APA Action Alert

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Psychologists in the Medicare program face a significant reduction in payment in 2013 if Congress fails to take action by the end of the year. Congress has blocked the Sustainable Growth Rate (SGR) cut 14 times since 2001 and it must do so again or Medicare rates will be reduced by 26.5% starting January 1, 2013. Your Senators and Representative need to hear from you TODAY to do what’s right for Medicare beneficiaries and prevent the SGR cut.

Legislators return to Capitol Hill this week and must quickly restart negotiations to avoid the fiscal cliff, an economically challenging combination of expiring tax provisions and unemployment insurance, approach of the debt limit, automatic defense and non-defense spending cuts (known as the “sequestration”) and the once again looming SGR. Much remains at stake for practicing psychologists, as changes in Medicare reimbursement rates will not only affect Medicare beneficiaries but also individuals with TRICARE or private insurance from third party payers that follow Medicare’s lead.

What might this mean for your patients and practice? Below you will find examples of the impact of the SGR on approximate nationwide payment rates for several key services provided by psychologists (which vary regionally and may change depending on the implementation of various Medicare regulations):

Code Service w/o SGR w/ SGR
90791 Psychiatric diag. evaluation $151 $111
90834 Psychotherapy, 45 minutes $81 $59
96101 Psychological testing, professional $83 $61
96118 Neuropsychological testing, professional $92 $67
96119 Neuropsychological testing, technician $74 $55

Take Action!

Click here to urge your Senators and Representative to halt
Medicare cuts to psychological services

http://capwiz.com/apapractice/issues/alert/?alertid=62191001

If you are not able to reach the Legislative Action Center from the above link, please visit http://www.capwiz.com/apapractice/issues/alert/?alertid=62191001&type=CO. Please take action as soon as possible and at latest by Wednesday, December 5.

Grassroots feedback is also extremely important to our advocacy efforts, so we would very much appreciate it if you would e-mail ([email protected]) or fax (202-336-5797) us any substantive responses you receive from your Representative or Senators.

 

[JeyRo]

Psychologists in the Medicare program face a significant reduction in payment in 2013 if Congress fails to take action by the end of the year. Congress has blocked the Sustainable Growth Rate (SGR) cut 14 times since 2001 and it must do so again or Medicare rates will be reduced by 26.5% starting January 1, 2013. Your Senators and Representative need to hear from you TODAY to do what’s right for Medicare beneficiaries and prevent the SGR cut.

Legislators return to Capitol Hill this week and must quickly restart negotiations to avoid the fiscal cliff, an economically challenging combination of expiring tax provisions and unemployment insurance, approach of the debt limit, automatic defense and non-defense spending cuts (known as the “sequestration”) and the once again looming SGR. Much remains at stake for practicing psychologists, as changes in Medicare reimbursement rates will not only affect Medicare beneficiaries but also individuals with TRICARE or private insurance from third party payers that follow Medicare’s lead.

What might this mean for your patients and practice? Below you will find examples of the impact of the SGR on approximate nationwide payment rates for several key services provided by psychologists (which vary regionally and may change depending on the implementation of various Medicare regulations):

Code Service w/o SGR w/ SGR
90791 Psychiatric diag. evaluation $151 $111
90834 Psychotherapy, 45 minutes $81 $59
96101 Psychological testing, professional $83 $61
96118 Neuropsychological testing, professional $92 $67
96119 Neuropsychological testing, technician $74 $55

Take Action!

Click here to urge your Senators and Representative to halt
Medicare cuts to psychological services

http://capwiz.com/apapractice/issues/alert/?alertid=62191001

If you are not able to reach the Legislative Action Center from the above link, please visit http://www.capwiz.com/apapractice/issues/alert/?alertid=62191001&type=CO. Please take action as soon as possible and at latest by Wednesday, December 5.

Grassroots feedback is also extremely important to our advocacy efforts, so we would very much appreciate it if you would e-mail ([email protected]) or fax (202-336-5797) us any substantive responses you receive from your Representative or Senators.

