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need help with medicare billing

  1. Default need help with medicare billing
    Medical Coding Books
    I work for a company that provides primary care to patients in assisted living facilities. I kind of found out today from someone that if I include psych diagnosis like depression, dementia, schizophrenia, along with diagnosis codes like COPD, or diabetes, or heart disease etc That Medicare cuts the amount of claim payment in half . Does anyone know if this is right????? Ken. kasch.1@netzero.net

  2. #2
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    I also bill for a family practice provider that treats patient's in a nursing facility. If the primary dx is considered "mental health" they will use a psych reduction.

  3. #3
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    Quote Originally Posted by kasch.1@netzero.net View Post
    I work for a company that provides primary care to patients in assisted living facilities. I kind of found out today from someone that if I include psych diagnosis like depression, dementia, schizophrenia, along with diagnosis codes like COPD, or diabetes, or heart disease etc That Medicare cuts the amount of claim payment in half . Does anyone know if this is right????? Ken. kasch.1@netzero.net
    This is from 2011, but it explains it (and gives the rates through 2014): http://www.trailblazerhealth.com/Pub...icServices.pdf

  4. #4
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    Yes the payment amount is different for psych diagnosis but the allowed amount is the same. So instead of the patient only owing 20% they owe 50%. If the patient has a secondary insurance depending on the plan they will pick up most if not all of the balance but you would have to check the benefits for the secondary to be sure how much they will pick up in those cases.
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

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