My name is Bridget (Weide) Brooks, and I’ll be your host for today’s call, which is sponsored by w-Tech Solutions Inc. and TherapySites.com.
This is our second teleseminar call, and I’m thrilled to be able to offer therapists the chance to ask questions of our distinguished guest, Deb Winsor, of W-Tech Solutions. A little background on Deb: she has a bachelor’s degree in business administration from the University of Nebraska Lincoln worked in a hospital setting for more than five years before joining what we call an extremely well-known insurance company here in Omaha, where she has worked for the past 11 years. Deb has experience with Medicare, Medicaid, managed Medicaid, PPO insurance, Tricare, and numerous other insurance companies and she has a wealth of information to offer to therapists who have questions about billing or insurance. Her company, W-Tech Solutions, provides billing services to mental health therapists. Welcome, Deb!
Deb: Thank you.
Bridget: So, just like last time, first off, I wanted to let the therapists who are participating live on the call ask their questions, and then we’ll get to the questions that were submitted by therapists via e-mail. So if there is anyone on the call with a question, let’s go ahead and take it now.
Caller #1: My question is how much transferability is there between how Medicaid in Nebraska handles claims and requirements versus Medicaid in other states — particularly Kansas? My office partner and I are both located in the greater Kansas City area.
Deb: My first question is: Do you have any patients that have Nebraska Medicaid?
Caller #1: No.
Deb: So your patients have Kansas Medicaid? Correct?
Caller #1: Will have. Right.
Deb: Each state has their own program. It’s on a state-by-state basis. But I am trying to find on the web if there is any kind of provider line for you.
Caller #1: We’re both in the process of applying for (Kansas Medicaid). I was a (Medicaid) provider in Nebraska. I think we probably have the provider line (number).
Deb: So you are in the process of setting up your provider status with Kansas Medicaid, and you’ve contacted them. The paperwork is in the mail.
Caller #1: And (my office partner) has been a Kansas Medicaid provider in other situations (with other employers).
Deb: So they’re going to send you a packet of information and assign you a specific number. Once that is done, they will send you a letter of acceptance, stating that you are now eligible to see this type of patient. You should be able to file claims electronically to them. As far as that is concerned, the billing itself is just a different location, but it’s the same CPT codes. You fill out your HCFA 1500 form the same way, and you shouldn’t have any problems. I would just say make sure you cross your “t”s and dot your “I”s and you shouldn’t have a problem. But any questions with them, contact their office.
Bridget: To answer the caller’s question also, each state administers their own program, so while federal guidelines are the same, each state is allowed to contract with its own providers, for example, with Managed Medicaid, so that’s where you’re going to get a little bit of discretion for how things are authorized, paid, and that sort of thing. If Magellan is administering the Medicaid in Kansas, you might see that a lot of their policies and procedures are the same (as in Nebraska), because they don’t want to duplicate efforts across the different states, but if it is a different provider – Coventry, or some other one — that’s when you’re likely to see a little bit of difference between how they do things. I know Magellan and the state of Nebraska right now are working to clarify some of the service definitions in particular in Nebraska, and there has been a little bit of back and forth on that on how they’re clarifying certain things and how they want to handle medical necessity and those sorts of things. So probably the first step is to find out who is administering Medicaid and that might give you some sort of insight into how much will be transferable.
Caller #1: We’re in the process of applying for Tricare – I think it was Tricare -- and (my office partner was) told that they were holding off on accepting new applications, but that she could be a “pseudo-provider,” which was a new term.
Bridget: I’ve never heard of a “pseudo-provider” before. What kinds of rights and responsibilities does a pseudo-provider have?
Caller #1: Well, that’s what we didn’t know. We didn’t know if there was a “pseudo-provider application” – but I wondered if you were familiar with this term. She was told she could go ahead and bill as if she was a provider, but I wondered if you had heard of this.
Deb: What is her credentials?
Caller #1: She is a licensed, master’s-level psychologist, so “LMLP.”
Deb: I have never heard that term (“pseudo-provider”) before. Usually, with Tricare, you have your Tricare Prime... Be very careful with Tricare. They are very good about paying, but make sure you have your pre-authorizations before you submit for your services because if you don’t have your authorizations, they will either deny, or they will pay at a much lower benefit. Also, for the member (for out of network services), they have a much larger deductible rather than a certain dollar amount of a copay.