I've worked at the VA for 7+ years in geropsych. and am about to take a stab at independent practice (as opposed to consulting with groups, which I've done on and off for the past few years) and I'm seriously considering officially opting out of medicare, depending on what offers I get, even if these cuts don't take place. Medicare paperwork and regs seem ridiculous to me and even if the rates got a modest bump (as opposed to this big cut) I'd find them less than worth my time, I think.

 

[Goobernut]

I've worked at the VA for 7+ years in geropsych. and am about to take a stab at independent practice (as opposed to consulting with groups, which I've done on and off for the past few years) and I'm seriously considering officially opting out of medicare, depending on what offers I get, even if these cuts don't take place. Medicare paperwork and regs seem ridiculous to me and even if the rates got a modest bump (as opposed to this big cut) I'd find them less than worth my time, I think.

You know, I completely understand this from a providers point of view. But the irony is that Medicare is considered the cash cow of a facility. Maybe because I'm in Florida? They pay very quickly, and with very little hassle once you understand the billing system. Once I got experience billing/coding Medicare on both the provider and facility side, I could write my own ticket in the billing world (in several states, not just Florida). Yes, Medicare has low reimbursement, but at least they pay you. Blue Cross and Blue Shield will stall claims for as long as they can get away with. Regionally, different companies are different, and every area will have its worst offender. But everyone wanted to a Medicare provider, because although the pay was low, at least it was steady money.

Sooooo as I've searched for career paths, it was important to pick an option that allowed me to bill medicare. Do any of you that are on panels notice a difference with different companies? And some of the companies make the billing rules so difficult, they overtax the abilities of those poor billing staff getting paid $10 an hour to file your claims. I know that psychologists don't have the volume that MD's do, so maybe you all don't notice as much difference? Or perhaps the demographics are that different?

 

[Sanman]

You know, I completely understand this from a providers point of view. But the irony is that Medicare is considered the cash cow of a facility. Maybe because I'm in Florida? They pay very quickly, and with very little hassle once you understand the billing system. Once I got experience billing/coding Medicare on both the provider and facility side, I could write my own ticket in the billing world (in several states, not just Florida). Yes, Medicare has low reimbursement, but at least they pay you. Blue Cross and Blue Shield will stall claims for as long as they can get away with. Regionally, different companies are different, and every area will have its worst offender. But everyone wanted to a Medicare provider, because although the pay was low, at least it was steady money.

Sooooo as I've searched for career paths, it was important to pick an option that allowed me to bill medicare. Do any of you that are on panels notice a difference with different companies? And some of the companies make the billing rules so difficult, they overtax the abilities of those poor billing staff getting paid $10 an hour to file your claims. I know that psychologists don't have the volume that MD's do, so maybe you all don't notice as much difference? Or perhaps the demographics are that different?

For facilities and medical staff, medicare is a cash cow as it allows for volume and easier billing even if profit margins are slim. However, unlike medical staff, therapists tend to bill more based on time rather than procedure, so we get squeezed more than those that can easily make up slimmer margins with reduced procedure time. That said, psychologists can still make up the difference slightly doing lots of 90801 and follow up 90804 (minimum sessions of 20 min) rather than the traditional 90806.

 

[Sanman]

I've worked at the VA for 7+ years in geropsych. and am about to take a stab at independent practice (as opposed to consulting with groups, which I've done on and off for the past few years) and I'm seriously considering officially opting out of medicare, depending on what offers I get, even if these cuts don't take place. Medicare paperwork and regs seem ridiculous to me and even if the rates got a modest bump (as opposed to this big cut) I'd find them less than worth my time, I think.

For independent practice, I do not take medicare. There is not enough profit in it to cover overhead of a practice unless you are doing PP full-time. Even then it pays less than most other payors. The point, to me, of private practice is lower volume and higher returns per patient.

