What limitations on charges apply to Medicare beneficiary services?
When applying to become a provider, should I call myself an "independently practicing psychologist" or "clinical psychologist"?
Which of my services does Medicare deem "reasonable and necessary?
For those with their hands raised, APA now provides answers in the "Medicare Handbook, A Guide for Psychologists."
APA's Practice Directorate prepared this 20-page booklet to elucidate Medicare topics of import to psychologists--particularly the specific titles, criteria and codes used to distinguish various services. The guide clarifies uncertainties such as whether a claim falls under Medicare Part A or B, plainly explaining how psychological treatment is covered under Medicare Part B and administered by local insurance companies. The guide emphasizes that psychologists should keep abreast of any revisions to local carrier policies by requesting updated copies from the carrier or by monitoring relevant Web sites.
The handbook includes an overview of medicare law specifically affecting psychology practices. An important summary explains the "unbundling" of psychological services that resulted from a 1989 amendment to the Social Security Act liberating psychologists to treat beneficiaries
outside of specified settings such as hospitals.
The "Medicare Handbook" also alerts psychologists to the system's pitfalls. For example, what is perhaps the program's most problematic clause states that Medicare only covers "reasonable and necessary" services. While Medicare's definition may not correspond to the views of either provider or patient, services that are not viewed by Medicare as "reasonable and necessary" will not be reimbursed. To this end, the guide provides psychologists with information on identifying excluded services, appealing claims denials, and collecting directly from beneficiaries by signing an "advance beneficiary notice" or private contract.
The guide also offers a valuable overview of services excluded from Medicare coverage--ranging from experimental treatments to certain kinds of family therapy--and defines such related topics as "carrier screens," or factors used to determine an equitable amount of care.
APA members may access a Web version of the guide at the practice directorate's section of the APA Web site, www.apa.org/practice. Single printed copies of the guide also are available to members free of charge by calling
the directorate's government relations department at (202) 336-5889 or
by sending an e-mail message to Practice Directorate.
--E. O'CONNOR
