Calling on your wisdom

[randomdoc1]

Hello everyone. I plan to write a letter to the governor's office to ask for review of the Medicaid fee schedule. In brief, I'm hoping my state can have the E&M code rates increased so physicians are more incentivized to work with this population. I'm calling on everyone's wisdom here, if anyone knows of any articles showing that addressing MH needs leads to better outcomes such as lower health care costs, better outcomes in mortality and morbidity, any data to show that this is a worthy investment of the state. Many patients carry Medicaid but one of the biggest barriers is the low reimbursement for physicians. I think this could be a win win. This is also part of my grand scheme to try to get my clinic as far away from Optum's influence as possible, so teaming up with local payers will certainly help take some power away from these biggies and how they treat us providers. So tired of the convoluted phone trees that keep transferring you to a third world country...

I can't speak for other states, but Medicaid in this state treats MH providers in general pretty well. The reimbursement is very very nice for psychotherapy and the customer service is great. Just wish there were better E&M code rates. Wish me luck, I'd love any help and link to articles to convince the higher ups!

---

Members don't see this ad.

 

[WisNeuro]

Hello everyone. I plan to write a letter to the governor's office to ask for review of the Medicaid fee schedule. In brief, I'm hoping my state can have the E&M code rates increased so physicians are more incentivized to work with this population. I'm calling on everyone's wisdom here, if anyone knows of any articles showing that addressing MH needs leads to better outcomes such as lower health care costs, better outcomes in mortality and morbidity, any data to show that this is a worthy investment of the state. Many patients carry Medicaid but one of the biggest barriers is the low reimbursement for physicians. I think this could be a win win. This is also part of my grand scheme to try to get my clinic as far away from Optum's influence as possible, so teaming up with local payers will certainly help take some power away from these biggies and how they treat us providers. So tired of the convoluted phone trees that keep transferring you to a third world country...

I can't speak for other states, but Medicaid in this state treats MH providers in general pretty well. The reimbursement is very very nice for psychotherapy and the customer service is great. Just wish there were better E&M code rates. Wish me luck, I'd love any help and link to articles to convince the higher ups!

I would check with your state guild association as well. We are actually tackling this issue at the moment in our own state and partnering with NAMI to lobby legislators. We're currently at the point of proposing a formula to use so that the rates can auto adjust vs having to tackle this every 5-10 years.

 

[randomdoc1]

I would check with your state guild association as well. We are actually tackling this issue at the moment in our own state and partnering with NAMI to lobby legislators. We're currently at the point of proposing a formula to use so that the rates can auto adjust vs having to tackle this every 5-10 years.

I think that is a really great idea. I'll reach out to contacts I have in the local psychiatric association and medical society. I think most of us would feel this is a smart move and does not hurt to open the discussion. NAMI is a great idea too! Didn't even stop to think of the contacts already here! Maybe my dreams are too lofty, but I thought the local Medicare rates would be a start? Medicare already has a formula in place that at least here, is pretty fair. Don't know how exactly they calculate it. It would be an investment on the part of the state alright. But I think an investment that would pay off considering how little access to high quality providers the Medicaid population has and potential for collateral expenses from higher level of care that could have been minimized with more proactive/preventative care.

 

[PsyDr]

It's probably the wrong point of contact. I would call the board of directors on the Dept of Health, and the medical director for the state's medicaid office.

 

[WisNeuro]

I think that is a really great idea. I'll reach out to contacts I have in the local psychiatric association and medical society. I think most of us would feel this is a smart move and does not hurt to open the discussion. NAMI is a great idea too! Didn't even stop to think of the contacts already here! Maybe my dreams are too lofty, but I thought the local Medicare rates would be a start? Medicare already has a formula in place that at least here, is pretty fair. Don't know how exactly they calculate it. It would be an investment on the part of the state alright. But I think an investment that would pay off considering how little access to high quality providers the Medicaid population has and potential for collateral expenses from higher level of care that could have been minimized with more proactive/preventative care.

I believe Medicare rates/reimbursements have to happen almost exclusively at the federal level. That's a higher hill to climb. Your state level legislators can do something about Medicaid rates, though that also dpeends on how much they have in funds/if they opted for Medicaid expansion. In one of my old states, the practices that I worked with took medicaid patients as pro bono pats as the reimbursements barely even covered the materials cost for evaluations.

I'll also echo @PsyDr in that the governors office isn't teh point of contact you want, unless they are passionate and are already thinking about this as a pet project.

