"Incident-To" (Supervisory) Billing with Headway and/or Hello Alma

[PX1985]

Hello all!

I am an early-career psychologist who has been paneled with Alma for a few years. My caseload is about 50% private pay and 50% insurance (providing Telehealth services in New York State). I only accept Aetna through Alma.

My question is this:

Is it possible to bill Aetna (through Alma/Headway) for services provided by supervisees (psychologists or mental health counselors who are accruing hours toward licensure). Aetna allows incident-to billing (supervisory billing), but Alma explicitly forbids it on their website. I contacted Aetna and they said it was allowed through Alma's Tax ID and NPI number, so I'm confused regarding the legality of submitting claims on behalf of supervisees through Alma.

Has anyone had any clarity regarding this? Do you know of any workarounds or whether this can be achieved through contracting with another company? I'm open to suggestions. At this point I have overflow (thank goodness) and a pipeline of new-grads who are interested in working under my supervision as they accrue hours toward licensure.

Any help would be appreciated! I'm open to paneling through another agency or directly through Aetna if that makes it "kosher."

Thank you everyone!

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[PsyDr]

1) Legality is separate from your contractual obligations. If your contract says you cannot do something, you can't do it. If you did, they would be well within their rights to take their money back, or sue you, for violating the terms of their contract. If you misrepresented the billing on billing forms, it could potentially be considered insurance fraud. Such liabilities are open to "qui tam" claims, which pay whistleblowers (i.e., pissed off post docs) ,who report these concerns, a percent of the money recovered.

2) Federal law defines supervision as being physically present in the same office. That probably cannot be accomplished in telehealth settings. Basically, "This means that the physician or psychologist must be physically present in the same office suite as the non-licensed practitioner providing the incident-to service and be immediately available to provide assistance if that becomes necessary"

3) Federal rule: "For psychology services rendered under the "incident to" provision, the billing provider must first evaluate the patient personally and then initiate the course of treatment. The appropriately trained therapists may then render psychological services to the patient under the billing provider's direct supervision."

 

[PX1985]

1) Legality is separate from your contractual obligations. If your contract says you cannot do something, you can't do it. If you did, they would be well within their rights to take their money back, or sue you, for violating the terms of their contract. If you misrepresented the billing on billing forms, it could potentially be considered insurance fraud. Such liabilities are open to "qui tam" claims, which pay whistleblowers (i.e., pissed off post docs) ,who report these concerns, a percent of the money recovered.

2) Federal law defines supervision as being physically present in the same office. That probably cannot be accomplished in telehealth settings. Basically, "This means that the physician or psychologist must be physically present in the same office suite as the non-licensed practitioner providing the incident-to service and be immediately available to provide assistance if that becomes necessary"

3) Federal rule: "For psychology services rendered under the "incident to" provision, the billing provider must first evaluate the patient personally and then initiate the course of treatment. The appropriately trained therapists may then render psychological services to the patient under the billing provider's direct supervision."

1) Makes sense--I haven't looked to see if it was explicitly prohibited in my contract, but I'm pretty sure it is.

2) This seems almost arbitrary at this point--I cannot count the number of colleagues, friends, mentors who are currently providing supervision to postdocs via telehealth at this point. I understand that this may be legally prohibited, but it seems rampant in practice (at least in my circles).

3) Yes, this makes sense. Again, this seems to be "best practices" but many (if not most) people I know don't follow this as a hard-and-fast-rule.

4) Do you have any suggestions to help address my main questions--i.e., do you know of any ways to bill incident-to billing legally and ethically for INN services rendered by a supervisee?

 

[PsyDr]

1) Makes sense--I haven't looked to see if it was explicitly prohibited in my contract, but I'm pretty sure it is.

2) This seems almost arbitrary at this point--I cannot count the number of colleagues, friends, mentors who are currently providing supervision to postdocs via telehealth at this point. I understand that this may be legally prohibited, but it seems rampant in practice (at least in my circles).

3) Yes, this makes sense. Again, this seems to be "best practices" but many (if not most) people I know don't follow this as a hard-and-fast-rule.

4) Do you have any suggestions to help address my main questions--i.e., do you know of any ways to bill incident-to billing legally and ethically for INN services rendered by a supervisee?

I suggest you quit breaking the law, quit being cavalier about it, and quit advertising the fact that you’re breaking the law… especially in a situation where a bunch of poor students could easily make money by reporting you to any number of qui tam attorneys in the state of New York.

It’s like I’m trying to explain to someone why it’s a bad idea to covering yourself in blood, walk into shark infested waters, and start wriggling around like an injured seal.

 

[WisNeuro]

I suggest you quit breaking the law.

But, I mean, other people are doing it, why can't I?

 

[PsyDr]

But, I mean, other people are doing it, why can't I?

“Hey forum full of poor students, I’m setting you up to make tens to hundreds of thousands of dollars. It will only take a few emails to get that paycheck.

I ain’t worried.”

 

[PX1985]

“Hey forum full of poor students, I’m setting you up to make tens to hundreds of thousands of dollars. It will only take a few emails to get that paycheck.

I ain’t worried.”

Why in the world are you being so patronizing about it? Tens of hundreds of dollars? I'm able to offer friends/mentees and colleagues nearly 80-100k right out of graduate school and I am trying to do so in an ethical and legal way.

