[PC-BH-Integration] Medicare Same Day Billing Issues Assistance

[Cheryl Holt]

This is posted on behalf of Mike Lardiere, Vice President Health Information Technology and Strategic Development with the National Council for Community Behavioral Healthcare:


The National Council through the Center for Integrated Health Solutions (CIHS), supported by Health Management Associated (HMA) has been engaged by SAMHSA to review Medicare Same Day Billing issues that may impede behavioral health and physical health integration efforts.

The Problem:
There are anecdotal stories of instances where Medicare has denied claims for a physical health service and a behavioral health service provided by two different providers on the same day which should be paid according to Medicare guidelines or based on good medical practice.

Our Need:
We need your help in this effort.  Specifically we are seeking feedback from your Billing Department Supervisor (or the person in your organization most knowledgeable about Medicare Claims Denials that hinder behavioral health and physical health integration).

We are seeking real examples of Medicare Claims that have been denied but should have been paid.  Examples should be supported by documentation via EOB's or other claims denial submittal documents.

We are seeking examples from all fifteen (15) Medicare Intermediary Regions.

Goal:
The goal of this activity is to provide CMS with real world examples of these barriers to integrated care and to make recommendations to CMS to resolve these issues and then subsequently to inform the state Medicaid programs, however, at this juncture we are focusing on Medicare Claim Denials Only.

Time Commitment:
We expect the time commitment to be limited.  We will have a conference call after the information is obtained across Fiscal Intermediary Regions and then we will follow up with everyone via email.

If you are interested in assisting us to make recommendations to CMS to address Medicare Claims denials hindering behavioral health and physical health integration please respond to this email to Michael R. Lardiere, Vice President Health Information Technology & Strategic Development (MikeL at thenationalcouncil.org<mailto:MikeL at thenationalcouncil.org>) .  We would like examples of your claims denials within two weeks xx/xx/xxxx.

We appreciate your assistance to resolve these barriers and look forward to working with you.

Thanks

Mike


Michael R. Lardiere, LCSW
Vice President Health Information Technology and Strategic Development
The National Council for Community Behavioral Healthcare
1701 K St, NW
Ste# 400
Washington, D.C. 20006
202-684-7457 xt 273
202-386-9391 (fax)
914-261-8370 (cell)
MikeL at thenationalcouncil.org<mailto:MikeL at thenationalcouncil.org>

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