Psychology Billing

DebraT

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I have just taken on a new clinic that bills for IOP, intensive out patient therapy, we are having a discussion regarding the billing. The director feels we can bill a flat rate for the individual counseling sessions (2 per wk), the group sessions, (3 per wk), Life skills sessions (2 per wk)and health sessions (2 per wk) over a 30 day period. One fee, for example $2000.00

I contend that the sessions are to be billed individually.

Can anyone tell me which of us is right?
 

DebraT

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Currently, everyone is self pay, but we are in the process of credentialing with the insurance companies so we will be billing the insurance
 

kevbshields

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I believe that Stark Law may prohibit you from offering a "package" deal to one set of patients, while not offering that same discount to the Federal payer system. As I've stated prior on this forum, I'm not in the business of pretending to be a compliance expert, those are just the considerations I would take.

Regardless, you are required to bill on a per diem basis, regardless of how your contracts with the payer are laid out--HIPAA makes that pretty clear.

I'm really not sure this helped you much, but it might be a question to consider taking to your Legal Dept. or the Compliance Officer.
 

DebraT

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How to bill per diem

Thanks for the info on the different price levels. Now can you give me some basics? I have no experience with substance abuse, I don't even know what codes to bill or which form to use. I have spent 30 years in billing and adminsitration, but it was all physician charges. I can use any tidbit.

Debra Thompson, CPC
 
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