September 2021 Client Newsletter
AmeriHealth Non-Covered Services
“NOT ELIGIBLE FOR SEPARATE REIMBURSEMENT
The Company covers the following care management and care planning services; however, these services are not eligible for separate reimbursement whether billed alone or in conjunction with other services. Participating professional providers may not bill members for these services.
Advanced Care Planning (ACP)
Chronic Care Management (CCM) and Complex Chronic Care Management (CCCM)
Comprehensive Management and Care Coordination for Advanced Illness (CMCCAI)
General Behavioral Health Integration (BHI)
Psychiatric Collaborative Care Management (CoCM)”
Note the interesting way to explain: AmeriHealth “covers the following care managements & care planning services; however…” they will not pay separately for them no matter how billed. Seems a bit odd – I wonder how they would feel about covering their patient’s healthcare if the patient does not pay their premium?
So, with the new E&M approach which allows for you to bill based on time, you can add the time spent on providing the above services. Be sure to show your actual start & stop time in order to total the time spent and document it in the medical record.
This would NOT be the case for any Medicare HMO patient since CMS requires that the same services be covered as Traditional Medicare covers.
Link to AmeriHealth’s Medical Policy:
Note there are a number of Preventive type services which are not covered for their Commercial policies.
This also emphasizes the importance of verifying benefits and often obtaining a copy of the various medical policies for the insurers you participate with.
Definition of a Medical Billing Clerk
We have been trying to find a basic job description for a medical billing clerk and think we may have found it:
An individual who does precision guess-work to bill medical claims based on unreliable insurance company data provided by those of questionable knowledge.
See Also Wizard, Magician