FQHC MCR Billing - Behavioral Health Providers

joycejackson

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Can anyone tell me or direct me to where I can find what Behavioral Health providers can bill to MCR? I only know that LPCs cannot bill. PLEASE HELP :eek:
 

cjtown

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FQHC Behavioral Health Providers

Joyce,
In our FQHC we bill the services of LCSW under the facility . G0469 – FQHC visit, mental health, new patient and G0470 – FQHC visit, mental health, established patient.
The following is an excerpt from the Specific Payment Codes for the Federally Qualified Health Center Prospective Payment System (FQHC PPS)
(Rev. 9-08-16) found at https://www.cms.gov/Medicare/Medica...Downloads/FQHC-PPS-Specific-Payment-Codes.pdf

FQHC Visits
A FQHC visit is a medically-necessary medical or mental health visit, or a qualified preventive health visit. The visit must be a face-to-face (one-on-one) encounter between a FQHC patient and a FQHC practitioner during which time one or more FQHC services are furnished. A FQHC practitioner is a physician, nurse practitioner (NP), physician assistant (PA), certified nurse midwife (CNM), clinical psychologist (CP), clinical social worker (CSW), or a certified diabetes self-management training/medical nutrition therapy (DSMT/MNT) provider.
If an established patient is receiving both a medical and mental health visit on the same day, the FQHC can bill for 2 visits and should use G0467 to bill for the medical visit and G0470 to bill for the mental health visit.

Qualifying Visits for G0469-HCPCS 90791Psych diagnostic evaluation 90792 Psych diag eval w/med srvcs 90832 Psytx pt &/family 30 minutes 90834 Psytx pt &/family 45 minutes 90837 Psytx pt &/family 60 minutes 90839 Psytx crisis initial 60 min 90845 Psychoanalysis

G0470 – FQHC visit, mental health, established patient: HCPCS Qualifying Visits for G0470: 90791 Psych diagnostic evaluation 90792 Psych diag eval w/med srvcs 90832 Psytx pt &/family 30 minutes 90834 Psytx pt &/family 45 minutes 90837 Psytx pt &/family 60 minutes 90839 Psytx crisis initial 60 min 90845 Psychoanalysis.


The following FQHC reimbursable services are referred to as core services:
• Physician services,
• Services and supplies incident to physician’s services,
• Physician assistant services,
• Nurse practitioners and nurse midwife services,
• Services and supplies incident to the services of nurse practitioners, physician
assistants, and certified nurse midwives,
• Visiting nurse services to the homebound,
• Clinical psychologist services,
• Clinical social worker services, and
• Services and supplies incident to the services of clinical psychologists and clinical
social workers.
NOTE: For reimbursement purposes, a service visit must be provided in order for a provider

I hope this helps with the Behavioral Health provider billing aspect for FQHC's. The following booklet is a good resource. https://www.cms.gov/Outreach-and-Ed.../Mental-Health-Services-Booklet-ICN903195.pdf
Carla
 
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joycejackson

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Joyce,
In our FQHC we bill the services of LCSW under the facility . G0469 – FQHC visit, mental health, new patient and G0470 – FQHC visit, mental health, established patient.
The following is an excerpt from the Specific Payment Codes for the Federally Qualified Health Center Prospective Payment System (FQHC PPS)
(Rev. 9-08-16) found at https://www.cms.gov/Medicare/Medica...Downloads/FQHC-PPS-Specific-Payment-Codes.pdf

FQHC Visits
A FQHC visit is a medically-necessary medical or mental health visit, or a qualified preventive health visit. The visit must be a face-to-face (one-on-one) encounter between a FQHC patient and a FQHC practitioner during which time one or more FQHC services are furnished. A FQHC practitioner is a physician, nurse practitioner (NP), physician assistant (PA), certified nurse midwife (CNM), clinical psychologist (CP), clinical social worker (CSW), or a certified diabetes self-management training/medical nutrition therapy (DSMT/MNT) provider.
If an established patient is receiving both a medical and mental health visit on the same day, the FQHC can bill for 2 visits and should use G0467 to bill for the medical visit and G0470 to bill for the mental health visit.

Qualifying Visits for G0469-HCPCS 90791Psych diagnostic evaluation 90792 Psych diag eval w/med srvcs 90832 Psytx pt &/family 30 minutes 90834 Psytx pt &/family 45 minutes 90837 Psytx pt &/family 60 minutes 90839 Psytx crisis initial 60 min 90845 Psychoanalysis

G0470 – FQHC visit, mental health, established patient: HCPCS Qualifying Visits for G0470: 90791 Psych diagnostic evaluation 90792 Psych diag eval w/med srvcs 90832 Psytx pt &/family 30 minutes 90834 Psytx pt &/family 45 minutes 90837 Psytx pt &/family 60 minutes 90839 Psytx crisis initial 60 min 90845 Psychoanalysis.


