Eastern Medical Billing
Eastern Medical Billing
Insurance Updates and Resources
Insurance Updates and Resources
An ongoing series of informational entries
An ongoing series of informational entries
Professional Counselors are now recognized by Medicare
Professional Counselors are now recognized by Medicare
January 15, 2023
After more than a decade of working to secure Medicare coverage for counselors’ services, NBCC, the Medicare Mental Health Workforce Coalition, and counselors across the country can celebrate the passing of the omnibus package, which achieved our goal! The package, which includes language from the Mental Health Access Improvement Act (S. 828/H.R. 432) that expands coverage of mental health counselors (MHCs) and marriage and family therapists (MFTs) under Medicare Part B, was signed into law by President Biden on Dec. 29, 2022.
Coverage of MHCs and MFTs under Part B of the Medicare program will begin Jan 1, 2024. Medicare is the largest healthcare program in the country, covering more than 55 million people. It currently recognizes psychiatrists, psychologists, clinical social workers, and psychiatric nurses for outpatient mental health services, and now counselors and MFTs will be added to the list. Because Medicare is the country’s flagship healthcare program, counselor inclusion is key to ensuring parity with other professions.
The Centers for Medicare & Medicaid Services (CMS) will now develop specific rules on how counselors can apply for provider status, receive a Provider ID number, and bill for services. The rules will be developed in 2023 ahead of the Jan 1, 2024, implementation.
Tricare Benefits Cards
Tricare Benefits Cards
January 09, 2022
BCBS of NC Telehealth Update
BCBS of NC Telehealth Update
January 09, 2022
Cigna Telehealth Update
Cigna Telehealth Update
January 02, 2022
Interim billing guidelines for Coronavirus (COVID-19)
Individual providers and outpatient clinics
If you are an individual provider or an outpatient clinic, you may use telehealth for outpatient therapy, applied behavior analysis (ABA),* medication management, and Employee Assistance Program (EAP) services. You may offer telephonic sessions to patients who do not have access to technology to participate in telehealth sessions, as appropriate and in accordance with current legislative guidance. Include the following information on your claim form:
Appropriate Current Procedural Terminology® (CPT®) code in Field 24-D for the service(s) provided
Modifier 95** in Field 24-D to specify telehealth
Place of Service (POS) 02 in Field 24-B
How to verify your benefits?
How to verify your benefits?
December 10, 2021
- Call your Insurance company and ask if your plan covers Mental Health or Behavioral Health benefits.
- Ask if your plan has a deductible: If so, ask if you have met any amount towards the deductible. Sometimes there is an individual and/or a family deductible.
- Ask if you have a co-pay or co-insurance: If so, ask what the co-pay or co-insurance is for therapy sessions.
- Ask if you have to have a referral or a prior authorization before you see us (or a therapist).
- Ask if there are any limits to how many sessions you can have in a calendar year: If so, how many? Sometimes there is an initial limit but there can be a request for more sessions if they are needed.
What if a therapist is not “In-Network” with your insurance plan?
What if a therapist is not “In-Network” with your insurance plan?
December 3, 2021
Ensure you get the fax number or address to submit for any reimbursements. If you are utilizing OON benefits for your therapy sessions, you will be expected to pay the full session fee at the time of service. The therapist should provide you with what’s called a ‘superbill’ to submit to your insurance company for the reimbursement.
A ‘superbill’ is similar to a detailed receipt that you can send to them.