Saturday, February 15, 2014

The Mystery of Two Dorothy/ Dorothea Dixes, both with Mental Health History Issues

Continuing w/ the matter of the Dorothy Dix, who wrote a column in the New Orleans Times-Picayne at the turn of the last century.  She was NOT the DOROTHEA Dix who earlier worked w/ the mentally ill.  This DOROTHY Dix, a pen name she chose as directed by her editor, 'The Major', had this birth name: Elizabeth Meriweather (descended, as I said previously from Meriwether Lewis of Lewis & Clark fame). 

From page 59-60: (in being directed by the editor of the paper to choose a pen name for her Sunday column, w/ she living in New Orleans, having left her mentally ill unstable husband who could not keep a job and had temper control issues):

"....Dorothy Dix....she liked the sound the sound of the words, and so did the Major (the editor), and that was it. Not until years passed did she hear about Dorothea Dix, the New Englander, who worked so devotedly to obtain fairer treatment for the mentally ill.  The newspaper woman's sly adoption of a similar name was no sly allusion, as some thought, to her husband's illness.

Well, isn't this curious? Its as if the younger Dorothy Dix was being 'directed' by the older Dorothea Dix to move in a certain direction...the claiming of her own life, snatching it away from the untoward influence of her mentally ill husband. 

And so Dorothy Dix writes:

"I stood yesterday.  I can stand today. And I will not permit myself to think about what might happen tomorrow."

And like myself, and this blog, referring to Dickens' character, Madame Defarge, the old crone purling away as the heads rolled off the guillotine of the French Revolution, "Nobody could spend a few hours with her without hearing something about a Dickens character." (p. 28)

"....By the time she was fifteen she was putting out her own private newspaper, making herself 'proprieter, editor, contributor, compositor, and sole subscriber..." (p. 31).

And as this Dorothy Dix recognized that she would never have any domestic stability due to her husband's mental instability, dragging them from city to city whereupon he lost job after job, she resigned herself to having no children---a woman who very much wanted children.  And her father, upon seeing how she was suffering, took her to the Mississippi Gold Coast for a long holiday when she was in her early 30's.  Her neighbor introduced her into the Times-Picayne as she resolved that hard work was the only antidote to her sorrow:

"The only panacea for grief is to keep so busy that you have no time to think of your sorrow, and to work so hard that you sleep at night through sheer exhaustion. I know, for I travelled the dark road for thirty-five years, and I should have gone crazy if I'd had enough time to do it."

"Dear Dorothy Dix" : Muse for the 21st Century

Part I: Its a funny thing: I lost my muse re: this  blog: too much work/ little inspiration. 

Part II: I was at the Grove Park Arcade Wine and Book Bar this evening....Val Day...by myself....red leggings and a short black skirt...looking pretty hot....looking thru the NC books section and whadyaknow: stumbled across a lost muse whose name floats across NC re: tearing down her mental health hospital (her husband of 40 years had a mental health challenge which inspired her column of 'Dear Dorothy Dix' at the New Orleans Times-Picayne---not her real name---she was a descendent of the Merriweathers..ya got that right...Meriwether Lewis of Lewis & Clark fame).  Her friends implored her to leave him time and again but she would not.

The subtitle of the book was laughable once you start to look at what and how she wrote:  "Dear Dorothy Dix: The Story of a Compassionate Woman."  I ASK YOU: what is it about the South that sentences women to the lesser of emotions, in terms of action.  The woman was a FIREBRAND.  To suit, the author was a man, Harnett T. Kane; the book written in 1952. 

She was no wilting rose/ pitiful petunia.  On page 7 of the book is her written word, moving through time, with imagination and potency:

"I have been through the depth of poverty and sickness...I have known want and struggle and anxiety and despair...As I look back upon my life I see it as a battlefield strewn with the wrecks of dead dreams and broken hopes and shattered illusions----a battle in which I always fought with the odds tremendously against me, and which has left me scarred and bruised and maimed and old before my time.

But I have learned to live each day as it comes, and not to borrow trouble by dreading the morrow.  it is the dark menace of the picture that makes cowards of us. I put that dread from me because experience has taught me that when the time comes that I so fear, the strength and wisdom to meet it will be given me."

And SO: I determine that THIS year, 2014, will be associated with a channeling of that muse, Dorothy Dix.  Dear Dorothy Dix: we have so many problems in NC associated with mental health issues.  Thank you, in advance, for your quiet, solid, potent suggestions.  We'll be getting back to you very soon. 

And so, as re: muses, here is one of my favorite songs about the matter, by Loudon Wainwright III (his father was the famous photographer for LIFE magazine for many decades; his son, Rufus, was a 'tit man' (his dad's term, sorry), and is an openly gay musician.  Last time I saw Loudon was in Atlanta about three years ago when he was amazingly, on the stage, w/ Richard Thompson.  What a funny duo: two tremendously talented men, coming from completely different folk music traditions....

