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Verden Group, Telephone Codes, Harvard Pilgrim

February 05, 2009 / 0 Comments / in coding, insurance / by Chip Hart

I was paging through my daily Verden Alerts and I noticed that Harvard Pilgrim had released a new set of payment policies regarding E&M codes.  In fact, you can read it here on their WWW site, Verden just makes this a lot easier.  I suspect that most of you are like me and wouldn't normally take more than a second or two to go through the details of their announcement, but something drew me to it and I read carefully.  This part jumped out at me:

Harvard Pilgrim reimburses two telephone E&M services (5–10 minutes of medical discussion) per calendar year for members with associated behavioral health diagnosis, for the purposes of medical management.

Whoa, since when? That's news to me. Another payer, picking up the phone codes!  And are our MA clients billing it?  Let me ask.  Client number one:

"No, I had no idea!"  [You know who you are.]

Client number two:

"I thought I'd heard about that..." [You know who you are.]

OK, so it appears to be limited to patients with associated behavorial health diagnoses (whatever that means), but this is such a good example of how it's so easy to get overwhelmed with what you need to know.

It's also - and take this as a sales pitch - proof that all it takes is one good message from Verden to pay for itself every year.  It's like the GPOs - why are people not using these services?  I called Susanne and asked, "How long have they been paying this code?"  Sure enough, she can check her archives in two seconds and said, "It was in their October, 2008 announcement." Thus, our clients have had three months to prepare for this change, yet they don't appear to be taking advantage of this fairly revolutionary code.


Tags: coding, insurance

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