Three things you need to know about mental health billing in 2012

We live in the world of mental health billing. When you live in that world, it is very easy to forget that not everyone else lives where you do. Some folks have never heard of what we do. Others just visit our world when they must.

As you know, there are massive changes happening in the healthcare world. Many of those changes pertain to electronic medical records (EMRs), but there are also important occurrences related to the billing/practice management side of the behavioral health organization.

So here are those three things you need to know:

  1. The 5010 changes only relate to electronic claims. If you are still filing claims on paper, changes from the 4010 to the 5010 versions of the 837 claim filing format do not affect you.
  2. January 1, 2012 is still the deadline for beginning to send 5010 formatted claims. CMS and the Office of Civil Rights (OCR) have indicated that they will not begin to fine organizations that are not yet sending 5010 claims or payers who are not yet receiving them, but the deadline date still stands. After March 31, 2012, OCR will begin the enforcement process
  3. Our clearinghouse partner, Emdeon, made this transition easier than anyone could have imagined.
    We use only one clearinghouse, but we have customers who send claims directly to several Medicare and Medicaid payers. Those custom, direct-sends have been a royal pain. Some of the payers were not ready for us to test until the last possible moment. Some of them were ready for testing but required that our customer start sending the 5010 even before the deadline. Some changed the testing process along the way; others had a procedure but did not inform us of all the steps when we first contacted them months ago. Many have been virtually impossible to reach by telephone in order to get assistance for our customers.Emdeon has done just what a clearinghouse is supposed to do. They began a timeline for testing and implementation almost two years ago. They had a testing system in place so our development staff could get help if needed but could also do iterative testing without someone there needing to intervene at each step. And finally, they assured us that there would be the capability of sending a 5010 early or continuing to send a 4010 with them translating to 5010 if a customer needed that to occur.

    Once our customers started sending, Emdeon was ready! Our customers are able to check the status of their claims using Emdeon’s Vision. If there were problems, we have an account representative we can speak to who intervenes immediately. In the couple of cases were there was an issue with a payer, Emdeon dealt with the payer, not us.

    By our standards, all of those things make our Channel Partner relationship an extremely valuable asset for our customers.

The next big, systemic change will be the move to the ICD-10, with a current deadline date of October 1, 2013. This one will affect everyone, those who file claims electronically and those who file on paper. The American Medical Association (AMA) has decided to fight that deadline on behalf of American physicians. They believe the cost to providers is too large, especially following so quickly upon the move to EMRs. Whatever the deadline, this will be a massive change requiring everyone to use different diagnosis codes and requiring hospitals to use different procedure codes. We can only hope the chaos will not be as great as could be possible.

Please share your experiences and thoughts about these changes. Just comment below.

0 thoughts on “Three things you need to know about mental health billing in 2012

  • “Once our customers started sending, Emdeon was ready! Our customers are able to check the status of their claims using Emdeon’s Vision. If there were problems, we have an account representative we can speak to who intervenes immediately. In the couple of cases were there was an issue with a payer, Emdeon dealt with the payer, not us.

    WRONG!!! ON ALL COUNTS. WE CAN’T GET THE STATUS ON VISION AND IT’S NEXT TO IMPOSSIBLE TO REACH AN EMDEON REPRESENTATIVE. NEXT TO NORIDIAN, EMDEON IS ONE OF THE WORST OFFENDERS WHEN IT COMES TO COMMUNICATING 5010 INFORMATION TO ANY OF ITS CLIENTS. I KNOW YOU ARE LOSING CARRIERS IN DROVES. YOU ARE ALSO LOSING PROVIDERS. WHO WANTS TO PAY FOR ABSOLUTELY NOTHING?

    • Sorry your experience has not been the same as ours. One of the benefits of being a Channel Partner with Emdeon is that we support our customers and Emdeon supports us. We have an account representative who will always talk with us even when it is not possible to get through on phone lines. Our customers virtually never talk to Emdeon. It appears that your software vendor does not have the same relationship with Emdeon that we do.

      That said, of course some folks have experienced difficulties. Most of the problems they have had have been due to payers not being ready to receive 5010…or wanting to receive it with edits for which we were not prepared. Several Medicare intermediaries did not transfer the enrollment status of their providers to the 5010 system so they did not recognize those claims. If you have not seen it, you might want to take a look at this letter from Dr. Susan Turney, president of the Medical Group Management Association:

      http://www.mgma.com/WorkArea/mgma_downloadasset.aspx?id=1369699

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