CPT-Not so Easy

The launch of the new CPT codes has not been so easy for many providers. The issues are being identified across the country and APA is investigating many outstanding issues. These are the major problems we are finding:

– BCBS is not processing claims yet so they may be violating prompt pay laws. In NY it is 45 days.

-There have been some significant rate reductions in connection with the new codes.

-Some companies are paying the same rate for 90834 and 90837.

UBH is requiring pre auth for 90837.

Please let me know if there are additional code related issues.


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DSM 5 or ICD 9

DSM 5 is scheduled for release in May 2013. There will be major changes in the codes and categories offered.There will be controversy. But are we compelled to use it?
We actually have a choice. We can choose to use DSM or ICD. The revised ICD 10 will be out in Oct. 2014 so ICD 9 can be used until then.
Insurance companies will accept either coding. They just cross walk DSM to match ICD.
DSM 5 will cost $199. ICD 9 is free and is on line.
NYSPA will host a 4 hr live webinar on March 3 from 9:30-2;00. You can register at the NYSPA web site. This is not an endorsement for DSM as I am likely to switch to ICD for my group practice but also attend the webinar.

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When Practice Ceases-Temporarily or Permanently

State Education Department sends out practice alerts on various topics; this is their latest.  Subjects covered include what to do with records, confidentiality, patient abandonment, and selling a practice.


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UBH update

The bottom line, from UBH, is that “there is no change in current authorization protocols” That is for commercial and Empire Plan.
The very confusing letter from UnitedHealthCare is still confusing. The end result is business as usual.
And for those who are still asking about 90837, UBH requires pre auth for this code. Be it a one time use or ongoing you must be prepared to make the case for its use. No pre auth then rejection of your payment.

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United Health Care letter – preauthorization confusion

A letter from United Health Care received yesterday indicated the need for preauthorization for behavioral health services.  I am researching this issue which is causing considerable confusion.  UBH does not know anything about this letter or its implications, but they are looking into it.  At present, the only preauthorization is 90837.  At present there is NO preauthorization for services for the entire plan.  Stay tuned for updates as they become available!  Please leave comments and ask any questions you may have!

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The Year of Change

So 2013 starts with new CPT codes and quickly moves into PQRS medicare reporting. What a start. But what is next?

By mid year we will have a new and troubling DSM 5 to learn and struggle with. We will have the Health Insurance Exchange introduced and by 2014 they  will add one million new insurance participants. We are getting new and often lower reimbursement rates from many insurance companies.

All this and pt centered medical homes and Accountable Care Organizations requiring integrated care models.

Never have we been so challenged to adjust to so many changes in such a short time.

Welcome to 2013.

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SGR up date

Attention Health Professionals: Information Regarding the 2013 Medicare Physician Fee Schedule
The negative update of 27% under current law for the 2013 Medicare Physician Fee Schedule is scheduled to take effect on January 1, 2013.
Medicare Physician Fee Schedule claims for services rendered on or before December 31, 2012, are unaffected by the 2013 payment cut and will be processed and paid under normal procedures and time frames.
The Administration is disappointed that Congress has failed to pass a solution to eliminate the sustainable growth rate (SGR) formula-driven cuts, and has put payments for health care for Medicare beneficiaries at risk. We continue to urge Congress to take action to ensure these cuts do not take effect. Given the current progress with the legislation, the Centers for Medicare & Medicaid Services (CMS) must take steps to implement the negative update.
Under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. CMS will notify you on or before January 11, 2013, with more information about the status of Congressional action to avert the negative update and next steps.
Posted 12/19/2012
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