Bridget: That might be a good question to call the provider relations folks and ask them.
Deb: I would call their provider line and ask them about that. Because the first thing that came to my mind was maybe that it was like a PLMHP that was submitting under an auxiliary provider.
Caller #2: It didn’t seem to be about my licensure, it seemed to be about having me be part of a group that was already established. She (the provider relations rep) didn’t explain it well.
Bridget: So it seemed to be part of a network provider issue rather than a credentialing provider issue.
Caller #2: Right.
Bridget: I am Googling the words “Tricare” and “pseudo-provider” and they use the word “pseudo” a lot, so I think they like that word.
Caller #1: I hope they don’t send “pseudo-payment!”
Bridget: I agree with you! They talk about “pseudo sponsor IDs” and “pseudo social security numbers” — so specifically what they are referring to in terms of your responsibilities would be a great question for your provider relations representative. Ask them: What distinguishes me as a “pseudo” from a “real”? I wonder if maybe it’s that their network is pretty full, but they don’t want to turn you down flat, just in case they need you later.
Deb: They might have restrictions on how many providers they can actually have on the panel. I’ve seen that before, once in a while. Like a waiting list.
Bridget: So you can see them, but maybe it’s on a case-by-case basis. But I agree with Deb, you want to make sure you’re approved and pre-authorized for specific sessions and clients before you see them… because “pseudo” or not, you don’t want that “pseudo-payment.”
Deb: I am going to do some research on this, and I’ll send Bridget my findings. I would love to give you a definite answer. I pride myself on getting the right answer, and I want to find the right answer for you before I give out any information. Let me research it and I will give Bridget an e-mail and have her forward it on.
Bridget: Next up are questions we received via e-mail from therapists who weren’t able to make the call live, but wanted to get their questions in.
Question: Do the CPT codes for home visits have a certain time frame, and if so, are they 15-minute increments, like health and behavior interventions?
Deb: I have researched this, and I have personal experience with this too. The answer to that would be, the information I have is that you should just bill as if you were in the office. You can use your 90806s, 90801s as if you were in the office. You would bill the same as if you’re out of the office at a patient’s home. I can tell you from experience, when we moved to our current home, my son was little at the time and he was having a little harder time adjusting, so we had a very nice man come out, an LMHP, and he sat with my son and spoke with him for 50 minutes at a time, two or three times a month. I got to stay in the home; I didn’t have to drive anywhere. He just submitted the regular 90806 to the insurance company, and they paid. It was almost as if we were in the office, just a different location, and it got paid like a normal office claim.
Bridget: So, in general, they would be paid – but, if you had a particular claim, this would be a good question to ask the specific insurance company.
Deb: I would. It’s always good to call if you have any doubts, to ask questions. They are always willing to answer, and you won’t be the first one to ask, and you won’t be the last one to ask. To my (personal) experience — and to my billing experience — you can bill the same code that you would as if you were in the office.
Bridget: And with the same time length.
Deb: Right. If you’re seeing them for 25-30 minutes, you’d bill them 90804, but 45-50, 60-75, use the right code.
Bridget: And that’s face-to-face interaction; you can’t count your driving time.
Deb: Right.
Question: We received this question from a therapist after the first billing teleseminar call: I just listened to the recording of the initial billing teleseminar and am a little confused about using my tax id instead of my social security number on claims. I already have a federal tax id, but was told by my tax preparer that I should use only my social security number so I've billed with it for years. Since I already have the federal id, do I just contact each insurance company I participate with and have my information changed?
Deb: I was glad we got this question. It’s a very good question. My answer to that would be: With regards to privacy (and this is what I was trying to say last time), I am very proactive when it comes to HIPAA and personal privacy. I go above and beyond what is required.
With regard to privacy, any time you can keep you SSN for the purpose of personal tax identification, the better. If you choose to have an EIN (Federal Tax ID), that helps protect your personal social security number information from identity theft and other fraud activities. This is the reason why I was suggesting an EIN during the seminar; as I’m a big proponent for personal identity security, and I feel that an EIN gives you a layer of protection.
If you have an EIN, all the better. It would be great to use that. However, her tax preparer is correct. She can use her social security number but in regards to identity theft, if you don’t submit electronically (if you submit by paper), yes, the post office is safe, but anything can happen. It can just take one minor mistake and your social security number could be out in the open.
