DESCRIPTION OF THE ISSUE
Whenever we use Psychiatric related diagnosis as primary one on a claim, this will cause a payment reduction from Medicare. The reduction has covered by some of the commercial secondary Insurances and if the patient does not have such, we could not bill the balance amount fully to the patient responsibility, we can only bill the 20% of the Medicare balance to patient not the reduced amount.
CONCEPT
If a patient treated for an Office/ Hospital visit based on the Psychiatric problem and if the patient needs specialty treatment, this would cause reduction on payment.
SOLUTION
Once we receive a claim with primary diagnosis related to Psychiatric (ICD Starts from the numeric 3) we need to check with Client Office whether there is any alternative primary Diagnosis. If reduction done by Medicare then we should correct primary ICD through Medicare IVR Telephone Clerical Reopening option
