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A P T (Acadia’s Program for Teens)

We are Acadia Family Center Acadia Family Center provides prevention, education, and outpatient treatment services for adolescents, adults, and families affected by substance use, chemical dependency, and related mental health disorders

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A P T (Acadia’s Program for Teens)

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  1. We are Acadia Family Center Acadia Family Center provides prevention, education, and outpatient treatment services for adolescents, adults, and families affected by substance use, chemical dependency, and related mental health disorders • My name is Laura Shelby & I am the Billing Manager for this agency. • We provide Non-Intensive Out-Patient Substance Abuse & Mental • Health Counseling. Currently serving 60-80 clients per month. • We are a non-profit Behavioral Health Services Agency in the State of Maine with 4 clinicians & 3 Administrative Staff, focusing on Substance Abuse. • Our clinicians include: an Art therapist ATR-BC, LCPC; Ph.D, LCSW; LMSW-CC; & LADC. Recovery Through Community Recovery Through Community Recovery Through Community Recovery Through Community WE OFFER HOPE FOR A BETTER LIFE WE OFFER HOPE FOR A BETTER LIFE WE OFFER HOPE FOR A BETTER LIFE WE OFFER HOPE FOR A BETTER LIFE APT (Acadia’s Program for Teens) APT (Acadia’s Program for Teens) APT (Acadia’s Program for Teens) APT (Acadia’s Program for Teens) Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org

  2. In the State of Maine, Medicare does not cover our out-patient Substance Abuse services, so we do not bill Medicare. We cannot take clients that have Medicare unless they want to self-pay. Check with your state as to whether you can bill Medicare the services you provide in your particular setting. • We take MaineCare, which is our state’s Medicaid & Commercial • Insurances (Blue Cross, AETNA, Cigna & Harvard Pilgrim). We • also offer a sliding fee scale, treatment scholarships & have many • self-pay clients. • Today we will focus on third party billing…And let me start by saying • that it is not hard or expensive to do! Recovery Through Community Recovery Through Community Recovery Through Community Recovery Through Community WE OFFER HOPE FOR A BETTER LIFE WE OFFER HOPE FOR A BETTER LIFE WE OFFER HOPE FOR A BETTER LIFE WE OFFER HOPE FOR A BETTER LIFE APT (Acadia’s Program for Teens) APT (Acadia’s Program for Teens) APT (Acadia’s Program for Teens) APT (Acadia’s Program for Teens) Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org

  3. Billing Basics • What is an NPI? This is your National Provider Identifier. This number is required by all Insurance Companies. Agencies & individual clinicians need their own unique NPI’s that stay with them forever. • How do you get one? Google “National Provider Identifier” & a web site will come up. There is a 6 page application that takes about ½ hour to fill out & submit. Recovery Through Community Recovery Through Community Recovery Through Community Recovery Through Community WE OFFER HOPE FOR A BETTER LIFE WE OFFER HOPE FOR A BETTER LIFE WE OFFER HOPE FOR A BETTER LIFE WE OFFER HOPE FOR A BETTER LIFE APT (Acadia’s Program for Teens) APT (Acadia’s Program for Teens) APT (Acadia’s Program for Teens) APT (Acadia’s Program for Teens) Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org

  4. Billing Basics • What is an NPI? This is your National Provider Identifier. This number is required by all Insurance Companies. Agencies & individual clinicians need their own unique NPI’s that stay with them forever. • How do you get one? Google “National Provider Identifier” & a web site will come up. There is a 6 page application that takes about ½ hour to fill out & submit. • You will need your EIN or Tax ID # & a “Taxonomy” code for your type of practice. You can find this by Googling “Taxonomy Codes”. I found it at www.adldata.com/Downloads/provider-taxonomy.html or www.wpc-edi.com/taxonomy Recovery Through Community Recovery Through Community Recovery Through Community Recovery Through Community WE OFFER HOPE FOR A BETTER LIFE WE OFFER HOPE FOR A BETTER LIFE WE OFFER HOPE FOR A BETTER LIFE WE OFFER HOPE FOR A BETTER LIFE APT (Acadia’s Program for Teens) APT (Acadia’s Program for Teens) APT (Acadia’s Program for Teens) APT (Acadia’s Program for Teens) Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org

