BPM Billing

01/17/2023

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10/10/2021

Celebrating Mental Wellness

07/16/2021

Did we forget to mention we cleanup old AR!?
Our clients trust our follow-up and appeals processes. Don’t get discouraged if you’re not understanding why your claims are constantly being denied. We’re here to help!

06/07/2021

Here’s an update from Cigna for our Behavioral Health Providers:

Beginning June 4, 2021, Behavioral providers will have access to Cigna's Procedure Code Benefit Look-up feature on the Cigna for Health Care Professionals website, CignaforHCP.com.

The new Procedure Code Benefit Lookup feature allows you to access a patient’s benefit information by procedure code (Current Procedural Terminology [CPT®], Healthcare Common Procedure Coding System [HCPCS] excluding J codes, or revenue [REV] codes) on CignaforHCP.com, including whether precertification is required.

Patient plan deductibles, coinsurance, and maximum out-of-pocket costs are now displayed in a new, simplified format that makes the information easy to find and understand. Plan benefit details are richer and more complete.

05/26/2021

COVID-19 has had a huge mental health impact on our world. If you’re looking for a licensed therapist or mental healthcare provider in your area, we are here to help. We provide our services to excellent Mental Health providers that are here to meet your needs. Let us help you find the right provider.

03/30/2021

Hope Everyone is staying safe and healthy!

Here's an update for billing UHC for COVID-19:

Urgent care testing: Effective March 26, 2021, UnitedHealthcare will reimburse COVID-19 testing by urgent care facilities only when billed with a COVID-19 testing procedure code along with one of the appropriate Z codes. This applies to claims for Individual and Group Market health plans. Reimbursement will be 100% of the CMS allowable rate.

Specimen collection codes: Claims for Individual and Group Market health plans should use either CPT codes 99000 or 99001, so that cost share waivers for COVID-19 testing are appropriately applied.
New codes for monoclonal antibody treatments: Bill using HCPCS code Q0245 and administration code M0245 for Bamlanivimab+Etesvimab treatment.

Services received during vaccination appointments: Members will not have any out-of-pocket cost share for the COVID-19 vaccine or vaccine administration. They may be responsible for the copays, coinsurance, deductibles or out of-network changes for any additional services received during the vaccination appointment.
Mass vaccination programs: We are accepting roster billing for COVID-19 mass vaccination sites for multi-tax identifier number (TIN) health care professionals. This applies to claims for Individual and Group Market fully insured health plans only.

Let us help you with all your billing needs!

06/26/2020

Covid 19 update:
BCBS extends timely filing deadline for covid testing.
As a result of the National Emergency declared on March 1, 2020, the Employee Benefits Security Administration, Department of Labor, Internal Revenue Service and the Department of the Treasury extended certain timeframes to ease the burden of maintaining benefits and compliance with notice obligations.

Applies to: Members of all fully insured and self-funded groups that are regulated by the Employee Retirement Income Security Act.

What it means: Between March 1, 2020, and 60 days after the announced end of the National Emergency, certain timeframes and dates are suspended for timely filing of claims, appeals of adverse benefit determination and requests for external review.

06/17/2020

United Healthcare Covid-19 update:

UnitedHealthcare Extends COVID-19 Temporary Telehealth Expansion and Cost Share Waivers

-UHC Extending Temporary Telehealth Expansion and Reimbursement Through Sept. 30, 2020

-Extending Telehealth Cost Share Waivers

06/01/2020

Information from UHC regarding billing for COVID-19.

Billing Guidance
To help you understand how UnitedHealthcare will reimburse services during the national public health emergency period, please download the COVID-19 Provider Billing Guidance. It outlines billing codes and modifiers. Because guidance may change, please check regularly for updates.

Other Key Reminders
Mental Health Resources for Health Care Professionals: Resources and support are available to help you focus on, manage and understand your mental and physical well-being during this challenging time.
HouseCalls and Optum at Home Visits: These visits resumed in some markets on May 22, 2020. We are continuing virtual visits in other markets and will continue to evaluate and resume in-person visits where possible.
Antibody Test Registration: We’re asking all laboratories and health care professionals who perform COVID-19 antibody tests to register the tests they use. The registration takes only a few minutes to complete.

05/24/2020

https://www.beckershospitalreview.com/digital-transformation/optum-buys-navihealth-5-details.html

Optum acquired post-acute care management platform naviHealth, according to a statement Optum provided to Becker's.

05/21/2020

Tip of the day:

WASH YOUR HANDS!

Covid-19 is still living among us. Do not let your guard down. Stay safe and WASH YOUR HANDS!

05/19/2020

Tip of the day:

File Your Claims within a timely fashion...I repeat: File Your Claims within a timely fashion.

It is so critical to make sure you’re getting your claims in on time. While some insurers allow a period of a year to 18 months for you to submit your claims, taking that long to do so is not a good idea. The earlier you can submit a clean claim, the better. In some cases, timely filing could result in a more substantial reimbursement. Some companies will even allow you to file reimbursement claims in advance for some services. It’s also crucial to have a tracking system for the claims you have filed. Instead of sending claims off into the void, ensure you have a clear record of when they went out. That way, you’ll know when you need to check in if the company is taking too long to inform you of its decision. Once the timely limit is passed, it is very difficult and almost impossible to get your claims paid. Besides following timely guidelines for the insurance carriers, it helps with your business’s organization as well.

05/15/2020

Tip of the day:

Clean claims are the key to getting correct reimbursement the first time. Any errors in a claim will likely raise red flags at the insurance company and may cause them to reject, delay, or deny payment. Sometimes, making a mistake on your billing codes will result in a lower rate of reimbursement that may or may not seem worth it to appeal. Unfortunately, one of the most significant challenges in clean coding is learning the different rules different carriers have related to codes. Issues with coding are not the only reason insurance carriers deny claims, and these issues may go unaddressed when there is only a slight discrepancy between the rate you expected and the reimbursement you received. Cleaning up your codes can significantly increase your reimbursement rates from private insurance.

05/14/2020

Aetna is making a move to Availity. See what to expect with this change...

https://www.availity.com/aetnaproviders

Aetna is partnering with Availity to simplify business processes and improve you online experience.

05/13/2020

05/13/2020

Let us help with all your Covid-19 Billing concerns.

https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-telehealth-services.html

UnitedHealthcare has expanded its policies around telehealth services during the COVID-19 health emergency. Check back often for updates