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
E mail: chomskysright@gmail.com
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)
posted by Marsha V. Hammond, PhD at 2:02 PM
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