 

[randomdoc1]

I believe Medicare rates/reimbursements have to happen almost exclusively at the federal level. That's a higher hill to climb. Your state level legislators can do something about Medicaid rates, though that also dpeends on how much they have in funds/if they opted for Medicaid expansion. In one of my old states, the practices that I worked with took medicaid patients as pro bono pats as the reimbursements barely even covered the materials cost for evaluations.

I'll also echo @PsyDr in that the governors office isn't teh point of contact you want, unless they are passionate and are already thinking about this as a pet project.

Thanks! Oh no, I wasn't asking for Medicare rates to be adjusted. I was thinking Medicaid could use Medicare rates maybe as a benchmark to decide what to do with the Medicaid formula. Medical director for the state's Medicaid office is a good idea.

 

[Merovinge]

I'm in a state where medicaid is absolute garbage for OP reimbursement and it's a tragedy for our youth. I cannot even imagine how amazing it would be if kids could get any of the actually needed services beyond waiting for a year and crossing their fingers at an academic institute locally. I think most CAP would make less money than a similarly booked hair stylist if they took medicaid, I don't know a single doc who does accordingly.

 

[randomdoc1]

I'm in a state where medicaid is absolute garbage for OP reimbursement and it's a tragedy for our youth. I cannot even imagine how amazing it would be if kids could get any of the actually needed services beyond waiting for a year and crossing their fingers at an academic institute locally. I think most CAP would make less money than a similarly booked hair stylist if they took medicaid, I don't know a single doc who does accordingly.

I was floored by the past few years when the reimbursement for psychotherapy shot up for master's and doctorate providers. But it was so refreshing to see. I'm gonna starting trying for the physician services. I'm more hopeful about state legislation change than Optum ever being willing to negotiate their fee schedule. Optum reimburses our office decently, but they randomly demand rigorous chart reviews and I never feel easy about them. I'm always on edge with that presence in the clinic.

 

[ObsequiousAplomb]

Thanks! Oh no, I wasn't asking for Medicare rates to be adjusted. I was thinking Medicaid could use Medicare rates maybe as a benchmark to decide what to do with the Medicaid formula. Medical director for the state's Medicaid office is a good idea.

One of the few redeeming qualities about Ohio is that medicaid reimbursement is equal to Medicare rates for CMHCs. It's seems like a good model to try to parrot.

 

[Sushirolls]

I believe these are lofty goals and a waste of your precious time.

State budgets are already bloated with waste. Medicaid and healthcare is something the state doesn't want to do, and they are always trying to reduce.

States got rid of the asylums back in the day, when probably, it would have been more cost effective for society as a whole to keep a modern version around to some degree - but no state is going to dare bring this up as a solution to the homeless crisis because of the history of the percentage of state budgets asylums used to consume.

Even if you get a slightly higher rate for medicaid you will still be facing a double edged sword - a population that has greater severity of symptoms. And secondly, they will have "authorized visits" and thick paperwork bureaucracy layers. You will need more staff, and your staff will be worn down more processing this insurance, and you will be worn down more by the severity of the population. This doesn't even factor in the No Show rate, or even the poor collections of anything out of pocket - which would be easiest and most likely way to increase rates - put it on the patient as co-insurance...

Thirdly, before anything mental health gets reviewed with medicaid, dialysis is higher up the need food chain, and housing for MRDD.

I'm the debbie downer on this goal. In summary, lost cause. But don't worry, you'll likely watch your state throw money at DEI, homeless housing "solutions" by the millions, or instigating laws they know will trigger lawsuits just for political virtue signaling, and lawyers gobble up the other millions to defend these laws.

 

[randomdoc1]

I get what you're saying @Sushirolls ! I'm not sure which is worse, Medicaid or Optum. I'll give things a shot. With the Medicaid population here for therapy, we've mastered the attendance and inability to charge for no show issue. We just have a strict policy about attendance. For therapy, we don't need authorizations. It's been amazing with the great payout and patients can come in weekly for whoever knows how long. I dipped my toe with one provider, trying out Medicaid. And it's grown massively since. All we need to do is provider sees patient, no auth needed, I send claim, claim pays within 3 weeks. Attendance is actually pretty darn good. If a patient has needs we cannot fulfill, we refer out. And there is a subpopulation that is not as severe and they are motivated enough to maintain a healthy working relationship. No trouble from the state, knock on wood. I think they are too busy chasing the fraudulent clinics who are billing for services never rendered and collecting in the millions per year so we're small potatoes.

