Wiki Billing for MSW interns...I'm so confused!

[Nstatley17]

Hello! We have a group practice with an MSW intern who will be seeing patients for individual therapy sessions under the supervision of a CSW. The MSW will only perform Stabilization phase/ coping skills during the sessions. My question is what can we bill insurance? Would this be considered incident to services since the MSW is only doing a part of the treatment plan and the patient is assigned to the CSW? Also, do we bill the insurance the normal fee even if we are charging a discounted fee for services performed by the intern? For example, our normal fee for 90837 is $160 but for the intern we will only charge patients $50. I've tried to find answers online but some things I read seemed to indicate that you cannot bill any services performed by interns. Further context is this group is in Utah where they do allow MSW's to perform services. Please help! Thanks!

 

[munchlaxe]

Hi,

I bill in Oregon, and our payers vary on if they allow us to bill out for these services performed by interns. Some of them do, others don’t, but at the end of the day, they are considered incident-to, assuming the MSW will be billed under the CSW’s NPI. If your payers will allow it, then it can be billed. It all depends on their policies and your contract.

If you’re billing out to an insurance company, it should meet the agreed upon fee schedule for your contract. As far as I know, however, you can’t bill insurance companies one thing and turn around and bill patients another amount, i.e, have two different sets of fee schedules: one for patients and one for insurance companies. So, whatever you bill to insurance companies has to be the same rate you bill to patients that pay out of pocket/don’t have insurance, excluding whatever Time of Service policy you may have in place for patients.

 

[ckeeney]

Our state Medicaid is the only payer that allows us to bill for interns with an HL modifier using the supervising clinician as rendering (incident to). Does the intern have an MSW and is interning for CSW? We have many commercial payers that will allow us to bill an MSW as rendering. We can also bill our state Medicaid for MSW's with the supervising clinician and HE modifier per their rules. Basically, you should check payer policies.