Billing Frequently Asked Questions
Here are answers to frequently asked billing-related questions. Please select a topic below:
Topics
1. Which Business Unit do I contact for Billing questions or information?
The Patient Accounts or Billing Unit is the central billing office for the Riverside County Department of Mental Health and can be reached at (951) 358-6900. This Unit processes claims to bill 3rd party intermediaries such as Medicare, Insurance, Medi-Cal and private payors. Monthly claims are submitted for payment of mental health & substance abuse services rendered by department staff both in an inpatient and outpatient setting. The Unit is comprised of four sections; Clerical, Billing, Payment Processing and Accounting. The Unit works as a team to ensure that client health insurance policy information is entered into the billing system, review and process monthly bills (claims), and receive and enter payment and denial information from 3rd party intermediaries. Staff also troubleshoots claims returned, denied or stalled by 3rd party payor sources and responds to telephone inquiries and written correspondence requesting additional information necessary to finalize claims such as a clients’ medical records. The Unit receives approximately 1,000 items of mail from payors, clients, their agents and other sources each month in addition to fielding 300-500 phone calls regarding billing-related inquiries.
To contact the Billing Office, call (951) 358-6900 or write:
> Riverside County Department of Mental Health
Attn: Patient Accounts Unit
P.O. Box 7549
Riverside, Ca 92513
2. What is the cost of services?
Specific client charges for services are determined by the information you provide during the financial screening process. A financial screening occurs at the time of your first visit and annually thereafter. State law requires that everyone pay all or some part of the cost of treatment received, if possible. Your ability to pay is determined by a sliding scale and is based on variables such as gross household income, size, and assets. The method used to determine your portion of the cost of treatment is called the UMDAP, or Uniform Method Determining Ability to Pay. Additionally, you may be required to pay a co-insurance or a deductible amount if you have Medicare or a share-of-cost amount if you have Medi-Cal. In some cases, you may be eligible for programs that assist with paying all or a portion of your cost for treatment. These programs include, but are not limited to Medi-Cal LINK: http://www.medi-cal.ca.gov/ and Healthy Families. LINK: http://www.healthyfamilies.ca.gov/hf/hfhome.jsp. If services are for a school-aged child in the public school system who is enrolled in special education, they may be eligible for IEP, Individualized Education Program. You will need to request an IEP meeting with your child’s school to determine if this program will benefit your child. You may also visit the California Department of Education website for more information on California’s IEP (AB2726) program. LINK: http://eit.otan.dni.us/speced/laws_search/searchLaws.cfm.
Note: It is a requirement for service providers such as Riverside County Department of Mental Health to attempt to collect Medicare co-insurance/deductibles, Medi-Cal Share-of-Cost and/or Insurance co-payments from clients. Riverside County Department of Mental Health may collect at the time services are rendered or may elect to bill the client.
3. What can I expect during my first visit to one of your treatment facilities?
During your initial visit to one of our clinics, you will be required to complete a series of financial intake forms. Completion of these forms enables the Department to accurately determine your portion of the cost for services and to bill any health coverage you may have. You will also be required to complete and sign authorization forms enabling the Department to bill Medicare or your Insurance company on your behalf. Failure to complete and sign the authorization forms may result in your being liable for the total cost of the services rendered at the Board approved rates. Additionally, if you have Medi-Cal, Medicare or other health coverage, you will need to provide the clinic with your insurance card so that a photocopy can be made and placed in your chart.
Note: Most mental health programs and some substance abuse programs are certified to accept Medi-Cal. Some mental health programs are also certified to accept Medicare. You may confirm if the clinic is a Medi-Cal or Medicare certified site with you call or visit the clinic.
4. How do you determine rates?/How do I get a copy of my statement?
Most rates for services provided by the Department are based on the cost per day, per minute, per hour or per contact. The Department evaluates its existing rates on an annual basis based on several factors including but not limited to the actual cost of services during the previous year, rates charged by neighboring counties and statewide rate averages. Once the analysis is completed, the Department may recommend rate increases and/or decreases for approval by the County Board of Supervisors. These rates are referred to as the “Board Approved Rates.” For specific charges to your account or to request an itemized statement of your account, contact the Billing office at (951) 358-6900. Please provide your account number and current address and telephone number when you call.
5. I’ve contacted the Billing office and they have informed me that I owe an UMDAP amount. What does UMDAP mean and where does this amount come from?
