At the beginning of 2019 psychologists who test children or adults were required to learn a complex coding and billing system after the American Medical Association (AMA) and the Center for Medicare and Medicaid Services (CMS) overhauled the Current Procedural Terminology (CPT) codes for central nervous system assessments.
Prior to the change going into effect, APA predicted that some third party payers would not make a smooth and timely transition in their systems.
APA was right. At least 15 state Medicaid systems and several commercial payers had not made the transition as of mid-April, causing delays in payment or no payment for work already done, according to an APA memo sent to practitioners.
Leslie McClure, Psy.D., a geropsychologist in private practice in Kent, Ohio, said she experienced reimbursement delays due to insurers not loading codes in their systems early in the year.
McClure said, “Most of our billing problems have resolved but a few denials from work done in January and February that are still in appeal are related to us not completely understanding that all psychological testing had to include at least two tests.”
The Ohio managed Medicaid plans are still not paying properly for testing services. McClure is working with her state association to address that.
Lisa Lind, Ph.D., chief of quality assurance for Deer Oaks Behavioral Health in San Antonio, Texas, said her group has experienced limitations of the number of hours that some managed care plans will allow for testing without submitting forms indicating the need for each testing unit.
Others have disallowed payment for administration of tests and write up on the same day of service, she said.
In a phone interview, Jared Skillings, Ph.D., APA’s chief of professional practice, said APA has sent out a survey to practitioners to gather information about reimbursement problems throughout the country.
Preliminary data from 800 completed surveys at the time of the interview indicate three major issues: some insurers not uploading the codes at all, others paying inappropriately low rates or not reimbursing for testing administered across multiple days.
Skillings said to help fix the problems APA recently finished an advocacy campaign with the National Correct Coding Initiative (NCCI), a program of CMS designed to prevent improper payment of procedures.
According to Skillings, CMS agrees with the APA position that when it is necessary to complete an evaluation over several sessions, psychologists can bill for add-on codes on more than one date of service and get paid for each session separately without waiting for the entire evaluation to be completed.
He said APA’s next step will be to update and submit a payment policy document to the regional Medicare Administrative Contractors (MAC), private healthcare insurers that have been awarded a geographic jurisdiction to process Medicare claims.
Before coming to APA, Skillings worked at a large healthcare system, Spectrum Health in Grand Rapids, Mich., where he learned the importance of having a consistent message and communicating it to all the stakeholder groups.
“The MACs will get the policy from NCCI but we’re sending it to them also so they will integrate it into their systems.”
APA will send the payment policy to state associations and ask them to disseminate it to their local and regional carriers.
Resources for psychologists
In addition to completing the APA survey, Luana Bossolo from the APA communications department said APA members with problems can e-mail the Practice Directorate: firstname.lastname@example.org. The staff monitors this daily and makes sure the appropriate experts receive member inquiries.
State associations have been turning to APA for direction on the testing code issues. APA is sharing online resources and encouraging them to pass the information on to members whether or not they also belong to APA.
The direct link for the resources is www.apaservices.org/practice. Click on reimbursement to find the testing code resources.
APA is planning another round of webinars for May now that they have updated info from NCCI.
According to Antonio Puente, Ph.D., past APA president, reimbursement for the new testing codes is a major issue for a significant percentage of psychologists. “We are continuing to work very hard on this topic and on multiple fronts,” he said.
Paula Hartman-Stein, Ph.D., has been Medicare correspondent for The National Psychologist for over 25 years because of her clinical work with older adults, involvement in Medicare policy and work as an expert on panels for depression and elder maltreatment screening. She offers seminars on ethical billing practices under Medicare and educational resources regarding documentation of psychotherapy that can be obtained through her website, www.centerforhealthyaging.com.