Sustain & Grow Your Mental Health Practice
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:
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.
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:
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).
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).
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.
Mental Health and ABA services are not processed through Health Net, but through a third party company.
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.
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).
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.