# Psychotherapy billing after auto accident



## ali2gark (Jul 25, 2016)

Hi all, just gathering some input because this is not a situation I've come across yet.  We had a patient who came for mental health counseling/individual psychotherapy for anxiety related issues within several days of an MVA where their vehicle was hit by another who was found at fault at the scene.  They state the need for services is directly due to the accident and the initial diagnosis is unspecified anxiety disorder.  They provided the auto claim number and the claim rep contact for the auto policy as well as their personal health insurance.  
I don't know what order to bill or how to submit.  The patient has their own private insurance so would we go through that at all?  Do we do an actual CMS 1500 and send direct to the auto policy or do we need to bill the patient and they use that bill for reimbursement?  We have not actually collected from the patient although we noted the costs so they are aware.
Any input would be greatly appreciated.  I do intend to contact the companies involved, as needed, but was hoping for a general process overview from a more experienced biller.


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## danskangel313 (Jul 25, 2016)

ali2gark said:


> Hi all, just gathering some input because this is not a situation I've come across yet.  We had a patient who came for mental health counseling/individual psychotherapy for anxiety related issues within several days of an MVA where their vehicle was hit by another who was found at fault at the scene.  They state the need for services is directly due to the accident and the initial diagnosis is unspecified anxiety disorder.  They provided the auto claim number and the claim rep contact for the auto policy as well as their personal health insurance.
> I don't know what order to bill or how to submit.  The patient has their own private insurance so would we go through that at all?  Do we do an actual CMS 1500 and send direct to the auto policy or do we need to bill the patient and they use that bill for reimbursement?  We have not actually collected from the patient although we noted the costs so they are aware.
> Any input would be greatly appreciated.  I do intend to contact the companies involved, as needed, but was hoping for a general process overview from a more experienced biller.



First, and most important, the HIPAA Privacy Rule says you cannot release ANY psychotherapy notes to anybody without a signed authorization from the patient specifically for those records. 
Equally as important, depending on the type of liability insurance she has, they may not be a covered entity at all, meaning more authorizations have to be signed.

AFTER you get authorization, as far as billing goes, you always bill the liability first. We always drop them to paper claims and attach only the notes specific to each particular claim's DOS. We also document in our billing system what claim we mailed and what records we attached. They may ask for additional medical records, but you can only send them IF the patient has authorized the release and only for the particular claim and date of service they are requesting the records for. They are never permitted to have any documentation unrelated to the MVA, including records prior to the accident, and any afterwards if they aren't pertaining to the MVA. You can add her health insurance as a secondary payer but they will either deny for liability or pay and then ask for a recoup. Depending on the payer, they may agree to a subrogation. 

Pertaining to the psychotherapy notes, the provider would have to document specifically that the condition(s) are due/caused by/brought on by the MVA. If there is no documentation that links the accident and the anxiety together, then that bill would go off to her primary insurance. If the provider linked the anxiety to the accident, the proper primary DX would be the unspecified anxiety, followed by the typical codes for indicating it was an accident, auto, etc.

One *HUGE* thing to keep in mind, you want to provide the *LEAST* amount of information to the MVA insurance people. When you have to speak with them on the phone, be very, very, very limited in the amount of information and details you give out. 

On a side note, although it doesn't pertain to you whatsoever, one of the primary goals of most liability carriers is to get enough information to either deny or pay out the minimum amount to a patient. They will record phone calls, they will write down everything you say, etc. So the less you can contribute to that (disgusting) goal, the better off the patient is in the situation overall.


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## ali2gark (Jul 26, 2016)

Thank you so much @ danskangel313, that was very informative! We have the patient's signed consent/authorization for the first date of service, are you saying it's best to get one for each date of service if it's relevant, or is one release to the specified liability company enough?  I am inclined to just send the claim with the diagnosis primary of anxiety and there is a Z code for the accident history as secondary, without medical record information unless they request it.  Is this atypical?  Do you send the record info with the claim, without them specifying?


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## danskangel313 (Jul 26, 2016)

Most authorization forms have an area where the patient can write in specific dates of service, or a range of dates, or from such and such date until the release expires (for us it's 2 year). Usually the patient enters the date of the accident and leaves the end date open (meaning until it expires). Usually there are also boxes he/she can mark that limits the amount of information that can be released. You only need one as long as the DOS falls within the dates the pt approves.

I HIGHLY recommend the patient check the "Minimum Necessary" if it's on a form you use. Also, you want to make sure the patient gets a copy and the original gets put into his/her medical record.

I'm attaching a copy of what we use, but I blocked out some information like our address and my phone #, etc.


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## ali2gark (Jul 27, 2016)

Thanks again for lending your experience!  Your form is more concise than ours and I am introducing it to our clinical director pronto.  Really, really appreciate the pointers.


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## danskangel313 (Jul 27, 2016)

Here's an example with the appropriate header and footer info, just generic information, so you know where the rest of the information would go.



If this gets up the "food chain" at your facility, I'd be more than willing to send him/her a copy of our form with all the original information included. Just send me a message.


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