Here's Loudon's Muse Blues:

I went down to the library, you know
The big one way downtown
I went down to the library
You know the big one way downtown

I pulled out my spiral notebook
And my Scripto pencil
These are the words
I did put down

I'm a dud firecracker, I ain't got any fuse
I ain't got no inspiration since I lost my muse
I'm a table with two legs, I'm a spider with five
I'm going down, slow muse, when will you arrive?

Oh muse, where are you?
Oh muse, where are you?
You know I eat, drink and I smoke stuff
I don't know what to do, I don't know what to do

Went to the mountain and the desert too
I was there, ladies, so where were you?
I'm a flattened out wave, I ain't got any curl
I'm an empty old oyster, I ain't got any pearl

Muse, where are you?
Oh muse, where are you?
You know I eat, drink and I smoke stuff
I don't know what to do

Sit up late, stay up, wait
That's a rule of thumb, she's got to come
Sit up late, stay up, wait

I take lots of cold showers and I go for long walks
I wait for a pitch but the fickle bitch barks
Took a shot of whiskey and a snort of cocaine
Opened up my head and stuck electrodes in my brain

Oh muse, where are you?
Oh muse, where are you?
Yeah, I eat, drink and I smoke stuff
Eat, drink and I smoke stuff
Eat, drink and I smoke stuff
I don't know what to do
Read more at http://www.songlyrics.com/loudon-wainwright-iii/muse-blues-lyrics/#p4qUU3rb52lxsGrX.99

Sunday, November 10, 2013

NC Psychological Associations: No Mention of Public Mental Health Issues

From: Marsha V. Hammond, PhD, Licensed Psychologist NC

Dear Susan Hill PhD, North Carolina Psychological Association, Mountain Representative: 

Thanks for your hard work as the rep for NCPA for the "Mountain Region."  I just received the November/ December 2013 news letter and I have some comments: 

You indicated that the Executive Director of NCPA, Sally Cameron, is a 'mover and shaker,'  Prove it as re: public mental health.  

Sally Cameron, IMO, is no 'mover and shaker'; indeed, the woman has nothing at all to say, that is useful, re: public mental health e.g., Medicare/ Medicaid.  Twice I have joined NCPA and twice un-joined re: complete lack of attention to public mental health e.g., Medicaid/ Medicare.  I am not suggesting that she be the only person carrying the public mental health 'ball' but I hear/ see/ smell no information from any direction from NCPA re: public mental health.  

To suit, these are some of the pressing problems at this time: 

If one bills 96152, the Health and Behavior codes e.g., 96152 series which APA put into place vis a vis Medicare in 2000-----as of 1.1.2013 (yes, I have talked on the phone w/ Diane Pedulla at APA re: this matter and basically was suggested to "take it to your state org" which is dysfunctional re: public health matters) there is no wrap around to Medicaid under Smoky Mountain Center LME----which is managing Medicaid for about one-fifth of all of NC counties since the collapse of Western Highlands Network LME.  Forget even talking about the thankfully moribund Western Highlands Network LME.  

There is a class action lawsuit around this matter and other non-payment of Medicaid items.  I don't know all the details about that as I am too busy working.  However, Paul Tax, who is over claims at SMC simply had the suggestion to pursue the matter in this way.  

Dr. Bert Bennett, a psychologist at DMA, has no useful information on this.  I have used him as a person who knows what is going on re: these kinds of issues in the past but have no info forthcoming about this lack of wrap around which was formerly in place prior to 1.1.2013. 

That the state psychological association and WNCPA do not even have this on their written radar----as per the WNCPA newsletter-----is perplexing. There was nary a mention of SMC LME or WHN LME collapsing or any other public mental health concerns in the November/ December, 2013 newsletter.  

NCPA and WNCPA are not social clubs for me.  Rather, they should be a place where work should be getting done.  

But that's just my opinion.  Pass this to anyone you like.  

Marsha V. Hammond, PhD, Licensed Psychologist, NC

cc: Irene Matiatos: drirenem@gmail.com
Sally Cameron, NCPA
Paul Tax, Claims, SMC LME
Diane Pedulla, PhD, APA
Bert Bennett, PhD, DMA NC

Friday, August 09, 2013

NC Medicaid 'forgot' to Include Wrap-around Codes to Medicare When LME's took over Medicaid Management


Marsha V. Hammond, PhD, Licensed Psychologist, NC

Address: ______________________ cell: 828 772 5197


NC Mental Health Reform blogspot: http://madame-defarge.blogspot.com/

                                                 Date: August 9, 2013

RE: NC Medicaid ‘forgot’ to include wrap around to Medicare CPT 96152, Health &          Behavior code, for psychologists, when LME’s took over management of Medicaid 1.1.2013

Dear Dr. Diane Pedulla of the American Psychological Association Practice Directorate:

I am writing to you  about a very pressing practice matter which concerns NC psychologists. 

