We get auth after the eval visit, but we include the eval visit in our request & make sure to request auth under G code. We have had no issues billing eval visits at all & we do not get paid less for them. it’s the standard rate.

 

 

 

Our stumbling block has been because evaluations are not supposed to need authorization but no one is clear on what code to use.  And then when you do get them to pay they pay less on evals

 

 

 

My understanding is that you do not need to seek prior auth for therapies BEFORE the 1^st visit. But when you seek authorization, you need to include that visit. They will always cover that one at least but you still need to include it when requesting auth. Our biggest frustration is that you are allowed 15 NV and HHA for some plans but not for others. Then you have to constantly be looking at your UCARE clients…

 

 

I bill therapy visits as (1) to  Ucare as per their billing requirement for therapies.   G0152 (PT) & G0151 (OT) for MSHO  and Ucare for Seniors.  S9129 (OT) & S9131 (PT) codes for Ucare Msc + and SNBC.    I do not have any problems.  According to UCare policy we do not need an authorization for PT or OT evals but I have found that the EVAL visits do not get paid if there is not an auth from HSM in UCARE’s system.  I request an auth for the 1 visit.  HSM puts the auth in as 4 units but I still bill 1 visit (per UCARE billing requirement) and get paid correctly. 

 

 

 

 

What codes are you using for OT and PT evals with UCARE MDCR?   We are having issues with getting our evaluations paid.

 

Thanks

 

 

“Whether you believe you can or cannot you are right”  Anonymous

 

Mary Jonason

Accounts Receivable Manager

Prairie River Homecare

 Phone 763-682-0665  fax 763-682-6543

 

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