10, documentation should improve

Claims Implications

For purposes of claims payment, the correct ICD diagnosis coding should be utilized based on the date of service. For dates of service prior to October 1, 2015, the ICD-9 coding format should be utilized. For dates of service October 1, 2015 and later the ICD-10 diagnosis coding should be the format utilized. Claims will need to be split between these two dates if submitting for a range of dates.

This applies to all claims regardless of the method of submission.

In Addition, I found this little crosswalk that I thought might be useful.  For more information on this, contact our office at 877-891-9352