CPT Codes and United Behavioral Health

Just in case you are not aware of it this is the only insurance company that requires an authorization for you to use the code 90837.  According to their Medical Policies the 60 minute session is not medically necessary.   You would have to supply a dissertation to get this code allowed.  Any time you bill this code you will get a denial of course unless you have an authorization.

Provider Enrollment Bottleneck

We provide a lot of Provider Enrollment services to our customers.  Most of this entails submitting the applications for individuals to get them enrolled as providers in the various Networks so that they can provide services to clients with different insurance companies.  In recent months since Humana changed from LifeSynch doing the provider enrollment and credentialing pieces there has been a bottleneck and providers are not getting credentialed for more than 120 days.  You cannot even find out status of a provider request until it has reached 120 days from the time you submitted it.    On another front we are also seeing another bottleneck with Aetna after the providers are approved it is taking anywhere from 30-120 days before the contract is received.    I suspect a lot of this has to do with the mergers and acquisitions going on in the industry and new management taking over.   Provider Enrollment is a tedious mission and the follow up is time consuming.  So this is just a little heads up to let you know what appears to be going on in the Industry.

PQRS Medicare

Just in case you missed it the latest and last revision to the rules for PQRS are listed below:

Major highlights include:

  • Individual eligible professionals and group practices that meet the criteria for 2016 PQRS satisfactory reporting/participation will avoid the PQRS negative payment adjustment in 2018
  • PQRS group practices can participate in 2016 PQRS via the Qualified Clinical Data Registry mechanism in 2016
  • There are 281 measures in the PQRS measure set and 18 measures in the group practice reporting option web interface for 2016

The 2018 PQRS payment adjustment is the last adjustment that will be issued under the PQRS. For more information about participating in PQRS in 2016, visit the PQRS website.

Medicare Fee Schedules 2016

Medicare Fee Schedules will be available for 2016 by the end of the week.  Be aware that the new deductible for 2016 is 166.00 for Part B.  Place your order now to get one sent to your office.  Information provided on the fee schedules is by discipline

Allowable

Medicare Expected

Secondary or client responsibility

The expected amount will differ due to sequestration and PQRS reductions for 2016.     Please do not hesitate to contact us at dbmanagement@dbmafl.com for your new 2016 Fee schedule.