Wiki Seeing a patient twice a week

[tomtom2]

One of my providers had a question about seeing two of her assisted living patients twice a week. The patients are Medicare primary and there seems to be medical necessity. I'm new to mental health billing so any help is appreciated.

Thanks in advance,
Tom

 

[Tspencer76]

Twice a week

Hello,

Most behavioral health insurance companies will not allow a patient to be seen more than once a week in an outpatient setting. I would contact the insurance and benefits department to verify medical necessity for this patient and even if no authorization is usually not needed, for being seen more than once a week, it usually is required in order to get paid and they can set this up per med necessity from your provider that is seeing the patient. If their isn't a med necessity for them to be seen more than once a week, this is usually paid out of pocket by the patient and not billed to the insurance because they will deny the claim.

Tanya S