Our health system located in New York state has an Article 28 clinic that is owned and operated by our hospital, which provides behavioral health services. Those providing the services are licensed clinical social workers (LCSW) and the overseeing doctor is a psychiatrist. There is some confusion as to the way the services should be billed to Medicare. We bill our technical fees and there are no problems. Our professional fees are billed on a 1500 form with only the LCSW listed, rather than an overseeing psychiatrist. As a result, our services are denied because LCSWs are not credentialed with Medicare. We have had many discussions as to whether the overseeing psychiatrist should be on the 1500 form when we bill these charges. The overseeing psychiatrist does sign all documentation done by the LCSWs.
The organization is “treading lightly” due to the services being rendered and the complexity surrounding these types of services. We are not mental health certified or Outcome and Assessment Information Set (OASIS) certified at this clinic.
In summary, if the overseeing psychiatrist is initiating the treatment plan and signing all documentation done by the LCSW, are these professional services billable to our Medicare Administrative Contractor, which is National Government Services (NGS)?
Answer: I don’t think an “overseeing psychiatrist” makes the professional charge billable. If the LCSW is not a Medicare billable provider, then you can’t bill it. The NGS website lists provider qualifications. A log-in is required to view the document.
This question was answered by: Ruth Landé, senior vice president, patient revenues, Memorial Sloan-Kettering Cancer Center, and a member of HFMA’s Metropolitan New York Chapter.
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