Wiki Residential Detox billing question

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shadi01130113

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Hello to everybody!

Hope to find answers to my questions.
We currently opened residential detox in the state of Ohio, facility taxonomy code
324500000X - Substance Abuse Rehabilitation Facility
I am new to this type of billing and feel the need to ask the experts, hoping to find answers to my questions
1. what services are included under the level of care 3.7? and what services are carved out - can be billed separately?
2. are all per diem services billed as facility (institutional) billing? if yes, what would be the most appropriate rev and rate codes?
3. are carved-out services billed as professional services (HCFA)?
 
At my facilites
1. 3.7 is Detox- most of our contracts use Rev Code 0126 or HCPC H009/10/11
2. We have a couple of case rate contracts that are negotiated for the entire length of stay and have a commitment period of 180 days. We are paid a lump sum for Detox/Resi/PHP/IOP. Our other contracts are per diem with profee carve outs. We bill Rev codes or HCPCs based on the contract. Our most used Rev codes are 0126, 0128, 1002, 0913, 0912, 0906. Most common HCPCs are H009, H0010, H0011, H0015, H0035. A few of our payers do want the equiv. S codes.
3. We do bill our profee claims on a CMS 1500.
Hope this helps!
 
I'm interested in what is carved out of the per diem charge. I'm having trouble knowing what is bundled into that - Encoder and HCPCS don't have much to say about the H codes. Are lab fees and medications included?
 
What is included or excluded from the per diem rate is going to depend on what each of your contract with the various insurance companies you have contracted with state. In your position I would review each contract and identify what is considered as part of the per diem rate and then make a list of all the other charges you might bill to the insurance companies.

From there I would contact my provider contracting representatives for each company to find out where you can find the reimbursement rate information for the items you identified as being something you might bill and is not included in the per diem rate.

This isn't really a place where we can tell you what your per diem rate includes as it varies from payer to payer and the rates the payer sets for one facility may be different from the rates that set for another facility that is providing identical services.
 
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