  5. AFC’s Taxonomy Code

  6. Credentialing/Contracting • This verifies to the Insurance Companies that your providers are licensed & who they say they are! • You will need to call each Insurance Company that you would like to bill. Ask for the “Provider Relations Department” for the forms/applications to be “Credentialed”. • You will need to gather some info, you may want to start a file for each Insurance Company that has a copy of the Agency License, Clinicians’ License & Certificate of Liability Insurance & necessary NPI #’s. • Once Credentialed, you are “In-Network” with that carrier also known as “Participating”. This also means that you will accept the “Contractual Rate” from that Insurance Company. Recovery Through Community WE OFFER HOPE FOR A BETTER LIFE APT (Acadia’s Program for Teens) Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org

  7. Insurance Information • When the client comes in, get a copy of their Insurance Card, front & back. • Call the Insurance Company for “Behavioral Health” benefits & eligibility… you’ll need the Client Member/ID #, DOB & probably the Social Security #. You will also need your agency NPI #. • Ask if there are any Pre-Authorization or on-going Authorization requirements. • You can give the client an Idea of what their co-pay or charge will be, but until it is processed there is no way to know for sure. • It may say on the card there is a $20.00 co-pay, but they may not yet have met their Deductable. So, I always preface it with “Depending on your policy, this is what we estimate the Insurance Company will pay”. Recovery Through Community WE OFFER HOPE FOR A BETTER LIFE APT (Acadia’s Program for Teens) Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org

  8. Member ID # Call # for Information

  9. We use this CMS-1500 form. Iorder them on-line at www.databusinesssystems.com Customer Service # 1-800-778-6247 Can be submitted handwritten – you have to fill in all required fields/blocks. Keep a copy for your files, then send in the original. This is how we started!!

  10. Billing Codes (Block 24D on this form) I have a list/chart of “Service/Procedure Codes” from the Insurance Companies called a “Fee Schedule” that I choose from to bill a certain service. For example, Commercial Insurances use: 90801 - Psychiatric Evaluation (Assessment) 90806 - Psychotherapy 45-50 Minutes 90808 - Psychotherapy 75-80 Minutes 90847 – Family Psychotherapy (w/Client) 90846 – Family Psychotherapy (w/o Client) 90853 - Group Psychotherapy 120 Minutes For MaineCare (Medicaid), I have different codes that come from what they call a “Cross Walk”. They are: H2000 – Evaluation (Assessment) H0004 – Individual Therapy H0004 HH – Individual Co-Occurring Therapy H0004 HQ – Group Therapy H0004 HQ HH – Group Co-Occurring Therapy Co-Occurring = Having a S.A. diagnosis & M.H. diagnosis. The HQ & HH are modifiers

  11. Getting Remittance Advice • Remit • EOB – Explaination of Benefits Recovery Through Community WE OFFER HOPE FOR A BETTER LIFE APT (Acadia’s Program for Teens) Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org

  12. “Service/Procedure Codes”

  13. Amount Covered “Contractual Rate” does not always equal the Amount Charged. The difference is the “Contractual Adjustment”.

  14. Is your head spinning? Take a deep breath… • You can submit the claims by hand. • Also Practice Management Software is available. • We use Psych Advantage by Compulink, which runs in the $2000 - $10,000 range with an annual service agreement fee of $$? It fills in the blocks/fields with the info entered in the system. • To bill electronically, which we have just started doing; we use a clearinghouse called Emdeon. Our software works to verify the claims then sends them on to each Insurance Company. Recovery Through Community Recovery Through Community Recovery Through Community Recovery Through Community WE OFFER HOPE FOR A BETTER LIFE WE OFFER HOPE FOR A BETTER LIFE WE OFFER HOPE FOR A BETTER LIFE WE OFFER HOPE FOR A BETTER LIFE APT (Acadia’s Program for Teens) APT (Acadia’s Program for Teens) APT (Acadia’s Program for Teens) APT (Acadia’s Program for Teens) Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org Acadia Family Center 1 Fernald Point Road P.O. Box 807 Southwest Harbor, ME 04679 207-244-4012 www.acadiafamilycenter.org info@acadiafamilycenter.org

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