Thanks to the American Psychological Association, beginning in 2000, psychologists were allowed by CMS to utilize the Health & Behavior CPT code 96152 which allows more effective integration of health care.  Prior to the LME’s completely managing Medicaid in NC (in my practice area, it is Smoky Mountain Center LME, about to become the largest LME in NC as Western Highlands Network LME is to be incorporated into SMC LME 10.1.2013), this Medicare CPT code, 96152, paid appropriately and it automatically wrapped around to a DIFFERENT outpatient therapy code via NC Medicaid.  There were no payment issues prior to the LME’s taking over NC Medicaid.  For the past 8 years, I have been paid on time and appropriately for my dually eligible clients, those people being insured primarily by Medicare, w/ a wrap-around to Medicaid.

Prior to 1.1.2013, Value Options and HP Enterprises managed authorizations and payment of NC Medicaid.  Since the LME’s have taken over the complete management of NC Medicaid, utilizing a system known as “NC Tracks”, there is no wrap around available.  I have spoken, at length, to people working at NC Tracks.  I spent an hour today on the phone with an employee there, going over the 288 page Medicaid manual and there is NO MENTION ANYWHERE of 96152 ‘cross-walking’ to any Medicaid code: nada; nothing; does not exist.  I received a ‘number’ which creates a complaint which hopefully will be addressed by the Claims department associated w/ NC Tracks/ NC Medicaid.  

Undoubtedly, when the CPT codes changes and when Value Options and HP Enterprises exited the picture---and the LME’s and NC Tracks via NC DHHS took over the management of NC Medicaid, the ball was dropped re: including the wrap-around for psychologists re: this Medicare code, 96152.  As I stated, prior to 1.1.2013, NC Medicaid AUTOMATICALLY CHANGED THIS OUTPT CODE in order to facilitate wrap-around.  I do not have my old Remittance paperwork indicating what I was paid and since there is no more HP Enterprises or NC Webclaims, where I could view the information online, I cannot pass that to you.  All I can tell you is that the employee at NC Tracks and I were startled to find out that there was so little mention in the NC Medicaid 288 page manual re: psychologists.  That should have been addressed by NCPA, IMO.

Please do not advise me to contact NC Psychological Association.  I already have. Many times over the past 13 years I have complained loudly about the lack of involvement of NCPA re: public mental health e.g., Medicare/ Medicaid.

Today  I left Executive Director Sally Cameron (ncpasally@mindspring.com) a very clear message.  I have joined and un-joined NCPA twice over the past 13 years as they pay no attention to public mental health.  If you have any leverage re: NC Medicaid via NCPA, perhaps you could utilize that. I know that Dr. Tony Puente, who lives in Wilmington, NC, has done a great deal of work re: psychologists’ reimbursement vis a vis CMS (as well as his colleague George, whose Greek last name I cannot spell).  Perhaps you can pass this to him or another pertinent party. 

Every practice day I utilize the appropriate 96152 CPT code.  Every day psychologists in NC undoubtedly use it.  Why? Because it pays at the 80% ‘medical rate’ and because it is an ‘integrative’ CPT code, if you will.  Doctoral level psychologists, such as myself, do doctoral level work and that includes integration with primary care practitioners, etc.

I am looking forward to hearing some information about this.  Feel free to pass this to any pertinent party.  Thanks for your hard work over the years.

Sincerely,

Marsha V. Hammond, PhD, Licensed Psychologist, NC

Cc: Sally Cameron, Executive Director NCPA; Mr. Tax, Claims Director Smoky Mountain Center LME; other employees associated w/ Claims at SMC LME

Bert Bennett, PhD, Psychologist (Behavioral Health Division NC DHHS)

 

Thursday, August 08, 2013

(About to Be) Largest LME in NC unable to manage fine points of Medicaid re: payment to providers

This is a long series of e mail exchanges between myself and the head of Claims at Smoky Mountain Center LME which, as a reminder, will be taking over Western Highlands Network LME 10.1.2013.  It will be---by far---the largest LME in the state.  There is nothing confidential in these e mails and so I am publishing them on my blog so that other providers can see that the LME's continue to not be able to 'manage' Medicaid.  It is not acceptable. 
 
Sorry to continue to be the pain in the arse to these LME's but someone should do it. 
 
Start at the end and you will see just what a mess NC Tracks is.  NC Tracks is some weird thing that took over Value Options and HP Enterprises who were doing just fine until the LME's took over 'managing' Medicaid.  Do I smell consulting by former Secretary of DHHS, Lanier Cansler, "Mr Revolving Door", in and out of government/ in and out of consultation... here?  I wonder if Lanier Cansler has anything to do with these entities that took over, specifically "CSC is Computer Sciences Corporation, the entity that NC DMA contracts with to deliver and administer the NC Tracks MMIS Claims Processing system."
 
