Coding glitch leaves mental health providers out in the cold

BLUE CROSS Blue Shield of Rhode Island is one a number of health insurers around the country that have denied claims from metal health providers due to glitches in billing codes.  / COURTESY BLUE CROSS & BLUE SHIELD OF RHODE ISLAND
BLUE CROSS Blue Shield of Rhode Island is one a number of health insurers around the country that have denied claims from metal health providers due to glitches in billing codes. / COURTESY BLUE CROSS & BLUE SHIELD OF RHODE ISLAND

PROVIDENCE – A glitch in billing codes for claims from mental health providers – including psychotherapists, clinical social workers and psychologists – has resulted in hundreds of claims being denied by health insurers, including Blue Cross & Blue Shield of Rhode Island, according to Lisa M. Rocchio, president of the R.I. Psychological Association.

“In Rhode Island, many of the bills for psychotherapy were not paid in January, creating significant cash flow difficulties for many practices,” said Rocchio, a psychologist in a private practice in Johnston. “Blue Cross owed [one practice] more than $50,000.”

The problem began on Jan. 1, when changes took effect for the current procedural terminology, or CPT codes, in the psychiatry section of the American Medical Association’s claims procedures. The new codes reduce both the time allowed for psychotherapy sessions with patients and the payment for services, according to Rocchio.
Blue Cross acknowledged the problems with claims.

“This was the first overhaul to the codes since 1998 and we acknowledge that it has resulted in problems,” said Stacy Paterno, assistant vice president of Blue Cross. “The implementation has been more difficult than anticipated and as a result many providers have been impacted. We take these matters seriously and are working to resolve the problems and apologize for the inconvenience.”

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Paterno, who said that the claims had been handled “in-house,” said the problem was being corrected. “We acknowledge that many providers did not receive payments in January, and that we have successfully processed a number of claims late last week. We anticipate full resolution to this issue by the end of February.”

“The big snafu occurred because the computer systems were not equipped in time to handle these changes,” Rocchio said. The R.I. Psychological Association, which has more than 200 psychologists as members, “was advised by Blue Cross to tell our members to hold claims because they anticipated not being able to pay them,” she said.
The glitch affected not just psychologists but all mental health providers – social workers, licensed nurses, licensed mental health counselors and psychiatrists, according to Rocchio.

The problem with denied claims and delayed payments occurred not just in Rhode Island but across the country, and involved many of the larger health insurance companies, according to Rocchio. Among those having problems getting paid was Marc Milhander, a psychologist who co-owns a Niles, Mich., counseling center. He conducted more than 100 psychotherapy sessions in the first few weeks of January, treating patients from the mildly anxious to the severely depressed – including a 24-year-old with an antisocial personality disorder who really wants to get his hand on a gun, according to an NBC News story on Feb. 7. “I’ve been paid for five hours of work for the month of January,” Milhander, who supports a staff of four and oversees 300 patients a month, told NBC. “I just wrote a big, fat check out of my personal bank account to keep us afloat.”

Under the new billing codes, mental health providers are being asked to do more in less time, for less money, according to Rocchio. The standard 50-55 minute psychotherapy session has been reduced to 45 minutes, and a longer 75-80 minute session, recommended by evidence-based guidelines for patients with post-traumatic stress disorders, has been eliminated, according to Rocchio.

Instead, there is an option for a 60-minute session, but some health insurers, such as Tufts Health Plan, are reimbursing the 45-minute session at the same rate as the 60-minute session., according to Rocchio.

In addition to having claims denied and payments delayed, providers – many of whom are small businesses operating on a shoestring budget, have not yet been told by insurers what the fee schedule for services will be, according to Rocchio. “Imagine going to work in January, and being told: ‘We’ll tell you in a few weeks how much you’re going to be paid.’ You can’t run a business this way.”

On Feb. 8, R.I. Health Insurance Commissioner Christopher F. Koller said that his office was in the process of investigating the situation. “Since the start of the new year, we have received one complaint on behalf of the R.I. Psychological Association about payment issues with one carrier which we are investigating,” Koller said, responding to questions from Providence Business News. “We do not have any conclusions yet about the magnitude of the concern or the causes.”

Rocchio, in response to Koller’s comments, said the health insurance commissioner appeared to be mistaken, mixing up a letter sent by the association in July 2012 with the current situation. Rocchio said that the R.I. Psychological Association had not made any formal complaint related to the CPT code snafu.

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