90837 reimbursements

[LadyHalcyon]

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We recently changed EHR systems and I'm looking over my paycheck and I'm getting reimbursed 130ish for many of my Medicaid and Medicare clients. I'm surprised it is so high. Just wondering if this is typical.

 

[WisNeuro]

Yeah, that's the facility charge for that code.

 

[LadyHalcyon]

And why do they get to charge more?

Yeah, that's the facility charge for that code.

 

[WisNeuro]

And why do they get to charge more?

For medicare, it's down to whether or not they are charging facility vs. non facility.

 

[Sanman]

And why do they get to charge more?

Cause the gubermint is always holding down the little man!

 

[ClinicalABA]

For medicare, it's down to whether or not they are charging facility vs. non facility.

Isn't the facility rate LESS THAN the non-facility rate?

 

[WisNeuro]

Isn't the facility rate LESS THAN the non-facility rate?

Yes, but they can also collect a certain portion of facility fees on top.

 

[LadyHalcyon]

I do know this system is billing 180 for an individual session, while the prior system only billed 150

 

[Sanman]

Have you checked the CMS fee schedule for your locality?

 

[WisNeuro]

I do know this system is billing 180 for an individual session, while the prior system only billed 150

What you bill for and what you collect are two very different things.

 

[LadyHalcyon]

Oh yes. I know this. But if they are billing more shouldn't they be getting more, even if it is substantially lower than what we request?

What you bill for and what you collect are two very different things.

 

[WisNeuro]

Without seeing the billing statements and knowing what facility/NF fees you are billing, I can't say. When it comes to medicare though, it doesn't matter what you bill, you are still just getting their rate for your locality. Now, your billing people can sometimes screw it up, like in not getting facility fees when you are technically part of a facility, but the rates are the rates.

 

[LadyHalcyon]

That's what i figured. Just curious how a person I have been seeing, with Medicaid, since Sept has jumped from about 80 bucks a session to 130....

Without seeing the billing statements and knowing what facility/NF fees you are billing, I can't say. When it comes to medicare though, it doesn't matter what you bill, you are still just getting their rate for your locality. Now, your billing people can sometimes screw it up, like in not getting facility fees when you are technically part of a facility, but the rates are the rates.

 

[Sanman]

If it is Medicaid, it may be a little different. In some states, 90837 won't be reimbursed by medicaid only 90834. Hence the $80. Medicaid may have changed or the new software may not register this yet. Just a theory.

 

[LadyHalcyon]

It is Medicaid. Definitely haven't changed the billing code. Oh well, not complaining. I bill 90837s for all Medicaid clients.

If it is Medicaid, it may be a little different. In some states, 90837 won't be reimbursed by medicaid only 90834. Hence the $80. Medicaid may have changed or the new software may not register this yet. Just a theory.