Monitor on Psychology - May 2012 - (Page 16c)

REIMBURSEMENT FOR PSYCHOLOGICAL SERVICES | MAY 2012 Billing Pointers for H & B Services Medicare mandates payment for H & B codes except for 96155. However, many private carriers do not cover the six H & B codes, nor do most Medicaid programs. It is crucial for psychologists to contact a carrier to determine whether the codes are covered before attempting to bill them. Several more tips are helpful to keep in mind when billing for H & B services, including: Four APA Practice Organization Advocacy Initiatives on Reimbursement 1 2 3 4 Collaborating with state psychological associations on class action litigation involving out-of-network reimbursement for psychological services Challenging steep rate cuts by managed-care companies such as Florida Blue Cross/Blue Shield Advocating for Medicare payment reform Seeking federal law to make psychologists eligible for incentive payments to providers who implement electronic health record keeping systems • Before providing H & B services, learn details about coverage from your Medicare Administrative Contractor (MAC) and any private-sector plans in which you participate. Payment policies and restrictions – for example, limits on the number of units that may be billed for a particular H & B service – vary among health plans. Websites for your MAC and private carriers generally contain this information. H & B services are billed and paid in 15-minute units that include only time spent face-to-face with the patient. For example, a practitioner should bill 4 units for one hour of an outpatient H & B intervention. Use of H & B codes requires a physical health diagnosis, which generally is established by a physician. Only an ICD-9-CM physical diagnosis code – not a DSM diagnosis code – should be used in connection with H & B services. Medicare precludes you from billing for H & B services at the same time you bill for psychotherapy. The program will not pay for multiple services to a patient by the same provider on the same day, and the same is true of most private insurers. More Reimbursement Tips for Practitioners For many psychologists, the health of their practice finances is tied directly to the process of submitting insurance claims to Medicare, Medicaid and private-sector insurance companies – whether the claims are for health or mental health services. Submitting claims properly and challenging inappropriate denials are crucial. The following tips may be helpful. Claims Submission Pointers • • • • Also keep in mind that Medicare reimburses providers at the same rate – 80 percent of the total amount allowed – for H & B services as for physical health services. Beneficiaries are responsible for paying the remaining 20 percent. Use the proper CPT procedure codes and ICD-9-CM diagnosis codes. Visit the American Medical Association website at ama-assn.org for additional information about the CPT codes. The website includes a search function that allows a limited number of free online searches for code numbers and provides the Medicare payment rate for each code based on geographic area. Information about ICD-9-CM is available on the Centers for Disease Control and Prevention website at cdc.gov/nchs/icd/ icd9cm.htm. Continued on the next page http://www.ama-assn.org http://www.cdc.gov/nchs/icd/icd9cm.htm http://www.cdc.gov/nchs/icd/icd9cm.htm

Table of Contents for the Digital Edition of Monitor on Psychology - May 2012

Monitor on Psychology - May 2012
Letters
President’s Column
Contents
From the CEO
Math + science + motherhood = a tough combination
The rights of indigenous people take center stage at AAAS meeting
Interdisciplinary programs that are leading the way
Good Governance Project moves into its next phase
APA publishes third edition of seminal ADHD book for kids
Government Relations Update
In Brief
Random Sample
Judicial Notebook
Psychology’s first forays into film
Time Capsule
Questionnaire
Presidential programming
Obesity researchers receive lifetime achievement awards
Top speakers for psychology’s top meeting
Science Watch
Homing in on sickle cell disease
Psychologist Profile
Alone in the ‘hole’
Public Interest
State Leadership Conference ‘12
Perspective on Practice
Education tops council’s agenda
Meet the candidates for APA’s 2014 president
Presidential election guidelines
Division Spotlight
American Psychological Foundation
Support for sexual miniorities
Personalities

Monitor on Psychology - May 2012

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