Q1.

If a Medi-Medi client receives inpatient services and crisis stabilization services within 72 hours of the inpatient stay, Medicare requires all of these services to be claimed on one claim (837I).  The Medicare reimbursement is not itemized.  The MHP is paid the same Diagnostic-Related Group (DRG) rate whether or not crisis stabilization is provided when crisis stabilization occurs within 72 hours of the inpatient stay.  How should the MHP apply the Medicare reimbursement to the Medi-Cal claim?

A1.

 The MHP should claim Medi-Cal for the hospital inpatient services on the 837I and crisis stabilization on the 837P.  All Medicare reimbursement should be applied to the Medi-Cal 837I for the hospital inpatient services.

Updated: 10/21/2010

Q2.

If a Medi-Medi client receives crisis stabilization services with no inpatient services, or no inpatient services within 72 hours and the MHP claims portions of what DMH recognizes as crisis stabilization to Medicare (e.g., physician services), how should the MHP apply the Medicare reimbursement to the Medi-Cal claim?

A2.

The MHP should claim Medi-Cal for the balance of the claim not paid by Medicare for crisis stabilization on the 837P.  The MHP must submit the Medicare reimbursement as a coordination of benefits (COB) amount so it can be applied to the SD-MC payment.

Updated: 10/21/2010

Q3.

Is code H2017 to be used for all specialty mental health services under the Federal Rehabilitation State Plan Option ("Rehab Option")?

A3.

No.  The code H2017 is only to be used for claiming the service activity “Rehabilitation” (Title 9, California Code of Regulations (CCR), Section 1810.243) under Mental Health Services.  Rehabilitation is a service activity under Mental Health Services that is not Medicare reimbursable regardless of where it is provided.  Some “Rehabilitation Option” services under California’s Medicaid State Plan are Medicare reimbursable.

Updated: 10/21/2010

Q4.

How is billing coded for services rendered in the community?

A4.

Specialty mental health services provided in the community are not Medicare reimbursable and should be claimed directly to Medi-Cal.  When a service is provided in the “community” and no other appropriate place of service code applies, the place of service code should be indicated as 99 (other) and the modifier “HQ” should be used with procedure codes H2010 and H2015 to specify that the service was provided in the community.  Medi-Medi claims with place of service code 99, but no modifier will be denied as requiring coordination of benefits.  Similarly, Medi-Medi claims for procedure codes H2010 or H2015 services with the procedure modifier “HQ” that do not include place of service 99 will be denied.

Updated: 10/21/2010

Q5.

What constitutes a service delivered by telephone and how is billing coded?

A5.

Specialty mental health services provided over the telephone are not Medicare reimbursable and should be billed directly to Medi-Cal.  When a service is delivered by telephone, the appropriate place of service code should be indicated and the modifier “SC” should be used with procedure codes H2010 and H2015 to specify that the service was provided by telephone.  For example, if a telephone service is provided in an office use modifier “SC” with place of service code 11 (office).  Claimed services provided over the telephone must be actual, Medi-Cal reimbursable services.  Leaving a telephone message, scheduling an appointment, or other clerical functions are not Medicare or Medi-Cal reimbursable activities.

Services provided by telephone differ from telemedicine services.  Telemedicine benefits are Medicare reimbursable when provided from a clinic through interactive voice and visual interface between the provider and the client and when provided in specific, eligible geographic regions.  Services provided via telemedicine should be claimed to Medicare prior to Medi-Cal unless another exception to prior Medicare claiming exists.

Updated: 10/21/2010

Q6.

A6.

A facility whose primary purpose is education.

Updated: 10/21/2010

Q7.

How is place of service 15 (mobile unit) defined?

A7.

A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services.

Updated: 10/21/2010

Q8.

How should the service activity “plan development” (under Mental Health Services) be billed for Medi-Medi claims?

A8.

When claiming the service activity “plan development” (Title 9, California Code of Regulations (CCR), Section 1810.232) under Mental Health Services (Title 9, CCR, Section 1810.227), Mental Health Plans (MHPs) may use procedure code H0032 to bill Medi-Cal directly for Medi-Medi clients.  Plan development is a service activity under Mental Health Services that is not Medicare reimbursable regardless of where it is provided, or who provides it. 

Updated: 12/10/2010

Q9.

How should the service activities “assessment”, “therapy”, and “collateral” (under Mental Health Services) be billed for Medi-Medi claims?

A9.

The service activities “assessment” (Title 9, CCR, Section 1810.204), “therapy” (Title 9, CCR, Section 1810.250) and “collateral” (Title 9, CCR, Section 1810.206), under Mental Health Services (Title 9, CCR, Section 1810.227), must be claimed to Medicare prior to Medi-Cal, using procedure code H2015, unless an exception to Medicare billing exists (for example, the service is provided over the telephone or in the community, it is provided by a non-Medicare reimbursable provider, or in a non-Medicare reimbursable place of service).

Updated: 12/10/2010