 
 
                          **********************************
 
Dear Mr. Tax: thanks again for your suggestions.  As re: professional organizations, I have joined----and unjoined---- the NC Psychological Association x2 over the past 13 years and will not join again because they give not a fig about public mental health.  I will be contacting Tony Puente PhD over in Wilmington and his colleagues who interface w/ CMS and American Psychological Association.  "Forty day roll-out" means very little to me re: NC Tracks.  I am losing money every minute re: the non-continuation of a link between Medicare and Medicaid as associated w/ SMC 'managing' Medicaid.  And as I explained, NC Medicaid did not have this problem re: no ability to 'pass' if you will, the 96152 Medicare code over into Medicaid prior to the LME's 'managing' Medicaid.  I will call Vicki at NC Disability Rights.  And maybe you know a good attorney?  There is a Medicaid appeals attorney over in Charlotte who was doing a lot of work re: appeals as associated with public legal defense system.  Its not OK that SMC LME is not finding an answer to my very legitimate question.  If you have some more ideas, then let me know.  Have a good day.  Sincerely, Marsha V. Hammond, PhD 
--- Originally sent by paul.tax@smokymountaincenter.com on Aug 8, 2013 12:42 PM ---
This message was sent securely using ZixCorp.


My final suggestions:
 
Ø  You’ll find ample references to CSC and the NC Tracks system in the NC Medicaid Bulletins (monthly) and any posted Communications Bulletins.  See: http://www.ncdhhs.gov/dma/bulletin/index.htm
 
Ø  Use the published Customer Services contacts for phone, email, etc. that are provided for CSC, NC Tracks, and NC DMA.  Know that the lines/ queues may be long as we are not yet at the 40-day mark for the new system roll-out. 
 
Ø  Confer with any Provider Groups, Licensing Boards or advocacy group to which you may belong.  They are often tracking issues for their memberships…
 
Best wishes.  Thank you again for your consideration.
 
Paul
 
Paul Tax, Claims Director
Smoky Mountain Center
paul.tax@smokymountaincenter.com
828.586.5501 x. 1170
 
From: chomskysright@gmail.com [mailto:chomskysright@gmail.com]
Sent: Thursday, August 08, 2013 12:37 PM
To: Brian Ingraham; Sonia Eldridge; Paul Tax
Cc: Julia Sinclair; Patty Wilson; Donald Reuss; bert.bennett@dhhs.nc.gov; Lisa Slusher
Subject: RE: (cont'd) re: 96152 coding wrap-around

Mr. Tax: Thanks for the information.  Here is the webpage for CSC: http://www.csc.com/.  It appears to be a gigantic corporation and there is absolutely no information re: anything associated w/ NC Medicaid evident there.  Moreover, in maintaining my role as chief complainer as associated with both WHN LME and SMC LME (although SMC has improved greatly over the years) the NC Tracks is a barrier also.  Just who do I call in NC Tracks? Oh for the days of HP and VO. I find it very vexing that I have to spend so much time putting back into place a system which worked well prior to the LME's taking over Medicaid.  I have now telephoned Dr. Bennett, a psychologist within Behavioral Health at DMA, x2, leaving very specific messages; I have seldom caught him at his desk.  I have sent him all the information you have sent to me in two e mails today. If you have any other suggestions, please do pass them on to me. Thank you.  Again, 96152 is the most correct code for me to use given what I am doing which is pertaining to integrating health care between myself and the medical providers of my clients.  Moreover, it pays me at the medical rate, specifically, 80%, rather than the mental health pay of 50%.  I think you can understand why I am being so persistent here, particularly in light of having successfully used this code FOR YEARS as associated my dually eligible Medicare/ Medicaid clients.   Sincerely, Marsha V. Hammond, PhD


--- Originally sent by paul.tax@smokymountaincenter.com on Aug 8, 2013 12:17 PM ---


CSC is Computer Sciences Corporation, the entity that NC DMA contracts with to deliver and administer the NC Tracks MMIS Claims Processing system.  In an earlier period, I would have referenced HP.
 
Hope that clarifies.
 
Thank you
 
Paul
 
Paul Tax, Claims Director
Smoky Mountain Center
828.586.5501 x. 1170
 
From: chomskysright@gmail.com [mailto:chomskysright@gmail.com]
Sent: Thursday, August 08, 2013 12:09 PM
To: Brian Ingraham; Sonia Eldridge; Paul Tax
Cc: bert.bennett@dhhs.nc.gov; Lisa Slusher; Patty Wilson; Julia Sinclair; Donald Reuss
Subject: RE: (cont'd) re: 96152 coding wrap-around

Mr. Tax: 

Thank you for your reply. What is CSC that you refer to accordingly: "I would advise you to confer with Dr. Bennett or others to determine if there is an option for you to bill secondary claims to NC DMA via CSC for the dual eligible consumers that you referenced, as this is a non-covered service with SMC. "

 I note your NC DMA doc below.  It does not pertain to me.  As a Medicare enrolled psychologist, for the past 8 years, I have reliably used 96152 for MEDICARE ONLY .  

96152, was never and undoubtedly never will be a Medicaid code for use by psychologists.  It is a MEDICARE CODE as per psychologists. That is not the issue here.  

