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)