Wednesday, January 16, 2008

Part B Medicare (mental hlth): collapsing and defunded

Many citizens of NC utilize Medicare as their primary health care provider.

This post is a documentation of the difficulties of interfacing with this primary health care agency and it is intended to portray the severe problems experienced by providers who are attempting to provide mental health services for clients who have Medicare.

First of all, in NC, Medicare has for 2008 discontinued Behavioral Health CPT codes which placed mental health care rendered by a PhD psychologist into the 'medical' column of reimbursement which is 80%. No more. There is now only CPT codes associated with mental health which means that providers can expect no more than 62.5% payment for services.

The American Psychological Association worked a long time in order to put forward Behavioral Health Codes so that psychologists could be reimbursed in a professional manner.

You wonder why providers will not accept Medicare?

In 2008, Medicare reimbursement for therapy has been slashed by about 15% or more. A CPT code of 90808 (bill too many of these and you will certainly be audited) which is therapy for 70-90 minutes or more LAST YEAR was billable at $145.

THIS YEAR, 90808 is billable at $125.

90808 CPT code is not what most mental health care people will utilize as the top 10% of providers will receive a 'congratulatory' letter from Medicare telling them that they have to submit all of their paperwork, including patient notes, and if everything is not in order, then the provider has to re-pay Medicare.

So, without the Behavioral Health codes, which were an efficient mechanism for clients who had physical illnesses which were addressed in therapy, the provider is now stuck w/ the lesser paying, non-medical, mental health therapy codes which are paid at 62.5%.

You wonder why providers will not accept Medicare?

Not only that, but the North Carolina Psychiatric Association has 'discovered' that NC Medicaid (if the patient has dual eligibility which is very common, Medicare is billed first and then Medicaid picks up the rest) is not making up the difference and according to a NC Psychiatric Association member "this is legal." Its reportedly not done in any other state but 'it's legal.'

You might collect a few more cents off of the client in terms of their co-pay, which is not demanded by Medicare (you cannot avoid asking for the co-pay from clients but neither must you demand it from every client either)-----if you have the heart to try and squeeze that out of people who cannot feed themselves.

When a provider enrolls with Medicare, and pertinent to mental health services (Part B Medicare), you are given a 'Performing Provider Number.' This comes to you on a piece of paper which is your initial credentialing document. Psychologists are exempt from a UPIN number which physicians utilize. No other numbers are listed on this initial document. Over the course of billing and exchanging information with CIGNA Government Services, one is assigned, in no particular order, the following descriptors unique to the provider:

1. identifer #
2. Billing ID
3. Payor ID

This does not take into account any other identification sets which might be utilized by a billing entity (when the provider throws up their hands and cannot negotiate Medicare Claims Express software). The billing agency takes another chunk of the provider's money.

This does not take into account Medicaid identification data. Or Medicaid webclaims identification data. Or state funded clients identification sets of information. Or BCBS identification sets. Or any other third party payment identification sets.

A couple of years ago, providers were told they had to have an NPI number, which is a descriptor that is SUPPOSED to be usable across Medicare/ Medicaid. You might suspect that it takes a few years for this simple little NPI number to move into their process, but the real dilemma is that you can never get CIGNA GOVERNMENT SERVICES on the phone. NEVER.

You can, as I have done, enlist the assistance of Repeat Dialer software. Won't get you through. Someone from Medicare might even call and leave a message. You can't call them back. You are stuck trying to move through their system the best you can.

Upon the 7th set of faxes and correspondences re: simply trying to change my address and set up the automatic deposit, which they demand, I resorted to creating 'options' for the person on the other end. I sent CIGNA a multiple choice formatted selection of paperwork with the explanation that they could throw the useless paperwork out.


I am enclosing 4 possible selections of paperwork as associated with the descriptor 'Medicare Identification Number' (something I have never been given though you have paid me for services) and the way I figure it, it must be a,b,c, or d (which is all the permutations of what this exchange-a-term Medicare Identification Number) must be.

If I could get you on the phone I could ask you what that number is. However, what I get is 'courtesy calls' telling me that I simply need to resubmit the paperwork.


Your (some kind of ) Medicare Provider, Dr. Hammond


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