Wiki Psychiatrist Billing when IP Care denied by Payor

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I am a psychiatrist and I work at a couple of hospitals. I have a questions that pertains to situations in which Inpatient authorization is denied by the payor for the hospital. In these instances, can I still bill for my services provided to the hospital patients. Our office was recently told by an insurance company that we will need an "Inpatient Med Bed Authorization" and with such authorization number I can bill for my services using 90801, 90805 or 90807. Typically I bill 99221-223 for initial visit and 99231-33 for subsequent care. I am wondering if someone is familiar with this issue and guide us more on how to bill for our Part B services when Part A services for hospitals are denied by payor

Thank you very much
Mohsin Qayyum, MD
Progressive Behavioral Health, PLLC
 
I am a psychiatrist and I work at a couple of hospitals. I have a questions that pertains to situations in which Inpatient authorization is denied by the payor for the hospital. In these instances, can I still bill for my services provided to the hospital patients. Our office was recently told by an insurance company that we will need an "Inpatient Med Bed Authorization" and with such authorization number I can bill for my services using 90801, 90805 or 90807. Typically I bill 99221-223 for initial visit and 99231-33 for subsequent care. I am wondering if someone is familiar with this issue and guide us more on how to bill for our Part B services when Part A services for hospitals are denied by payor

Thank you very much
Mohsin Qayyum, MD
Progressive Behavioral Health, PLLC


1) Always obtain an authorization from insurance company for physician's services and be specific that if this service is consult at Med bed or inpatient hospital in psychiatric unit. Always list the cpt code when obtain the authorization because consult at med bed can be billed with 90801, 99231-99233 or 90816-90822
Hospital billed for their facility charge and physician billed for his/her services.
2) Medicare part A will only paid for facility charges (UB form for facility bill). Medicare part B will pay for physician. Physician submit 1500 claim form to Medicare part B.
90805-90807 are outpatient psychotherapy codes which should not be used to bill for IH.
3) 90816-90822 are IH psychotherapy.
90801 can be billed at IH or OH- it is called psychiatric diagnostic interview.
Hope this would help
 
Thank you for the reply. Can you please clarify what "Med Bed" means and how is it different from a regular IP bed on a psych unit

Thanks

Mohsin
 
Thank you for the reply. Can you please clarify what "Med Bed" means and how is it different from a regular IP bed on a psych unit

Thanks

Mohsin

if the hospital has a separate psychiatric unit and allow to admit patient to IH psych with psychiatric dx.

If the patient is not admitted to psychiatric unit, then the patient should be in the hospital and having medical treatment (dx should be medical dx) at medical bed. The medical docs request the psychiatric consult. You will be provide the psychiatric consult.
if the patient admitted to Psychiatric unit (should have psychiatric dx) to treating mental health only, you would bill your mental health charges as normal.
The following E/M-evaluation & Management codes can be used by all specialty providers at the hospital either for IP consult or inpatient hospital
99221-99223: initial hospital and 99231-99233-Susequent hospital.
You can't discharge patient if you were just requested to provide consultation to patient.
Question is if the hospital you practice is a psychiatric hospital or it is a hospital but has Inpatient psychiatric unit?
Within the hospital admission, you can do psychotherapies for patient to and those are 90916-90822.
Were you requested to see patient as a consult?
 
These are regular multispecialty hosptials not just stand alone psychiatric hospitals. I work in the psychiatric units at these hospitals

I am the attending psychiatrist for these patients. These are not consults. Usually we are OK with our billing if the hospital got the authorization from the insurance company (mostly commercial as Medicare/Medcaid is not an issue). In these cases we use the IP authorization number that the hospital obtained for their billing and we get paid for our physician services

The issue is when the hospital gets denied for their IP services by insurance company. We were told by some insurance careers that we should try to get a Med Bed auth for either 90801 -90807 codes or IP psychotherapy codes or Observation codes to get paid for our services. They would not cover 99223 and 99232 codes for regular inpatient billing. We have had some luck with insurances in getting at least our services covered even if the overall stay was denied for IP stay by the insurance

I hope this explains our situation better. I was just curious if other people have tried it for their physician billing. We have not yet billing for observation codes as my understanding is that the hospital has to be billing for observation as well.
Thanks a lot for your replies!
 
we always obtained a separate auth# our provider to bill physician fee services. We seldomly got advised from insurance company that the facility auth# does cover for professional services. Ensure that your staff call & request an auth# for provider's services.
Sometimes hospital fail to obtain an auth#, the physician's services wil be denied to get paid.
Whoever obtain an auth # should be specific that this is not a consult at medical bed, it is an IH psychiatry. Otherwise insurance will do assuming you do consults.
Good luck
 
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