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Question for Psychology Billers

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  • bluewriter24
    Question for any psychology billers out there please: I keep getting claims back from Medicare where on some of the claims for a patient they take off some for
    Message 1 of 6 , Apr 4 8:59 AM
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      Question for any psychology billers out there please:

       

      I keep getting claims back from Medicare where on some of the claims for a patient they take off some for "psychiatric reduction". This is the only insurance company I've had this with and from what I read means that they believe the diagnoses is psychiatric and therefore shouldn't be treated by a psychologist. However, the ones they feel this way about encompass all mental health diagnoses. What's more confusing is that they cover some claims per each patient without taking that off and others with taking it off even though it's the same diagnoses on the same patient. That makes even less sense. How do I fight this? Any advice on "psychiatric reduction" payments appreciated. Thanks!

    • Cheryl Crayden
      The first thing I would do is take a couple of the claims as examples (preferably for the same patient) and call Medicare and talk to a rep and ask them why
      Message 2 of 6 , Apr 5 1:35 PM
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        The first thing I would do is take a couple of the claims as examples (preferably for the same patient) and call Medicare and talk to a rep and ask them why they are processing differently. Also look closely at your adjustment and remit codes on the claims and their meanings. There may be something else going on besides the psychiatric reduction

         

        Cheryl M. Crayden

        Medical Billing and AR Recovery Specialist

        National Affiliate of Columbia Advantage

        117 N. Elm St. Orrville, Ohio 44667

        Phone: 330-400-2268

        Fax: 330-684-1202

         

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      • bluewriter24
        Thank you for your answer. I called Medicare and while on the phone with them I notice that the claims for 2013 had the psychiatric reduction but not the
        Message 3 of 6 , Apr 5 2:55 PM
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          Thank you for your answer. I called Medicare and while on the phone with them I notice that the claims for 2013 had the psychiatric reduction but not the claims for 2014. The man I was speaking with looked at comparison claims on the same patient and went to ask someone higher up about it. He came back to the phone 30 min later and said he couldn't find out why they charged it before and aren't now except that their allowed amount changed and that's probably what I'm seeing and that they were paid correctly and not to worry about it. That seems to be the most answer I am going to get on it.
        • melindadocsmith
          There s nothing to appeal. We as Primary Care run into this often when we provide mental health services at the PCP office. We just bill it onto the 2ndry
          Message 4 of 6 , Apr 8 1:41 PM
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            There's nothing to appeal.  We as Primary Care run into this often when we provide mental health services at the PCP office.  We just bill it onto the 2ndry ins., as Medicare Part B DOES assign it to patient responsibility. 

            It was phased out in full by 2014.  Thank goodness!

            Here's more info.

            http://www.apapracticecentral.org/update/2013/11-07/medicare-outpatient.aspx
            Melinda Brown, CMBS

            Ins Biller

          • bluewriter24
            Thank you, Melinda. This was the best answer given not that I m not grateful for everyone else trying. This is what I eventually found out myself. I m glad
            Message 5 of 6 , Apr 9 6:30 AM
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              Thank you, Melinda. This was the best answer given not that I'm not grateful for everyone else trying. This is what I eventually found out myself. I'm glad they phased it out because it made no sense that a psychologist couldn't see someone with a psychological problem. All's well that ends well. Thanks again!
            • melindadocsmith
              You are welcome!
              Message 6 of 6 , Apr 17 2:41 PM
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                You are welcome!
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