State Leadership Conference

State Leadership Conference attendees got the latest news on Medicare policies and reimbursement issues during a workshop run by government relations staff from the APA Practice Organization. Among the topics covered:

  • Keys to working with local Medicare carriers. By sharing information with and educating Medicare carriers about the value of psychological services, psychologists have begun to develop stronger relationships with their local carriers--resulting in the development of psychology-friendly coverage and reimbursement policies. The APA Practice Organization's government relations staff can guide psychologists in developing better relationships with their carriers, said Eric Garfinkel, PhD, of the New York Psychological Association, which successfully works with the state's local carrier (January Monitor).

  • Getting reimbursed under the new CPT codes. In January, psychologists became eligible to be reimbursed by Medicare for six new Current Procedural Terminology (CPT) codes for behavioral assessments and interventions with patients who have a physical health problem as their primary diagnosis (January Monitor, page 19). These codes now allow psychologists to "accurately bill and capture the services that they provide to patients who have a physical health diagnosis and not a mental health diagnosis," explained Diane Pedulla, director of regulatory affairs for the APA Practice Organization. "It really recognizes psychologists as total health-care providers, and not limited to providing only mental health services," she said.

Each state will determine if these services will be covered by Medicaid. Medicare will reimburse for all of the new codes but one--intervention for a family without the patient present--because Medicare coverage only applies to services that directly benefit the patient.

  • Recent efforts to reform Medicare regulations. The Health Care Financing Administration, recently renamed the Centers for Medicare and Medicaid Services (CMS), has reorganized into three business centers in an effort to be more responsive to Medicare providers and beneficiaries. In addition, CMS is holding public listening forums where Medicare providers and beneficiaries can suggest ways to improve CMS operations. To address regulatory reform, CMS has also formed several health-sector work groups that include physician and nonphysician providers, as well as nursing home and long -term care panels that will make recommendations to CMS to help improve its communication with providers and make regulations less complex. There's also an internal CMS working group, which is exploring ways to clarify and revise Medicare rules.

--D. SMITH

Further Reading

For more information on Medicare, contact the APA Practice Organization's Government Relations office at (202) 336-5889; e-mail:Practice.