For dually eligible clients ONLY e.g., those w/ Medicare as primary and Medicaid as secondary----until 1.1.2013----when SMC took over Medicaid for its catchment area----I reliably submitted and was paid, via my biller, Compuclaims Plus, 96152 for Medicare FIRST----as it is primary----and then NC Medicaid, via Value Options.  NC Medicaid, via Value Options, upon Medicare payment, would then wrap around WITH A DIFFERENT CODE that was a psychotherapy code.  It was an automatic wrap-around.  I submitted nothing.  I only had to submit to NC Webclaims for Medicaid ONLY clients.   

And as I stated before, since there is no more NC Webclaims and no more Value Options paying me, I cannot get access to any Remittance Advice statements to reveal that NC Medicaid automatically wrapped around once Medicare was 'engaged', so to speak, for these dually eligible clients . 

I will call Dr. Bennett in the Behavioral Health Section of NC DMA again now.  I left him a message earlier.  I have consulted w/ him intermittently over the years re: vexsome issues. 
--- Originally sent by paul.tax@smokymountaincenter.com on Aug 8, 2013 11:38 AM ---

Dr. Hammond:
 
I am providing you with couple pieces of information that are the basis for our decision as an MCO to not recognize the 96152 code.  Attached is an excerpt from the Behavioral Health Databook that governs our covered services, as established by NC DMA.  The 96152 code is not included in that table.
 
The second reference is a recapitulation of the June 2010 Medicaid Bulletin which references the services that fall under the original waiver pilot (Cardinal Innovation, f.k.a. Piedmont Cardinal, PBH).
Note that while 96152 is referenced, it is only included when provided by a Psychiatrist.  As a Licensed Psychologist, you would not be considered an eligible provider of this service to the MCO(s).
 
I would advise you to confer with Dr. Bennett or others to determine if there is an option for you to bill secondary claims to NC DMA via CSC for the dual eligible consumers that you referenced, as this is a non-covered service with SMC. 
 
Thank you for your consideration.
 
Paul
 
 
 
FYI
 
From June 2010 Medicaid Bulletin
 
Attention: All Providers
N.C. Mental Health, Developmental Disabilities, and Substance Abuse
Services Health Plan Waiver (Formerly, Piedmont Cardinal Health Plan)
Effective July 1, 2010, additional services will be added to the N.C. Mental Health, Developmental Disabilities
and Substance Abuse Services (MH/DD/SAS) Health Plan Waiver. The MH/DD/SAS Health Plan currently
operates in Cabarrus, Davidson, Rowan, Stanly, and Union counties and is administered by the area Local
Management Entity, Piedmont Behavioral Healthcare (PBH). Except for emergency services, all MH/DD/SAS
providers must obtain prior authorization from PBH to qualify for reimbursement of services provided to
Medicaid recipients who, for Medicaid purposes, are residents of the PBH five-county catchment area.

The services listed in the table below will be included in the MH/DD/SAS Health Plan beginning with dates of
service July 1, 2010, when
· the service is provided by a psychiatrist;
· the Medicaid recipient is a resident, for Medicaid purposes, of the PBH catchment area; and
· the Medicaid recipient’s primary diagnosis is in the 290 through 319 range.
If the conditions listed above are met, psychiatrists must obtain prior authorization from PBH to qualify for
reimbursement for these services.
Narcosynthesis for Psychiatric Diagnostic and Therapeutic Purposes
90865
Evaluation of Implanted Neurostimulator
95970 95971 95972 95973
95974 95975 95978 95979
Standardized Cognitive Performance Testing
96125
Biopsychosocial Assessment/Intervention
96150 96151 96152
Outpatient and Other Visits
99201 99202 99203 99204 99205
99211 99212 99213 99214 99215
Facility Observation Visits: Initial and Discharge
99217 99218 99219 99220
Inpatient Hospital Visits: Initial and Subsequent
99223 99231 99232 99233
Observation/Inpatient Visits: Admitted/Discharged
99234 99235 99236
Inpatient Hospital Discharge Services
99238 99239
Consultations
99241 99242 99243 99244 99245
99251 99252 99253 99254 99255
Emergency Department Visits
99281 99282 99283 99284 99285
Nursing Facility Visits
99304 99305 99306 99307 99308
99309 99310 99315 99316 99318
Domiciliary Care, Rest Home, Assisted Living Visits
99321 99325 99326 99327 99328
99334 99335 99336 99337
Care Plan Oversight: Domiciliary Care, Rest Home, Assisted Living and Home
99339 99340
Home Visits
99341 99342 99343 99344 99345
99347 99348 99349 99350
Prolonged Services Outside Customary Services
99354 99355 99356 99357 99358 99359
Alcohol and/or Substance Abuse Structured Screening
99408
Injections: Diagnostic/Preventive/Therapeutic
96372 96373 96374 96375 96379
Telehealth Originating Site Facility Fee
Q3014
All services provided in emergency rooms to Medicaid recipients residing in the PBH catchment area with a
primary diagnosis in the 290 through 319 range will be included in the MH/DD/SAS Health Plan beginning with
dates of service July 1, 2010. Providers of emergency room services must contact PBH for reimbursement.
These services are currently billed under the following revenue codes:
Emergency Room
RC450 RC451 RC452 RC456 RC459
Behavioral Health and Waiver
 