The following FQHC reimbursable services are referred to as core services:
• Physician services,
• Services and supplies incident to physician’s services,
• Physician assistant services,
• Nurse practitioners and nurse midwife services,
• Services and supplies incident to the services of nurse practitioners, physician
assistants, and certified nurse midwives,
• Visiting nurse services to the homebound,
• Clinical psychologist services,
• Clinical social worker services, and
• Services and supplies incident to the services of clinical psychologists and clinical
social workers.
NOTE: For reimbursement purposes, a service visit must be provided in order for a provider

I hope this helps with the Behavioral Health provider billing aspect for FQHC's. The following booklet is a good resource. https://www.cms.gov/Outreach-and-Ed.../Mental-Health-Services-Booklet-ICN903195.pdf
Carla

Thanks for the info Carla. I am new to this FQHC Billing and I still get confused. Kind of a slight turn from the subject, but was wondering if you know if this is correct. I have noticed that my staff is billing G0467 and 99213 for an OV with the physician. Is that correct? I am wondering if the logic behind that is you must use an FQHC code and a Qualifying visit code, but I am unsure. If that is correct, I am not understanding why that is a necessity if it is just going to be written off.

Thanks,
Joyce
 

cjtown

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You are correct on both points. It really messes with the A/R, but it also gets written off as a contractual adjustment so it works itself out just over inflates the charges and adjustments.

Medicare required that we list both of them on the UB-04 but the only pay line is the G code. It was a requirement due to determining what HCPC codes (99201-99215) that were being utilized with the G codes when they changed the payment process to the new PPS rate.
I am not aware of Medicare removing this requirement. If you have a copy of the newest PPS codes for FQHC you will see that there are certain codes that you can use under each one of the G codes. Try to check on the website I listed in the first paragraph periodically, they are making changes frequently. I do believe the newest update was 09/16/2016.

Example: you will not find a 99211 nor 95115 (allergy injection) listed under any of the G codes even though the codes are valid and billable on their own.

Carla
 

joycejackson

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You are correct on both points. It really messes with the A/R, but it also gets written off as a contractual adjustment so it works itself out just over inflates the charges and adjustments.

Medicare required that we list both of them on the UB-04 but the only pay line is the G code. It was a requirement due to determining what HCPC codes (99201-99215) that were being utilized with the G codes when they changed the payment process to the new PPS rate.
I am not aware of Medicare removing this requirement. If you have a copy of the newest PPS codes for FQHC you will see that there are certain codes that you can use under each one of the G codes. Try to check on the website I listed in the first paragraph periodically, they are making changes frequently. I do believe the newest update was 09/16/2016.

Example: you will not find a 99211 nor 95115 (allergy injection) listed under any of the G codes even though the codes are valid and billable on their own.

Carla

Thank you Carla.
 

joycejackson

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You are correct on both points. It really messes with the A/R, but it also gets written off as a contractual adjustment so it works itself out just over inflates the charges and adjustments.

Medicare required that we list both of them on the UB-04 but the only pay line is the G code. It was a requirement due to determining what HCPC codes (99201-99215) that were being utilized with the G codes when they changed the payment process to the new PPS rate.
I am not aware of Medicare removing this requirement. If you have a copy of the newest PPS codes for FQHC you will see that there are certain codes that you can use under each one of the G codes. Try to check on the website I listed in the first paragraph periodically, they are making changes frequently. I do believe the newest update was 09/16/2016.

Example: you will not find a 99211 nor 95115 (allergy injection) listed under any of the G codes even though the codes are valid and billable on their own.

Carla

I double checked and it is the same version as the one that you sent, 09-08-16. But I have bookmarked the link so that I can check it regularly.

Do you know of a G code for BH that is just a face-to-face for med mgmt.? I have one provider who will not use the mental health codes, he uses the 99213. However, because he is a psychiatrist we often get denied for no pre-auth from commercial insurances. I think with MCR he is okay with doing that, but poses a big issue with MCD and Commercial carriers.

I had been looking into the G9001 and G9002 but don't find much info on how and when we can use these codes. Do you use these codes?

Thanks for all of your insight! You have helped tremendously, so please accept my apologies for continuous questions. I have been looking into quite a bit to fix the billing issues of the FQHC I took over and nobody seems to know the answers.

Thanks,
Joyce
 

cjtown

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Joyce,
Sorry I normally do not keep this page open everyday and did not see your additional post.

I have never worked with psychiatrist. I would think that the psychiatric codes in the CPT book would be better suited then a 99213.
I did go to cms.gov and pull the following pdf that may help you. No we do not use the G9001 and G9002, but remember we only have LCSW on staff.

https://www.cms.gov/Medicare-Medica...cation/Downloads/behavior-billing-booklet.pdf

You are very welcome to the help. I have worked in FQHC and RHC billing for 16 years and it does get to be a handful sometimes. What state are you located? We are in Kentucky.

Hope this helps.
Carla :rolleyes:
 
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Telehealth

My name is Tracey and I work for an FQHC. Does anyone bill for Telepsychiatry? We need to know if we can bill for the provider as well as the facility charge if the provider is out of state?
 
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