UMDAP stands for "Uniform Method of Determining Ability to Pay", and is mandated by section 5718 of the California Welfare and Institutions Code. The UMDAP is a sliding scale charge schedule that determines an annual fee for a family, regardless of the type of service or the number of visits, and is based on family size, assets and income. All clients are liable for this annual amount unless they are a Medi-Cal beneficiary with no Share-of-Cost (SOC). If you believe your current UMDAP amount is inaccurate, you may request that a revised Payor Financial Information form (DOMH-P/A-002) be completed at the clinic where you or your beneficiary receives treatment.
|
*Example of Uniform Patient Fee Schedule
|
|
|
|
|
|
|
|
|
|
Persons Dependent on Income Annual Deductibles
|
|
Monthly Adjusted Gross Income
|
1
|
2
|
3
|
4
|
5 or more
|
|
0-569
|
37
|
33
|
30
|
27
|
24
|
|
700-749
|
56
|
59
|
45
|
41
|
37
|
|
950-999
|
99
|
90
|
80
|
72
|
65
|
|
1200-1249
|
177
|
159
|
143
|
129
|
116
|
|
1450-1499
|
326
|
293
|
264
|
238
|
214
|
|
*This is representative example and does not represent the UMDAP table in its entirety.
|
|
Source: RCDMH Uniform Patient Fee Schedule eff.:10/1/89
|
|
|
6. What forms of payments do you accept? Where should I send my payment (s)?
If your treatment clinic is authorized to accept payments, you may make a payment by check, cash or money order at the site. Otherwise, mail your check or money order to Riverside County Department of Mental Health, P.O. Box 7549, Attn: Revenue, Riverside, CA 92513. Checks and money orders should be payable to: Riverside County Department of Mental Health. The Billing Office does not accept payments in person.
7. I have Insurance, why am I getting a bill?
If you have insurance and you have notified & authorized the Billing office to bill your insurance company by returning a signed Authorization form to us, it is likely your insurance company either denied the claim or made a partial payment. If this is the case, you are responsible for the difference between what we billed (actual cost of services) and what your insurance company paid, up to your UMDAP amount (annual liability). If you fail to provide a signed authorization form to the Billing office, your account is made “full-pay.”
8. How do I ensure you have my correct insurance information?
The Department relies on its clients to provide accurate and up-to-date insurance information to ensure that you and your insurance company are billed properly. You should be prepared to provide a copy of your card and a completed and signed authorization form for each insurance company at your initial visit or as soon as feasible. Anytime there is a change in your coverage, a copy of the new card and a new authorization form should be completed and submitted to clinic personnel or mailed to the Billing office at P.O. Box 7549, Riverside, CA 92513. A new authorization form should be completed, signed and submitted to the clinic at least once per year. You may contact the Billing office at (951) 358-6900 to request authorization forms or complete them at your next office visit. Please provide your account number and current address and telephone number when you call or visit.
9. I contacted the Billing office to discuss my spouse/child/relative’s account and I was told they couldn’t because I am not the “responsible party.” Why?
When a client visits a mental health clinic for the first time, the client, or parent or guardian, if a minor, completes the financial paperwork to determine the amount the client or responsible party is obligated to pay for services. The person who is obligated to pay for services is referred to as the responsible party. There is only one responsible party or “RP” per account. Due to confidentiality laws, the billing office is prohibited from discussing the account with anyone other than the client or RP without the clients’ permission.
10. I am unable to pay my bill at this time, what should I do?
If you are unable to pay your bill, you should contact the Billing Office at (951) 358-6900 to make payment arrangements. We will do our best to arrange a monthly payment amount that fits into your budget. Please provide your account number and current address and telephone number when you call.
11. I disagree with the bill I received and want to dispute it. Who should I contact?
If you are disputing the bill you received from Patient Accounts because you believe the services were not rendered to you or the wrong services are being billed, you must contact the clinic where the services were provided to dispute your bill. The Billing Unit processes the claims and bills based on the services entered into the Billing system by clinic staff. If there is an error in the entry of services, it must be corrected at clinic level. You should contact the Billing Office at (951) 358-6900 for any other disputes. Please provide your account number and current address and telephone number when you call.
12. I received a bill in the mail and when I contacted the Billing office, I was told my account was made “full pay.”
If you have Medicare or Insurance and have failed to return signed forms authorizing the Department to bill these payors, then your account is made full pay and you are responsible for the total cost of the services. In order to change the full pay status of your account, you must complete and sign the authorization forms and submit to the Billing office or you may submit the forms to your local treatment clinic that can forward them to the Billing office. You may call the Billing office to have the forms mailed directly to you. Please provide your account number and current address and telephone number when you call.
13. I have Medicare. Does Medicare pay for Mental Health services?
If you are a Medicare beneficiary, it is important to know what your policy covers. Part A covers Hospitalization charges, while Part B covers Professional/Medical service costs. It is also important to note that Medicare will only reimburse the Department for eligible services rendered by Medicare eligible staff at Medicare eligible sites. Riverside County Department of Mental Health staff disciplines that are Medicare eligible are MD’s/Psychiatrists, Psychologists (Ph.D.) and Licensed Clinical Social Workers (LCSW). Certain services, such as Rehabilitation, Case Management and those provided in the field or over the telephone are not Medicare eligible. The Department currently has seven sites that are Medicare certified. Click on the link below to view these sites. Please note that the Department cannot bill Medicare without a signed authorization form. If you have Medicare and fail to return the signed authorization form to the Billing office, your account will be made full pay.