 
Paul Tax, Claims Director
Smoky Mountain Center
828.586.5501 x. 1170
 
From: Marsha Hammond,PhD [mailto:chomskysright@gmail.com]
Sent: Thursday, August 08, 2013 10:16 AM
To: Paul Tax; Sonia Eldridge; Brian Ingraham
Cc: Bert Bennett
Subject: (cont'd) re: 96152 coding wrap-around

I am sorry, Mr. Tax.  The e mail that you just received fired off before I could finish it.  Please discard that as it is incomplete.  Below is that e mail finished up.  thank you.  

                                         ********************************

Marsha V. Hammond, PhD, Licensed Psychologist, NC
cell: 828 772 5197
 
RE: MEDICARE code 96152 which wrapped around to NC Medicaid psychotherapy code e.g., 90806, etc.
 
Date: August 8, 2013
 
Dear Mr. Tax: 
 
Thank you for contacting me.  I KNOW that 96152 is not in my SMC contract.  It has NEVER been a Medicaid code.  It is a Health & Behavior code, put into use by the American Psychological Association in conjunction w/ discussions w/ CMS in 2000.  I have used it for years without the issues that are plaguing me as associated w/ SMC LME. 
 
If I could turn up my old Medicaid RA's, which are now unavailable as Value Options no longer manages any part of NC Medicaid, via the NC webclaims site, I could print them out and send them to you.  I do not keep my RA's from previous years.  
 
As I stated before, prior to the LME's taking over Medicaid, this is what would happen when I submitted a 96152 MEDICARE code for dually eligible clients.  NOTE: This is not what took place re: MEDICAID ONLY clients.  For those clients, I would simply go to NC Medicaid webclaims, submit the (then) 90806 or whatever applicable code and be paid. 
 
NC MEDICAID VALUE OPTIONS AUTOMATICALLY WRAPPED AROUND for the dually eligible Medicare/ Medicaid clients utilizing the 96152 Medicare code.  HOWEVER, a different psychotherapy code was applied.  I never asked why.  I simply got paid.  
 
I have contacted as per this e mail Dr. Bert Bennett of NC Medicaid, a psychologist working in Raleigh w/ Behavioral Health to see if he can advise you about this matter.  I have no idea how to contact Value Options and reobtain my RA's so you understand that this is how things occurred for years prior to the LME's taking over NC Medicaid.  
 
96152 is the most appropriate code for me to use as I interface w/ physicians, psychiatrists, etc., to provide integrated care for my patients who commonly have overlapping medical and mental health issues. 
 
I left you a voice mail a moment ago.  Thank you for continuing to look into this matter.  

Sincerely, 
Marsha V. Hammond, PhD

Continued Problems w/ Using Health & Behavior Codes 96152 under New NC Medicaid Management Assoc w/ LME's

Here is a letter to the head of Claims at Smoky Mountain Center LME.  If anyone has any information about how to hack through this, given that there is no more Value Options managing NC Medicaid, please let me know.  Thank you: chomskysright@gmail.com

                         ***********************************************
Marsha V. Hammond, PhD, Licensed Psychologist, NC
e mail: chomskysright@gmail.com

RE: MEDICARE code 96152 which wrapped around to NC Medicaid psychotherapy code e.g., 90806, etc.

Date: August 8, 2013

Dear Mr. Tax, head of Claims at SMC LME: 

Thank you for contacting me.  I KNOW that 96152 is not in my SMC contract.  It has NEVER been a Medicaid code.  It is a Health & Behavior code, put into use by the American Psychological Association in conjunction w/ discussions w/ CMS in 2000.  I have used it for years without the issues that are plaguing me as associated w/ SMC LME. 

If I could turn up my old Medicaid RA's, which are now unavailable as Value Options no longer manages any part of NC Medicaid, via the NC webclaims site, I could print them out and send them to you.  I do not keep my RA's from previous years.  

As I stated before, prior to the LME's taking over Medicaid, this is what would happen when I submitted a 96152 MEDICARE code for dually eligible clients.  NOTE: This is not what took place re: MEDICAID ONLY clients.  For those clients, I would simply go to NC Medicaid webclaims, submit the (then) 90806 or whatever applicable code and be paid. 

NC MEDICAID VALUE OPTIONS AUTOMATICALLY WRAPPED AROUND for the dually eligible Medicare/ Medicaid clients utilizing the 96152 Medicare code.  HOWEVER, a different psychotherapy code was applied.  I never asked why.  I simply got paid.  

I have contacted as per this e mail Dr. Bert Bennett of NC Medicaid, a psychologist working in Raleigh w/ Behavioral Health to see if he can advise you about this matter.  I have no idea how to contact Value Options and reobtain my RA's so you understand that this is how things occurred for years prior to the LME's taking over NC Medicaid.  

