State Leadership Conference

A round of applause greeted Diane Pedulla, JD, when she said, "You don't have to worry about another cut in Medicare in 2003," at a session on reimbursement issues at the State Leadership Conference.

Pedulla, director of regulatory affairs in APA's Practice Directorate, went on to explain that a recent change to federal law will result in Medicare increasing payments under its 2003 fee schedule by 1.62 percent more than the 2002 rates. She also shared some other good news related to Medicare, saying, "In 2002, advocacy by APA and state psychological associations resolved billing problems involving denied claims under the new health and behavior codes with eight Medicare carriers in 16 states."

But this good news about Medicare billing doesn't mean psychologists can sit back and relax. Pedulla urged psychologists to stay involved and vocal as many state carriers draft local medical review policies--guidelines individual Medicare carriers establish to determine coverage--for the new health and behavior codes. Medicare will track billing under the new codes, Pedulla noted, and when the payment values for the codes are reviewed this data will be taken into account. "It's very important that psychologists and state psychological associations work together to provide a consistent message to carriers," she said. "The best way to increase reimbursement for the health and behavior codes is to show that psychologists are consistently using them."

Panelist James Georgoulakis, PhD, APA representative to the American Medical Association's (AMA) Relative Value Update Committee and Practice Expense Advisory Committee and adjunct professor at Webster University, agreed. "A service or code without reimbursement doesn't do us any good," he said.

Georgoulakis and Antonio Puente, PhD, APA's representative to the AMA's Current Procedural Terminology Committee and professor at the University of North Carolina at Wilmington, gave attendees several tips for getting reimbursed under Medicare, including:

  • Stick to the approximately 40 to 60 possible Current Procedural Terminology (CPT) codes for psychology. "There are 7,500 total possible [CPT] codes, but we won't get reimbursed for them," said Puente.

  • Keep track of additions and changes in CPT codes. For example, Puente brought up the Health and Behavior Assessment and Intervention coding, which was developed to avoid inappropriate labeling of patients with acute or chronic illnesses as having mental health disorders. "This is a paradigm shift for psychologists," said Puente. "It takes you out of the psychiatric stronghold and into the realm of health care."

  • Diligently document services. Regardless of what codes are used, include dates, times, reasons for services, procedures, results and findings, and impressions or diagnoses. Avoid handwritten notes, don't use red ink, document during and after every encounter, every procedure and every patient, said Puente.

  • Be aware of modifiers within CPT. Modifiers, which are used to report that a service was altered in some fashion, are beneficial because they can ensure reimbursement when just a code alone does not, said Georgoulakis.

For example, if a psychologist performs a diagnostic interview in a hospital, but he or she isn't a hospital employee, the psychologist should use code 90801 with modifier 26 to ensure payment.

Finally, Leslie Rosenstein, PhD, of the National Academy of Neuropsychology (NAN), touched on some reimbursement issues facing neuropsychologists that she said generalize to other psychologists, such as:

  • Low reimbursement rates that are at or below the cost of providing services. For example, she noted, psychological tests can be expensive, which increases overhead costs and makes it more difficult to recoup the cost of providing testing services when reimbursement rates are low.

  • Lack of Medicaid coverage in many states.

  • Difficulty getting reimbursed even after billing preauthorization.

NAN, she added, is ready to work with state psychological associations to solve these issues for psychologists.