What You May Not Know About Medicare Gordon I. Herz, PhD February 27, 2014

Transcription

1 Division Virtual Learning Hour What You May Not Know About Medicare Gordon I. Herz, PhD February 27, What is Medicare? a. Basic Program Definition b. Program Creation c. Psychologist Inclusion d. Medicare Coverages i. Parts of Medicare ii. iii. Which Part covers psychological services? Differences between Original Medicare & Medicare Advantage 2. Why Participate in Medicare? a. Benefits to psychologist b. Risks to psychologist 3. How to Enroll 4. Psychological Services Covered

2 5. Medicare-specific Documentation and Record Keeping a. Diagnostic interview/evaluation b. Treatment c. (Neuro)Psychological Testing 6. Reimbursement How to Get Paid a. How much is current reimbursement? National rates for i ii iii iv v vi b. How much and why will these rates vary where you are? c. How to find out the rate for every procedure you might perform specific to your location d. How to file for reimbursement 7. How to handle specific billing situations a. Patient deductible b. Coinsurance c. Balance billing d. Noncovered services 8. Common psychological, evaluation and treatment issues in the Medicare population

3 REFERENCES AND RESOURCES Gordon I. Herz, PhD What You May Not Know About Medicare Div 42 Virtual Learning Hour 2/27/2014 Medicare/Medicaid Website: Medicare Specific Website: Medicare Fee Schedules General Information: Payment/FeeScheduleGenInfo/index.html Physician Fee Schedule (includes formula to calculate fees): Physician Fee Schedule Lookup Tool: Service-Payment/PFSlookup/index.html Comprehensive listing of National and Local Coverage Determinations with Search Capability: Glossary of Medicare Terms: Full Text of Title XVIII, Health Insurance for the Aged and Disabled : Psychologists added to Medicare: Definition of Psychologist in Medicare: Clinical Psychologist (Medicare Specialty 68): A person who (1) holds a doctoral degree in psychology; and (2) is licensed or certified, on the basis of the doctoral degree in psychology, by the State in which he or she practices, at the independent practice level of psychology to furnish diagnostic, assessment, preventive and therapeutic services directly to individuals. This is the category for which you will want to apply to allow you to provide both diagnostic and treatment services to Medicare beneficiaries. Independently-Practicing Psychologist (Medicare Specialty 62) is a person who Is licensed or certified to practice psychology in the State or jurisdiction where furnishing services or, if the jurisdiction does not issue licenses, if provided by any practicing psychologist

4 Definition of Medical Necessity in Medicare In language appropriate for patients: Services or supplies that: are proper and needed for the diagnosis or treatment of your medical condition, are provided for the diagnosis, direct care, and treatment of your medical condition, meet the standards of good medical practice in the local area, and aren t mainly for the convenience of you or your doctor. English&SubmitTermSrch=Search Technical Definition (Title XVIII of the Social Security Act, 1862 (a)(1)(a):... no payment may be made under Part A or Part B for any expenses incurred for items or services, which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. Definition of Assignment In language appropriate for patients: In the Original Medicare Plan, this means a doctor agrees to accept the Medicare-approved amount as full payment. Source: Glossary of Medicare Terms Technical definition:...accepting assignment of the Medicare Part B payment means requesting direct Part B payment from the Medicare program. Under an assignment, the approved charge, determined by the MAC/carrier, shall be the full charge for the service covered under Part B. The participant shall not collect from the beneficiary or other person or organization for covered services more than the applicable deductible and coinsurance. How To Enroll as a Psychologist in Medicare: Current Medicare Costs to Beneficiaries (Premiums, Deductibles, Coinsurance): What Medicare Region Am I In? List: Map: Information/RegionalOffices/RegionalMap.html

5 Medicare Administrative Contractors With Websites Cahaba Government Benefit Administrators, LLC CGS Administrators, LLC First Coast Service Options, Inc. National Government Services, Inc. NHIC, Corp. Noridian Administrative Services, LLC Novitas Solutions, Inc. Palmetto GBA Wisconsin Physicians Service Insurance Corporation ngsmedicare.com Comprehensive Listing of Contacts For Part B - Medicare Administrative Contractor (MAC - Part B): Advance Beneficiary Notice of Noncoverage (ABN) Medicare & You Handbook 2014: Current Proposed Changes in Amounts and Methods of Payment in Medicare: Bipartisan Plan: HR 4015: CITED IN ABOVE ARTICLE HR 4015: Summary: Bill Text is here: 113hr4015ih.pdf

6 Charts Gordon I. Herz, PhD (2014). All rights reserved.