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.
Posted 2/11/13

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.”

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.

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