RTabacco
New
Hello Everyone -
My clinic is small and non-profit. We mostly run on grants. We are just now trying to figure out how to bill insurances.
Our clients are the forgotten folks in the community; people living with HIV + AIDS, un-homed folks, drug users. Our goal is to provide care for these folks, keep them out of the ER, keep them safe, and help them get to the point where they can go into a larger clinic in our area for primary care. We are not contracted with any insurance yet. So this is who we are.
I am struggling with Molina as they are finding our claims as behavioral health and not medical, then denying the claims saying the patient should go to the larger clinic that is contracted with them. For most of our clients that is not an option.
We are billing out CPT 99213 with most often ICD-10 F11.20. In these visits we are trying to help the patient manage their opioid addiction with Suboxone. The ICD-10 F11.20 feel the most appropriate but Molina sees it as behavioral health when we are designated for medical. We see it as medical. Does anyone know of a way to make this work? Is there another DX code or modifier that should be added? Or do you have any other ideas?
Thank you
My clinic is small and non-profit. We mostly run on grants. We are just now trying to figure out how to bill insurances.
Our clients are the forgotten folks in the community; people living with HIV + AIDS, un-homed folks, drug users. Our goal is to provide care for these folks, keep them out of the ER, keep them safe, and help them get to the point where they can go into a larger clinic in our area for primary care. We are not contracted with any insurance yet. So this is who we are.
I am struggling with Molina as they are finding our claims as behavioral health and not medical, then denying the claims saying the patient should go to the larger clinic that is contracted with them. For most of our clients that is not an option.
We are billing out CPT 99213 with most often ICD-10 F11.20. In these visits we are trying to help the patient manage their opioid addiction with Suboxone. The ICD-10 F11.20 feel the most appropriate but Molina sees it as behavioral health when we are designated for medical. We see it as medical. Does anyone know of a way to make this work? Is there another DX code or modifier that should be added? Or do you have any other ideas?
Thank you