ACHA: In order to provide services in the best way possible with integrity, we need more information from you.
We need to understand what requirements are need for our employees who are Medicaid Providers. After asking individuals at ACHA and
We need to know what diagnosis are acceptable for the Behavior Analysis Provider 39 services. Funny story …
check this story out …
Enough to drive you nuts (although my husband tells me that is a short trip for me 🙂 … Be prepared to laugh ….
I spent a couple of hours the other day on the phone between my billing field rep from DX/Medicaid – the person who is we go to for help to resolve billing issues. I asked the billing rep why the diagnosis code on the patient I had approval for, would not process … the billing rep said she could not help me nor provide a list of acceptable diagnosis codes because people would commit fraud and had no answer to how this patient was authorized, billable, and yet not billable … OMGosh …. I got a patient approved through eQ, a PA# from Medicaid, and now they are telling me the diagnosis code is not authorized to be billable…. then the billing rep gave me a phone number to call the Policy Department at ACHA (laughing already aren’t you). Then I spoke with an employee at ACHA who said almost the same thing – we can’t help you and I was told to call my billing rep (no kidding). I did let her know that I had already done that and I was told to call ACHA (feels a little circular doesn’t it – or the definition of insanity). Then I called eQ, and was told the same thing, can’t help with claims we only determine medical necessity … (holy schamolie) … and then was instructed to call Medicaid… At that point, I called Beth Kidder’s office (ACHA Director) and they redirected me to the Fiscal Operations Department (this was 9:30am) – I spoke with a lovely woman who told me a gentleman who was just going into a meeting but would make this their top priority …. (it is now 3 days later :). You’ve got to laugh. I know everyone is doing their best but it can certainly be frustrating.
~ Meanwhile back at the farm, I have three (3) calls to return for new patients, and six (6) assessments in process, and multiple ABA candidates in various stages to communicate with. Thankfully, it turned out that our patient in the above story has three (3) diagnoses and one (1) of them was accepted, and (PHEW!), we could bill.
Things like this are really difficult. Had this patient only had (1) diagnosis, we would not have been able to bill for the service we provided in good faith and be paid after an enormous amount of work just to get to this point alone. How did this patient receive authorization to be begin with, I can’t figure out.
These are the three (3) diagnosis I was working with:
- Pervasive Developmental Disroder F84.9
- Developmental Delay R62.0
- Expressive Language Disorder F80.1
to find out which was was accepted 🙂 – Shelly Lynn Henry, MS, BCBA 727-809-1328.