 

[Doctor Eliza]

You know, I completely understand this from a providers point of view. But the irony is that Medicare is considered the cash cow of a facility. Maybe because I'm in Florida? They pay very quickly, and with very little hassle once you understand the billing system. Once I got experience billing/coding Medicare on both the provider and facility side, I could write my own ticket in the billing world (in several states, not just Florida). Yes, Medicare has low reimbursement, but at least they pay you. Blue Cross and Blue Shield will stall claims for as long as they can get away with. Regionally, different companies are different, and every area will have its worst offender. But everyone wanted to a Medicare provider, because although the pay was low, at least it was steady money.

Sooooo as I've searched for career paths, it was important to pick an option that allowed me to bill medicare. Do any of you that are on panels notice a difference with different companies? And some of the companies make the billing rules so difficult, they overtax the abilities of those poor billing staff getting paid $10 an hour to file your claims. I know that psychologists don't have the volume that MD's do, so maybe you all don't notice as much difference? Or perhaps the demographics are that different?

I'm completely shocked by your post. We have a billing staff at our practice. They are absolutely amazing and everything they have said about Medicare is 180 degrees the opposite of what you said. Additionally, psychologists on our state list serve have posted extensively about their problems getting paid for the work they did through Medicare. They make things unnecessarily complex and seem to have a secret rule book. If you make an error on a secret rule, they reject the claim and are not very clear (or consistent) about why. They seem to love the frequent insurance company game of delaying and denying until you give up. Our state psych Assn has needed to get involved and advocate for some professionals who were unjustly not being reimbursed for services. People who deal with billing Medicare have told me time and time again that they are by far much worse than any insurer.

Just glad I don't have to do billing.

Best,
Dr. E

 

[Goobernut]

Thanks Dr. E and Sanman for responding!

I have worked both facility side and provider side, but not in the same state. So I didn't know if the differences in my experience were due to region or just nature of the beast. You guys helped clear that up!

Quite a few of the billers that worked with me at the hospital did not like Medicare, but it was the upper management who expressed the opinion that Medicare was the meat of the billing. In my opinion, there are CRAZY medicare rules on the facility side, but they tend to be stable. I.e. they are not changing on a weekly basis. I preferred that kind of situation to the private insurance companies that were constantly changing their rules. All that being said, if you aren't a Medicare provider here in Florida, you are unable to provide services to quite a bit of the state population. Which I'm guessing that's a big influence on why I thought you had to be able to bill Medicare to practice. 🙄

Also, I when I did provider billing, I worked for surgeons. So you also have to take into account that type of medical billing has more attention paid to it (for lack of a better phrase), and therefore might have more of the kinks worked out. Again, I'm just theorizing because I've never worked in a psychologists office or coded out of the DSM before, or the psych section of the CPT. While I'm sure the work is similar, it's still a different system. I was surprised to see JeyRo say that he didn't want to take Medicare, because of my recent experience here in Florida.

Billing for a PP is HUGELY different than billing for a facility. Different rules, different coding systems, bizarrely different. So again, what Sanman says makes sense to me 🙂

I know medicare seems like they have a secret rule book (my co-workers have all said the same thing!) but it's all very well published. It's just an insane amount of rules. Its all very easily accessible, but you really have to know where to look and understand their jargon. Which might as well make it a secret squirrel book.

No provider should have to do their own billing. It's sick and wrong.

I'm completely shocked by your post. We have a billing staff at our practice. They are absolutely amazing and everything they have said about Medicare is 180 degrees the opposite of what you said. Additionally, psychologists on our state list serve have posted extensively about their problems getting paid for the work they did through Medicare. They make things unnecessarily complex and seem to have a secret rule book. If you make an error on a secret rule, they reject the claim and are not very clear (or consistent) about why. They seem to love the frequent insurance company game of delaying and denying until you give up. Our state psych Assn has needed to get involved and advocate for some professionals who were unjustly not being reimbursed for services. People who deal with billing Medicare have told me time and time again that they are by far much worse than any insurer.

Just glad I don't have to do billing.

Best,
Dr. E