96152 is the most appropriate code for me to use as I interface w/ physicians, psychiatrists, etc., to provide integrated care for my patients who commonly have overlapping medical and mental health issues. 

I left you a voice mail a moment ago.  Thank you for continuing to look into this matter.  

Sincerely, 
Marsha V. Hammond, PhD

Sunday, August 04, 2013

How Does Humana Change from a 'Medicare Advantage' Company to a 'Private Company' w/o Advising Providers?

This is associated w/ a conversation w/ an aide in Senator Burr's office:  Cooke, Jason (Burr) <Jason_Cooke@burr.senate.gov> wrote:

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FROM: Marsha V. Hammond, PhD 
Clinical / Health Psychology
NC Licensed Psychologist

DATE: June 28, 2013


RE: request for policy paper from CMS as re: agreement w/ Humana that professional providers must go onto the Humana Panel


Hi Mr. Jason Cooke of Senator Burr's office: 

Thank you for speaking w/ me on the phone the other day. 

We spoke about the matter associated with some kind of contract or agreement which has obviously been created between CMS and Humana causing Humana to require professional mental health providers, such as myself, to move 'onto panel' when this was not an issue prior to 1.1.2013.  Humana did not tell providers that they had to do this.  Only after bugging NC Insur Comm office, a higher up woman stated that yes, it was her understanding also that providers had to apply to be on the panel.  I did this about a month ago. 

This is yet another barrier to health care.  As you know, Humana purports to be a 'Medicare Advantage' company which causes its insured or those considering jumping from regular Medicare to a Medicare Advantage company to believe there is no impact upon providers.  I have lost thousands of dollars re: Humana's management of its mental health services.  As I advised you, I have talked w/ a CMS representative, specifically the gentleman at this number: 410 786 1047) and have e mailed him.  The only thing he was able to do was to link BACK to Humana who, of course, had no answers.  

I want a copy of the policy paper or policy change that created the necessity of me, a PhD psychologist, long utilizing Medicare, to go onto the Humana Network.  As of this date, I have not been approved.  Humana indicated to me----after a dozen phone calls from my end----that it would 'take months' for this to take place.  So, meantime, I am paid at a lesser rate and less than what I was being paid last year.  Additionally, Humana is bothering me for a 'pay back'  as re: one of my clients as their system did not 'catch' that I continued to be paid at the same rate as last year for that client.  I advised them that as they had not advised me of the change in rates and that I therefore had no opportunity to decide whether I was going to continue to see the client or not.  I advised them  that I had no intention of paying them back. 



SMC LME Cannot Figure Out How to Use Main CPT Code for Dually Eligible Clients


Well its week three as associated with Smoky Mountain Center LME being unable to figure out how to do what used to be done automatically before the LME's took over NC Medicaid.  Specifically, the matter is this: 96152, a CPT code known as the 'Health & Behavior' codes, which was put into play by the American Psychological Association in 2000, is billed in 15 minute increments.  It is intended to be the code utilized by a mental health practitioner who is providing overlapping services in conjunction w/ other providers e.g., physicians/ psychiatrists, etc.  

PRIOR to the LME's taking over NC Medicaid, I simply submitted to my biller the following information: 
name of client; CPT code (96152 is NOT a Medicaid code; thus NC Medicaid PRIOR to the LME's understood how to wrap around when the Medicare code, 96152, was assigned); Place of Service; Date of Service.  I did not have to interface AT ALL with NC Medicaid as Medicare and Medicaid were interlinked PRIOR TO THE LME'S TAKING OVER NC MEDICAID.  It was a seamless system.  Now we have bits and pieces laying all over the place.  

Now, not only do I need to submit to my biller information to bill Medicare, but I then have to take my RA's or Remittances which outline what Medicare has paid me, and then submit that to my biller so she can submit to SMC LME that information.  So, now I am charged twice by my biller.  Lose/ lose situation across the board for me. 

Under Medicare, since 1.1.2013, Place of Service is no longer required, thankfully.  This frees me up to see patients while they are in psychiatric hospitals, etc.  This was an advance.  

Will no one rid us of this troublesome mess? Does anyone know how this is fixable? 

Monday, July 29, 2013

NC HB 937: Its Total War Now w/ the NC Republican Led State Legislature:Featured on Colbert Report 7.29.2013

Well, let's see: what have we gotten since McCrory, former Mayor of Charlotte, became Governor of NC----joining ranks w/ Republicans in control of the NC State Legislature: 

1. No expansion of Medicaid, w/ so many people w/o health insurance in a state w/ one of the highest unemployment rates in the nation. 

2. cut-back of unemployment benefits in terms of length of time of benefits as well as amount.

3. screwing around w/ abortion rights which is related to the ability of NC women to choose and decide the direction of their lives (all the while being dependent upon being able to obtain birth control pills which is related to non-expansion of Medicaid)...

...and now this...allowing people to carry concealed weapons onto (at least) college campuses.  

