Can a non-licensed provider, LPCC and LMFT bill Medicare under supervision with a GY or GZ modifier to get a denial so it can be billed to the secondary insurance? Thanks
Tina B 6 years ago in Billing/Electronic Modules • updated by Susan Davis LICSW 4 years ago • 9
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In reviewing my files, I find a letter from CMS dated a few years ago. Looks like my LMFT sent a letter to CMS requesting a written response stating she was ineligible to enroll in Medicare. That was then provided to insurers, I believe. We have several clients with Medicare primary and other secondary coverage, and have not had a problem getting paid by secondary.
If they are supervised by a Medicare credentialed provider; that also works. That's how we have gotten ours through.
What modifier do you use?
We just have the HN modifier, for supervised staff. Because the supervisor is credentialed with Medicare, they deny for non-coverage and send it to the PMAP.
I am trying to bill claims for an LPC for mental health claims. Medicare rejects the claims from the clearinghouse. BCBS states they need the primary EOB to process the claims for secondary payment. Can some please help me?
LPC, LPCC, LMFT are ineligible for Medicare regardless of whether or not they are bing supervised. LPC's under supervision are restricted to a very few insurance companies. I would encourage you to discuss with your contract managers at each insurance. LPC's are not allowed to see commercial HP or Optum clients.
You can bill a non-licensed, non-Medicare provider under supervision of a licensed Medicare provider and their NPI#. Then add the GY modifier. It works like a charm.
We are not talking about the same thing. All the best.