Sunday, August 04, 2013

SMC LME Cannot Figure Out How to Use Main CPT Code for Dually Eligible Clients

Well its week three as associated with Smoky Mountain Center LME being unable to figure out how to do what used to be done automatically before the LME's took over NC Medicaid.  Specifically, the matter is this: 96152, a CPT code known as the 'Health & Behavior' codes, which was put into play by the American Psychological Association in 2000, is billed in 15 minute increments.  It is intended to be the code utilized by a mental health practitioner who is providing overlapping services in conjunction w/ other providers e.g., physicians/ psychiatrists, etc.  

PRIOR to the LME's taking over NC Medicaid, I simply submitted to my biller the following information: 
name of client; CPT code (96152 is NOT a Medicaid code; thus NC Medicaid PRIOR to the LME's understood how to wrap around when the Medicare code, 96152, was assigned); Place of Service; Date of Service.  I did not have to interface AT ALL with NC Medicaid as Medicare and Medicaid were interlinked PRIOR TO THE LME'S TAKING OVER NC MEDICAID.  It was a seamless system.  Now we have bits and pieces laying all over the place.  

Now, not only do I need to submit to my biller information to bill Medicare, but I then have to take my RA's or Remittances which outline what Medicare has paid me, and then submit that to my biller so she can submit to SMC LME that information.  So, now I am charged twice by my biller.  Lose/ lose situation across the board for me. 

Under Medicare, since 1.1.2013, Place of Service is no longer required, thankfully.  This frees me up to see patients while they are in psychiatric hospitals, etc.  This was an advance.  

Will no one rid us of this troublesome mess? Does anyone know how this is fixable? 


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