Here is a right-wing nut-job (hey: I can say this: people w/ guns can kill themselves and other people: one of the first questions a psychologist asks is: DO YOU OWN ANY GUNS? 

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http: ://ncrenegade.com/editorial/tell-governor-mccrory-actons-speak-louder-than-words/

".....Supported by GRNC, however, Rep. Larry Pittman (R-Cabarrus, ****) threatened a floor fight to return the measure. As pressure from gun owners and his own caucus continued to build, Tillis eventually tasked Reps. Jacqueline Schaffer (R-Mecklenburg, ****) and Justin Burr (R-Montgomery, Stanly, ****) to draft a bill containing restaurant carry, state parking lots and limited campus carry (universities only). To Tillis’ credit, he and Rules Chair Rep. Tim Moore (R-Cleveland, ****) whisked it through the chamber, avoiding weakening amendments....."

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My letter to recently gerymandered NC State Representative (R) Tim Moffitt: 

FROM: Marsha V. Hammond, PhD, Licensed Psychologist, NC
e mail: chomskysright@gmail.com  cell: 828 772 5197

TO: 
Office:2119 Legislative Building
Phone:919-715-3012
Email:Tim.Moffitt@ncleg.net
Legislative Mailing Address:NC House of Representatives
16 W. Jones Street, Room 2119
Raleigh, NC 27601-1096

RE: HB 937 allowing concealed weapons on playgrounds and schools

July 29, 2013

Dear Tim Moffiff (R; Buncombe): 

I guess I have to find out what the Republican-led NC State Legislature is doing from other sources.  Certainly, no sanity is in play re: the passage of HB 937, as featured this evening on The Colbert Report, outlining how that Republicans have passed a bill which allows the carrying of concealed weapons to playgrounds and school campuses.  

Do you have any idea how many times I ask clients---who have been referred to me---- if they have a gun in their homes? Do you understand that this is a standard question that Veteran's Administration psychologists, such as I, are trained to ask of patients?  Can you imagine what it is like to ask a patient's husband if he has 'found' all the gun shells in the house with which his wife may kill herself? Can you entertain what it is like to treat a patient who has been referred by a local psychiatrist because----out of desperation---he pulled a gun on his wife and then himself?  Can you imagine a family under significant stress wherein the mom puts a gun in her mouth? 

Well, then, sir: you might imagine how DETRIMENTAL it is to make MORE GUNS available for people in a state that has one of the highest unemployment rates in the nation. 

I am disgusted by the non-expansion of Medicaid; the cutting of unemployment benefits; the strikes against women who are seeking to determine their lives as associated with fake and misogynistic laws that limit abortion rights----and now an expansion of concealed weapons.  

It is the Republican led NC State Legislature that needs psychotherapy. I'm sure your insurance is pretty good and so give me a call when your conscience pricks you as you consider what harm you are doing to the citizens of NC. 

Sincerely, 

Marsha V. Hammond, PhD, Licensed Psychologist, NC

                          

Monday, July 15, 2013

NC MEDICAID: No psychiatric providers available and NC Tracks does not work to provide payment

I don't know how many other ways NC Medicaid can screw up.  The list seems limitless.

I called Western Highlands Network LME (going out of business as of October 1, 2013: HOORAY!; to be taken over by Smoky Mountain Center LME) to say that my client could not find a psychiatrist that would take Medicaid as a secondary payer (for dually eligible clients Medicare is primary; Medicaid is secondary; some psychiatric providers have simply thrown in the towel and just forget the Medicaid payment; others do not).  So I asked: "Please give me the name of a psychiatrist that takes Medicaid under the WHN LME catchment area."  Answer: "I can't do that.  But here is the name of a 'center' that may take it: Mood Disorder Clinic over in Fletcher."  I advised the client to call that clinic on Monday.  If they don't take it, I'll create a stink all the way to Raleigh.

But I digress.  This blog is about the mess w/ NC Tracks which is yet another tier of mess re: NC Medicaid. It seems they get threw screwing up some part of NC Medicaid...like with the LME's....then they purposefully tackle another part to screw up.

I am not receiving but part of my Medicaid payments.  I use a biller.  This is my letter to NC Tracks today:

"Marsha V. Hammond, PhD
Clinical / Health Psychology
NC Licensed Psychologist
cell: 828 772 5197

Dear NC Tracks: 

When I call your 1 800 number given to providers in your e mails, I am told: "Your call cannot be answered at this time.  Please call back at a later time." 

This is unacceptable. Put some more people to work answering these important calls. 

I am calling to find out if you have my taxonomy code correct---the one I have used for 10 years---or if I am supposed to have some other taxonomy code.  My taxonomy code is: 103TCO700X. 

IS THIS THE CORRECT CODE? My understanding is that this is the code for doctoral level psychologists.  I am one of those.  

I also note that though Medicare no longer requires Place of Service, your recent note to providers indicates that POS IS REQUIRED. IS THIS THE REASON MY BILLING IS BEING DENIED? "