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Elizabeth M. Whitehorn, Director

Provider Notice issued 11/16/05

To: Participating Physicians and Long Term Care Facilities

Date: November 16, 2005

Re: Billing for Psychiatric Services

 

The purpose of this notice is to remind providers of the department’s policy regarding billing for psychiatric services. The department's policy relating to fee-for-service psychiatric services is codified in rule at 89 Illinois Administrative Code, 140.413 (a)(4) and is included in the Handbook for Physician Services, A-200, Topic A-210.4.

In the fee-for-service program, psychiatric therapies must be personally provided by the physician who submits the charges to the department. Services provided by psychologists, licensed clinical social workers or advanced practice nurses are not reimbursable under the fee-for-service program . Access to these professionals is only available through Federally Qualified Health Centers, Rural Health Centers, Encounter Rate Clinics, hospital-based psych clinics, the Medicaid Community Mental Health Services Program administered by the Department of Human Services, and through school systems for children with individual education programs ("special education").

In addition, physicians billing for psychiatric services are subject to special record requirements which limit the time eligible for reimbursement to the actual time spent in direct patient care, not including the time required for documenting the record, making reports, etc. The department does monitor compliance with this policy. Providers may be subject to the recoupment of payment if during an audit it is determined that department policy was not followed.

Providers wishing to receive e-mail notification, when new provider information is posted by the department, may register at the following HFS Web site at:

                             http://www.hfs.illinois.gov/provrel

Electronic claim submission via the Internet is available by registering on the department’s Medical Electronic Data Interchange, Internet Electronic Claims (MEDI/IEC) System: <http://www.myhfs.illinois.gov/>. The MEDI/IEC System is available to enrolled providers and their authorized staff, claim submitting agents and payees. During the registration process, you will be given access to specific claim formats based upon your enrollment status with the department.

If you have any questions regarding this notice, please contact the Bureau of Comprehensive Health Services toll-free at 1-877-782-5565.

 

Anne Marie Murphy, Ph.D.
Administrator
Division of Medical Programs