Medical Billing Success

The Web VS PC based medical billing software debate has been raging for years with those in the PC camp, seeming  to come out on top--until recently. Many of the concerns about web-based software centered around slower processing VS PC due to a slower internet connection. Another big concern was based upon the unknown aspects of the movement towards the “cloud based” software. The fear of not having full control of the software being loaded on their PC was often strong enough to keep a provider from even considering web based medical billing software.

But times have changed. Cloud, or web-based software, is becoming common place in all areas of business, not just medical billing. Internet speed is constantly improving and our comfort level with our information floating in the cloud seems to be increasing as well. The huge benefit of being able to access your practice information from just about anywhere appears to be out weighing previous concerns of not have complete control over your billing software.

As off October 1, 2015, medical claims filed with dates of service on or after 10/15/2015 will have to utilize the ICD 10 Codes. Dates of service on or before 09/30/2015 will still have to use the ICD 9 diagnosis codes.

To help make this process less painful, we have found several free tools that will make it easy for you when converting from ICD 9 codes to the new ICD 10 codes.

Medicare requirements; PQRS or Physician’s Quality Reporting System. It is required by Medicare to report patient’s condition and treatment. The program is supposed to be an incentive by allowing for a small payment for participation but in 2015, next year, physicians will be penalized for not registering and participating in the program. This is quite complicated and covers many specialties as well as PCPs. It will amount to a secondary CPT code added to the claim.

For a step by step review on how to get started with PQRS you can go to the following link; http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/PQRS/  to get your questions answered and keep up to date on any changes.

The new timeline for implementation of the new version of the CMS 1500 form:

January 6, 2014: Payers will begin accepting paper claims submitted on the 02/12 version of the CMS 1500 Claim Form

January 6 through March 31, 2014: Payers will accept paper claims submitted on the old 08/05 version of the CMS 1500 Claim Form and the new 02/12 version of the CMS 1500 Claim Form

April 1, 2014: Payers will only accept paper claims submitted on the revised 02/12 version 1500 Claim Form.

Procedure code (CPT Code) changes for mental health providers have gone into effect as of 1/1/2013. While the CPT code changes effect Psychologists, LCSW's, and other mental health professionals, it is the Psychiatrists that will see the biggest changes.

It would be prudent to make sure that your billing specialist or medical billing company is aware of all the  code changes as well as how and when to use each procedure code. As the provider, you will also need to be familiar with the documentation requirements.

Mental health providers need to be ready to use the new procedure codes by the first of January 2013. It appears as if all insurance companies will be ready to accept the new procedure codes. The major players such as medicare, Medicaid, UBH, BC/BS, Magellan, etc. have made it clear that all 2013 claims filed after the first of the year, with the old cpt codes, will be denied.  Claims with dates of service before 2013 should be billed with the old procedure codes unless the insurance carrier has provided info to the contrary.  Additional info can be found in the following article in Psychology Today and a very informative question and answer pdf from Magellan including "will you need to get an updated authorization to cover the new codes?"

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Latest update as of 1/31/2012

CPT code changes for psychologist and other mental health professionals go into effect January 1, 2013.  This is the most significant change in billing codes for mental health professionals in over a decade.

The following site has a great breakdown of all the cpt code changes (including a list of the procedure codes that will stay the same).