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Has anyone had luck in bypassing Medicare and billing MA or PMAPS as primary for non-Medicare providers?
Is anyone aware of a printable option in Procentive for a client "face sheet"? Basically a one sheet report with client's address, phone number, DOB, insurance policy info, primary diagnosis, etc. I have had a couple of requests from insurances companies for this when a fax is required for authorization.
I am following up on recent Procentive User Forum discussions about telehealth, in particular the question of whether insurance companies doing business in MN pay for telehealth when the recipient is in their home. I am working my way through the local and national companies, and so far every company has told me that they pay for telehealth when the recipient is in their home.
The outlier is BCBS MN, which has a policy that clearly states that payment is limited to services provided when the recipient is located at "another facility.
I have had an interesting exchange with a BCBS MN representative. He confirmed that they pay only for services provided when the recipient is in another facility, and not in the home. I pointed out, however, that DHS specifically covers telehealth when the recipient is in their home, and BCBS has a PMAP contract which requires them to cover DHS benefits. He acknowledged this and said that he would "have to research this further." I have not heard back, but it has only been a week and I expect that he will have to work with others at BCBS internally to sort this out.
The MN DHS Provider manual says the following about billing diagnostic assessments:
- Complete all Diagnostic Assessment (DA) Report Components before billing a DA
- Enter the date of service for the DA as the date the written DA report is completed
We have always used the face-to-face date as the DOS to bill a DA, and are billing after the DA is marked audit ready (completed). The State of MN, however has advised us to bill the date of service as the date the DA report is completed. (This is documented by the MHCP provider manual and via email correspondence we have received. I have also heard this said by DHS staff directly!)
I realize that agencies who use Procentive do both -- that is bill with the DOS as the face-to-face date or bill the date of service with the date the DA is completed.
If you use the DA completion date as the DOS -- a couple of questions:
How is it working / what is your process?
Do you do the same for all payers: MA & Private?
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