Monday, August 25, 2008

NCPA: depending on APA to solve our problems in NC

August 25, 2008

Dear Sally Cameron, Executive Director of the NC Psychological Association ("Sally Cameron" ):

You stated, in an e mail dated 8.25.2008, as associated with meetings at APA in Boston, one week ago:

"It was particularly gratifying in various meetings with the Practice Directorate Staff and leadership to hear them acknowledge that reimbursement is the top issue for the practice profession. I think you will see actions to follow up this acknowledgement - including the APA President Task Force on the Future of Psychology Practice. "

I hope you are inferring by 'I think you will see actions' to mean that NCPA will be paying attention to the people who are psychologists LP's and LPA's in the state of NC.

I still have NO answer re: my questions that I have sent to you x2, which you indicated you sent to the NCPA Board, associated with (no 1, specifically):

1. persisten utilization review problems in western NC associated with Western Highlands Network LME (no more than 8 therapy sessions for state funded clients/ year) and as per Smoky Mountain Center LME (no outpatient therapy except under the Service Defintion 'Community Support Services', which, as you know, is constantly being defunded.

These are other pressing reimbusement concerns:

2. Health and Behavior code reimbursement; apparently the NPI of the referring physician has to be put on the medicare billing or you cannot be paid. There is an online NPI Data Base. That the NCPA board had no idea about any of this blows my mind. Here is the link for the NPI data base. Why is this important? Because it means that psychologists do not have to spend additional time calling up a physician for his/ her NPI:

3. no wrap around to Medicaid vis a vis CIGNA government services.

4. Humana, a Medicare Advantage company, will not pay for anything other than 90806. They will not pay for Health and Behavior codes.

Please forward my e mail to the executive board. Maybe sometime I will hear something from one of them or perhaps the Public Sector psychologists who have never responded to any of these concerns associated w/ public sector reimbursement, in part, will someday respond.

Marsha V. Hammond, PhD

cc: Pedulla; Puente; members of WNCPA


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