My overarching goal is to avoid being predominantly vulnerable to any one major payor. The clinic now is paneled with over 20 insurances. I've steadily negotiated each one up in the rates. The insurances now have to compete with each other for spots in the clinic. There are some insurances that just don't care, but the beauty of having multiple alliances is you can play up the relationships that are working more favorably. I try to keep my options open. Still focusing my time on the practice, this is a bit of a side project. I fear Optum will only get more oppressive to providers with time and it's going to be hard to support more psychiatrists at this office without them because it takes many more patients to fill up a psychiatrist versus psychotherapy. Half the state carries Optum so this means with each new psychiatrist, if I exclude Optum it will take twice as long to fill up. But if I fill up with Optum, they keep bugging us with those random chart reviews and they are time consuming. And I foresee the more money Optum sees going to one place, the more aggressive they can get. Any chance of another ally is welcome. Optum is not much better to work with than the state....

and at this rate, for psychotherapy, the state is paying way better than Optum and review records way less.

 

[allantois]

I used to be endlessly frustrated working with medicaid patients. They would frequently no show up to 10 times to their app. Could not be charged a no show fee and did not seem to value their appointments. I don't necessarily find this to be true of pediatric patients with medicaid, however. Oh, they also could not access any specialists and often PCP so you would be hard pressed to manage things outside of psych. Sometimes they couldn't even get to a pharmacy to get their meds.. These days anyone with a phone can have access to psych, not so much anything else

 

[allantois]

One of the few redeeming qualities about Ohio is that medicaid reimbursement is equal to Medicare rates for CMHCs. It's seems like a good model to try to parrot.

Why is this limited to CMHC? They are dumping a difficult patient population on one type of mental health provider

 

[ObsequiousAplomb]

Why is this limited to CMHC? They are dumping a difficult patient population on one type of mental health provider

To incentivize being a CMHC. I agree that it should be for any providers, but it's designed so that CMHCs will absorb medicaid patients. Kind of like car dealership requirements in each state.

 

[smalltownpsych]

I get what you're saying @Sushirolls ! I'm not sure which is worse, Medicaid or Optum. I'll give things a shot. With the Medicaid population here for therapy, we've mastered the attendance and inability to charge for no show issue. We just have a strict policy about attendance. For therapy, we don't need authorizations. It's been amazing with the great payout and patients can come in weekly for whoever knows how long. I dipped my toe with one provider, trying out Medicaid. And it's grown massively since. All we need to do is provider sees patient, no auth needed, I send claim, claim pays within 3 weeks. Attendance is actually pretty darn good. If a patient has needs we cannot fulfill, we refer out. And there is a subpopulation that is not as severe and they are motivated enough to maintain a healthy working relationship. No trouble from the state, knock on wood. I think they are too busy chasing the fraudulent clinics who are billing for services never rendered and collecting in the millions per year so we're small potatoes.

My overarching goal is to avoid being predominantly vulnerable to any one major payor. The clinic now is paneled with over 20 insurances. I've steadily negotiated each one up in the rates. The insurances now have to compete with each other for spots in the clinic. There are some insurances that just don't care, but the beauty of having multiple alliances is you can play up the relationships that are working more favorably. I try to keep my options open. Still focusing my time on the practice, this is a bit of a side project. I fear Optum will only get more oppressive to providers with time and it's going to be hard to support more psychiatrists at this office without them because it takes many more patients to fill up a psychiatrist versus psychotherapy. Half the state carries Optum so this means with each new psychiatrist, if I exclude Optum it will take twice as long to fill up. But if I fill up with Optum, they keep bugging us with those random chart reviews and they are time consuming. And I foresee the more money Optum sees going to one place, the more aggressive they can get. Any chance of another ally is welcome. Optum is not much better to work with than the state....

and at this rate, for psychotherapy, the state is paying way better than Optum and review records way less.

Optum is worse. In my mind, the only thing worse than a government run program is a corporation that runs a government program.

 

[Sushirolls]

What Optum does, cigna will then follow. Trailing just behind that is Aetna and the blues (depending on the state).

I know your fear. I just moved from one area where one insurance was paying $200+ per 99214, to now realizing my reconnaissance for new practice area was wrong. Not $160-180, but $119. Upon this discovery I freaked out. Keep doing current plan, and chase volume? Close up, take employed job which this insurance is paying them more per 99214? Or retool and do the cash only with therapy. As of right now just gonna take the gut punch and pursue Plan A. But the fear of what would happen if the better rates plummet, has finally come knocking. Merry Christmas to all!