Riverside County Department of Mental Health Medicare Eligible Sites
14. I have a Medicare co-payment and/or deductible requirement. How are these charges billed?
The Medicare co-payment is the percentage of the Medicare payment rate or a hospital's billed charge that you have to pay after you pay the deductible for Medicare Part B services. A deductible is the amount you must pay each year before Medicare begins paying its portion of your medical bill. There are deductibles for both the Part A (Hospital Insurance) and Part B (doctor services) portions of Medicare. As a provider, the Department may ask you to pay a portion of your deductible at the time you get the service, or bill you after getting the notice from Medicare concerning the amount Medicare approves for the service(s). Typically, we bill you for the co-payment and/or deductible after we receive the Medicare Explanation of Benefits (MEOB) from Medicare. Medicare co-payment and deductible amounts are added to your annual liability amount (UMDAP).
15. I have Medi-Cal. Why am I receiving a bill?
If you are a Medi-Cal beneficiary, it is important to note the Aid Code your plan covers. It is also important that you notify your local clinic or the Billing office of your new 14-digit BIC code to ensure that we are billing Medi-Cal properly on your behalf. If you are receiving a bill, then it’s probable that the Department is unaware that you have Medi-Cal coverage. Contact your local clinic or the Billing office to notify us of your coverage. Be prepared to provide your 14-digit BIC code and current address and telephone number. If you have not received your new BIC card with the 14-digit BIC code, please contact your Social Worker at the Department of Public Social Services for assistance. Their main number is (951) 358-3000.
16. I was told I have a Share-of-Cost (SOC). What does this mean?
If you are a Medi-Cal beneficiary, the State may require you to pay a monthly Share-of-Cost amount towards the cost of services rendered by Medi-Cal certified providers located within the state. When applying for Medi-Cal, it is determined based on income, assets and expenses whether you are eligible for full scope Medi-Cal, or Share-of-Cost Medi-Cal. Title 22, Division 3 of the California Code of Regulations addresses SOC and how the State determines your portion or share of cost for the services you receive. Medi-Cal will not reimburse providers such as the Riverside County Department of Mental Health for your portion of the SOC, and requires that providers attempt to collect the SOC amount directly from you. If you have a monthly SOC, your statement will reflect the lesser of the cost of services received in a month or your monthly-unmet SOC.
17. My child is covered under the IEP/AB2726 program. Why do you want to bill my insurance company?
In order to provide quality, appropriate and timely services and programs to our clients, the Department needs a reliable and steady flow of revenue to help fund these services and programs. In addition to revenue sources such as Medicare, the Department also relies on revenue from insurance companies for their beneficiaries who have elected to receive treatment in County facilities instead of within their own provider networks. The majority of IEP clients are also Medi-Cal eligible. However, State Medi-Cal regulations require providers such as the Riverside County Department of Mental Health to bill Medi-Cal as the payor of last resort. In other words, Medi-Cal will not pay the Department if Medicare and/or your Insurance have not been billed first. The benefit to you by authorizing the Department to bill your insurance company is that the charges go towards meeting any deductibles you may have. The benefit to the Department is that we are able to generate revenue from the insurance company and Medi-Cal for legitimate services rendered to your child. This revenue stream enables the Department to continue to offer the quality services and programs you have come to expect from us. By not authorizing the Department to bill your Insurance, we lose out on revenue from multiple sources such as the insurance company AND Medi-Cal.
18. My child is IEP and his (her) services are covered by AB2726. Why am I receiving a bill?
If you have notified the clinic that your child is IEP and you are receiving a bill, it is likely that the code entered into the billing system is incorrect. Contact your treatment clinic to verify that the correct IEP code was entered into the system. If the correct IEP code was entered, contact the Billing office for further assistance. If the incorrect code was entered, request the clinic to make the correction. It may take a few billing cycles before the correction is reflected on your bill. Please provide your account number and current address and telephone number when you call.
19. What is Healthy Families? I have Healthy Families, why am I receiving a bill?
The Healthy Families (HF) Program offers low cost insurance for children and teens up to age 19. It provides health, dental and vision coverage to children who meet the program rules and do not qualify for free Medi-Cal. People who qualify for Healthy Families get 12 months of health coverage, as long as they pay the monthly premiums. They receive services through health, dental and vision providers such as the Riverside County Department of Mental Health that work with Healthy Families. If you have HF coverage and are receiving a bill, contact your local treatment clinic or the Billing office to notify us of your coverage. Be prepared to provide your account number and current address and telephone number when you call.
20. What is Medicare Part D coverage & who do I contact for information?
Medicare Part D coverage is the new federal prescription drug benefit for all Medicare beneficiaries that became effective January 1, 2006. Beneficiaries must pick a Prescription Drug Plan (PDP) by May 15, 2006 unless they are dually covered by Medicare and Medi-Cal. In that event, beneficiaries will be automatically enrolled in a PDP. For enrollment information, contact Medicare at (800) 633-4227 or a Medicare Counselor at (800) 434-0222.
LINKS:
Medi-Cal: http://www.medi-cal.ca.gov/
Medicare: http://www.medicare.gov/
Healthy Families: http://www.healthyfamilies.ca.gov/Home/default.aspx
DPSS: http://dpss.co.riverside.ca.us/
|