I’d like to go on to say: When you sign a contract with an insurance company, you are doing so under some type of identifying number: your SSN or an EIN. If you signed those contracts under your SSN, it can be difficult to switch to an EIN as, in many cases, the insurance company will want a new contract signed using the appropriate identification number (or they’ll want to update your current contract).
You can bill under either identification number; just make sure you are billing using the number used when you signed with the insurance companies. If a claim is submitted using your EIN, but you signed/registered with the insurance company using your social security number, payment of benefits may be extremely delayed or they could be denied.
My personal preference is to use an EIN as that allows you a level of personal security because your personal SSN is not distributed to so many people with whom you do not know. However, since you have been billing under your social security number for so long (this is a provider who had been in business for a number of years), switching to your EIN can be cumbersome. You can call the insurance companies that you are in network or PPO status with and ask to speak with the provider relations and let them know that you are currently using your social security number and ask what the process is in regards to updating that and using the EIN.
It just puts up red flags for me when people are using their social security number for billing. You can do it, but it just scares me to death to have that personal information going out. It’s my personal opinion to use an EIN so that you can be protected. Because it doesn’t mean anything to anyone else but you and the insurance company.
If you’re just starting out, take the extra steps and get the EIN. It’s your choice, but if I were you, and I were just starting out, I would use the EIN to set up my contracts with insurance companies.
Bridget: For therapists who might have started out using their social security number, what are some of the things that the insurance companies might balk at? You said they might want to update their existing contract or they might want to have you sign a new one. Would you maybe run into an issue where they might say, “You can’t do that, because you’d be considered a new provider, and we’re not taking new providers”?
Deb: Well, number one, it depends on the insurance company. As long as you’re an existing provider, they’re just updating information. If you started 10 years ago, using your social security number, the norm was to use your social security number, because we didn’t have the HIPAA laws like we did then. It’s possible they would want you to sign a new contract, because the old one was outdated, but that’s no big deal. It’s nothing to be afraid of. I just wanted you to be aware that they can do it.
Updating your contract can be a good thing too. Some providers are afraid of going electronic. Just making that change, you can get so much information. The insurance company can send you feedback, they’ll send you updates. They can catch things – “We notice you did ‘this’ a lot.” You’ll get newsletters with frequently asked questions. It can turn out to be a much better experience with that kind of information.
Bridget: So billing with your EIN makes it more secure for you to file your claims, both paper and electronic. And, of course, electronic billing opens you up to more recordkeeping and reporting information and resources from the insurance companies, because they want to reduce their costs, so they want to encourage folks to bill online, when possible.
Deb: I want to put out my little disclaimer here. Insurance companies are not always the bad guys. Employers will tell the insurance companies what kind of benefits they want, and there are contracts out there that have no mental illness benefits as part of the policy. That can be from the employer. I go to the pharmacy a lot to pick up my prescriptions and it just really gets my goat when people say, “My insurance company didn’t pay this. “I just want to say to them, “If you have a complaint, you really need to go back to your employer because your employer is choosing those benefits for you.” The same thing for mental illness. Just because you have an insurance company and they’re not paying, it could be that it’s not because of the insurance company – it could be because the employer wants to save some money, or they chose one benefit over another, because times are tough and money is tight. It’s not always the insurance company (at fault). Insurance companies have a lot of experience and they train their people to be ready for your questions and they’re more than willing to answer those questions.
If I get a representative who doesn’t answer my questions, or they’re rude to me, let the insurance company know. They need to know that information. They’re willing to answer your questions. Don’t be afraid of them.
Question: Are there separate billing codes used for transporting a patient from place to place?
Yes. What I found out, and what I’ve seen in the past, from billing, is that for Medicaid, currently the code is 99082. This is a CPT code for mileage. The reimbursement rate for Nebraska Medicaid managed care plan is $.45 per mile, but please note that many private insurance companies do not pay for this item. However, if your client is covered under Medicaid (remember, it’s a payer of last resort, so if the client has another insurance company, you’ll need to get a denial first), you may be able to get reimbursed.
I’d invite you to contact Deb at W-Tech Solutions at 557-8628 or e-mail w-tech_billing@cox.net if you have any billing questions or if you’re interested in working with her. W-Tech Solutions allows therapists to focus on the billing aspect of your business so you can focus on your clients.
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