I have office space for them to provide services in--I'm trying to be compliant with Alma/Aetna/State guidelines and came on here to ask for clarity regarding these pieces.

No need to be so rude.

Please reread my last question: "do you know of any ways to bill incident-to billing legally and ethically for INN services rendered by a supervisee?"

If you are unable to help, then you are invited to ignore this post and move on with your day.

 

[PsyDr]

Why in the world are you being so patronizing about it? Tens of hundreds of dollars? I'm able to offer friends/mentees and colleagues nearly 80-100k right out of graduate school and I am trying to do so in an ethical and legal way.

I have office space for them to provide services in--I'm trying to be compliant with Alma/Aetna/State guidelines and came on here to ask for clarity regarding these pieces.

No need to be so rude.

Please reread my last question: "do you know of any ways to bill incident-to billing legally and ethically for INN services rendered by a supervisee?"

If you are unable to help, then you are invited to ignore this post and move on with your day.

You are openly admitting to a federal crime in a public forum.

What is the ethical way to handle this?

 

[PX1985]

You are openly admitting to a federal crime in a public forum.

What is the ethical way to handle this?

Maybe something was lost in communication, but I'm in the process of attempting to hire postdocs and have them provide services under my license. I have not hired anyone yet, but I have overflow and would like to begin funneling them to junior colleagues.

That is why I am checking how to go about it here before taking any action and asking if other people have had any experience setting this up.

 

[AbnormalPsych]

f you misrepresented the billing on billing forms, it could potentially be considered insurance fraud. Such liabilities are open to "qui tam" claims, which pay whistleblowers (i.e., pissed off post docs) ,who report these concerns, a percent of the money recovered.

Side question, but just curious. How would filing this under the false claims act go down, hypothetically, given the trainees need to protect patient confidentiality here? They couldn't report specifics of each claim of alleged billing fraud with identifiers, right? Would it be a blanket complaint and left to the government to investiage if they accepted the case?

 

[smalltownpsych]

The CMS rule requiring supervisor be available when supervisee is providing services is pretty clear. This applies to Medicare patients so not necessarily all patients although what CMS says tends to be what everyone does. You would also look at the state law regarding this and also consult with an attorney regarding legality of your practices. This latter part might make a lot of sense especially since this is going to be your business model.

 

[PsyDr]

Side question, but just curious. How would filing this under the false claims act go down, hypothetically, given the trainees need to protect patient confidentiality here? They couldn't report specifics of each claim of alleged billing fraud with identifiers, right? Would it be a blanket complaint and left to the government to investiage if they accepted the case?

You call up an attorney, tell them, "I think my supervisor is falsely billing insurance". They ask some questions, and files the lawsuit. They have some process to protect the patients. Maybe a special master or something.

There was a case where a psych student did this a few years ago. Made him/her six figures.

 

[R. Matey]

Not that I disagree with @PsyDr, but it seems that Medicare may have temporarily waved that requirement during COVID-19:

Medicare Physician Supervision Requirements: CMS has temporarily modified the regulatory definition of direct supervision, which requires the supervising physician or practitioner to be “immediately available” to furnish assistance and direction during the service, to include “virtual presence” of the supervising clinician through the use of realtime audio and video technology. This flexibility is currently set to return to pre-PHE rules at the end of the calendar year that the PHE ends.

Source: https://www.cms.gov/files/document/...inicians-cms-flexibilities-fight-covid-19.pdf

Might be moot now consider the public health emergency has ended.

 

[ela]

I think the requirement for face-to-face (like most things) depends on the state you are in. In several states I am licensed in face-to-face includes telesessions.

Headway explicitly sells (or tried to sell me) on the idea of building a group practice/billing for supervisees so I'm pretty sure its legit within their contract.

 

[smalltownpsych]

Just to be clear, face to face supervision requirements and supervisor on-site requirements are two different things.

 

[PsyDr]

I think the requirement for face-to-face (like most things) depends on the state you are in. In several states I am licensed in face-to-face includes telesessions.

Headway explicitly sells (or tried to sell me) on the idea of building a group practice/billing for supervisees so I'm pretty sure its legit within their contract.

The company doesn’t care if you do legal things. They put a clause in your contract that says “I will only do things legally.”. If you engage in insurance fraud, they turn around and say, “they must have been working outside the scope of the contract. We are not liable.”.

I’ve had a few companies offer me dream jobs with promises that would require me to break the law.

I would HIGHLY encourage you to consult with an attorney. There are federal prisons that are full of people who say, “my boss said it was okay”.

If not, can you DM me the email they sent to you? I could take another few mil.

 

[PX1985]

The company doesn’t care if you do legal things. They put a clause in your contract that says “I will only do things legally.”. If you engage in insurance fraud, they turn around and say, “they must have been working outside the scope of the contract. We are not liable.”.

I’ve had a few companies offer me dream jobs with promises that would require me to break the law.

I would HIGHLY encourage you to consult with an attorney. There are federal prisons that are full of people who say, “my boss said it was okay”.

If not, can you DM me the email they sent to you? I could take another few mil.

Yeah this is getting pretty sticky--I've just scheduled a consultation with an attorney who specializes in law surrounding mental health practice in my state. Hopefully I can gain some clarity regarding all of this. Will keep everyone updated on this forum when I hear more (for present and future people who may be interested in the legality of these issues).

Thank you everyone for the feedback!