Posted by Behavioral Health Billing Solutions, LLC.
Imagine receiving a letter from an MCO that states they are initiating a “Pre-Payment Review”.
What does that mean?
This letter initiates a time period where you will not get paid for services without printing all notes, office documentation, testing results AND a 1500 HCFA form for each service, PRIOR to billing. So let’s talk about the logistics of this.
If you are an agency on an electronic health record, this can be done but would be extremely painful. An agency not using an EHR would not have the capability to print a 1500 HCFA but they should have paper notes. Hopefully, they have a good tracking system for tying the notes to claims. Either way, the review and withholding of payment is devastating.
Ohio Behavioral Health agencies are currently experiencing a very turbulent time due to the changes over the last year including coding, payer and registration requirements that have resulted in a number of issues. These issues include incorrect claim adjudications, a massive requirement change for re-billing corrected claims, missing and/or “pended claims”, TPL changes and now a timely filing deadline.
Over the last two weeks, Behavioral Health Billing Solutions met with Medicaid and demonstrated the continuing problems, listing multiple areas that are challenging and essentially severely broke. And we made recommendations for immediate relief. Since that meeting, this letter appeared, being the 4th type of traumatic letter going out to agencies seeking some kind of potential audit or payment take-back, appropriate or not.
We have also provided ODM with data that demonstrates over $2 million in claims that have been billed without a response from the MCO’s for a variety of agencies.
Their response on Friday was “ODM is not extending timely filing”.
BHBS has received multiple requests for assistance in the last week. Large and small agencies, desperate for assistance because although an extension of timely filing was mentioned by the new Director of Medicaid at the stakeholder’s meeting, it apparently is not going to happen and agencies are panicking.
So just imagine, if your agency, already struggling with the changes from the last year, and you receive this letter from the LARGEST MCO in Ohio.
Your payments will stop.
You will receive denials that state “Missing notes” and this letter can mistakenly end up in the hands of someone who doesn’t understand the magnitude of it until it’s too late.
And instead of proposing this like a normal audit where the auditor would be given access to your EHR, they are requiring all notes and related documentation to be printed, along with a 1500 HCFA form. Keep in mind, if you are manually entering claims on the portals, you may not have access to that form. However, you need it in order to possibly get paid. Apparently, they do not have a big concern for preserving the environment, otherwise, they would be managing this differently.