Your time is best spent in front of patients

As psychotherapists, psychiatrists and prescriptive nurse practitioners, your time is best spent in front of patients.

The reality is that you’re juggling what you love to do with the responsibilities of running a business.

Balls that you’re struggling to keep in the air include:

Calling Insurance
Calling insurance companies in between patient appointments
Answering Questions
Answering patients' questions about insurance benefits
Changing Regulations
Ever changing insurance rules and regulations
Completing Authorization Forms
Remembering to complete authorization forms before they expire

These tasks suck your time and energy and may send you into a frustrating tailspin

At Ponderosa, we have nearly 30 years of experience supporting providers just like you with their medical billing. We partner with you to create a seamless and consistent experience for both you and your patients.

On average, the providers we work with save 10-15 hours a week, increase their claims paid by 20%, and cut their time to collections in half.

The billing process is it is overwhelming and I can't imagine doing without Ponderosa Billing. They are truly credentialing and billing angels!!”
Alpha Gunn
Somatic Solutions, LLC

Because we care about our providers, we want you to have the most up to date information possible and to be aware of pertinent topics of interest:

Medicaid

Don’t mistake a welcome letter from the State of CO Medicaid program as indication that you can start treating clients for services—you still need to process your claims through the specific BHO that your patients are enrolled in (as of March 1st, 2017).

Click here to find the correct BHO for your county.

TRICARE

Except for active duty service members, TRICARE Prime beneficiaries no longer require a referral or prior authorization for outpatient, office-based behavioral health visits when rendered by a network provider (as of July 13, 2017).

Click here to see if your service requires an authorization with Tricare!

TRICARE ’s has new managed care support contractors effective January 1, 2018. TRICARE  East will be handled by Humana Military (previously only served the South region), and  TRICARE West will be serviced by Health Net Federal Services.

Are your patients’ plans affected by the changes to TRICARE?

Mental Health and ABA services are not processed through Health Net, but through a third party company.

Have you enrolled in the new plan?

CPT

Psychotherapy codes (90832, 90834, and 90837) are now for individual therapy only.  

Insurance companies have used a variety of efforts to limit providers’ use of CPT code 90837 in particular  because of its usually higher payment value.

90846 (without patient present) and 90847 should be used when providing family or couples therapy sessions 26-50 minutes long.

Learn more on how to to simplify CPT coding.

Get your copy of the American Medical Association’s new 2017 CPT manual.

Anthem of MA & MN

Codes 90837 and 90838 now require prior authorization for 90837 and 90838 after 12 session for HMO and POS policies. Medicare Advantage members do not have those restrictions as they follow Medicare policies (January 1, 2017).

Read more advice for use of CPT 90837.

Are you billing for code 90837 more often than your peers?

Non-Specific Codes Are No Longer Being Supported!

Since October 1, 2016, there have been more than 2,700 ICD-10-CM changes. Many affect diagnosis codes, such as diabetes and other commonly used codes. CMS' one-year grace period to use unspecified codes has come to an end and non-specific codes, like the codes used when converting ICD-9 to ICD-10, are not being supported.

Use AAPC Coder to quickly lookup codes and improve your efficiency and compliance.

To learn more about how we can help you download our free e-guide.