Expect Harsh, Intensive Scrutiny If Your Medicare Claims Are Audited

Operation Restore Trust, the anti-fraud and abuse program operated by the Office of the Inspector General, has placed psychologists are under harsh scrutiny, contending it is warranted by a history of Medicare claims that contained billing errors. The information emanates from James Georgoulakis, Ph.D., who is APA representative to the Health Care Finance Administration’s (HCFA) […]

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  • Barriers Preventing Suits Against HMOs Are Tumbling

    Slowly, and it would appear surely, the barriers preventing patients from suing health maintenance organizations (HMOs) for denial of necessary medical care are tumbling down. Some of those walls are being eradicated by legislation, others by judicial review on both the state and federal levels. The evidence was clear well before the U.S. House passed […]

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  • Rescue Health Care Day Allows Venting Anger, But Question ‘What Next’ Remains Unaddressed

    For many psychologists, social workers, psychiatrists and other health professionals, Rescue Health Care Day, April 1, was a therapeutic experience that encouraged them to vent pent-up rage about the bungling of managed care. Organized for nearly two years by Karen Shore, Ph.D., who heads the National Coalition of Mental Health Providers and Consumers, Rescue Day […]

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  • Two sides of managed care debated at Atlanta conference

    Atlanta–It’s surprising and refreshing that a managed care organization such as the National Mental Health Care Congress (NMHCC) would invite a keynote speaker to its annual convention, whose biases run afoul of the hand that feeds the honoraria. Take David Himmelstein, M.D., chief of the Division of Social and Community Medicine at Cambridge (Mass.) Health […]

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  • How a celebrated psychiatric hospital lived and struggled with hard times

    The final chapter of the Menninger Clinic’s fabled history in Topeka, Kan. has not yet been written, although the ending appears to be in sight. Two years ago, Menninger was prepared to move to Houston, TX to join forces with the Baylor School of Medicine and Methodist Hospital. When that plan fell through, Menninger revisited […]

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  • Disability protection is essential

    Most people have life and health insurance to protect them in the event of illness or accident. That means that their medical expenses are covered and their families are protected. But what happens in the event of a serious illness or accident that results in long-term disability? Who would pay for everyday living expenses? How […]

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  • Longtime Foe Of Managed Care Thrives In ‘Self-Pay’ Practice

    Ivan Miller, Ph.D., a Colorado psychologist who has frowned on managed care since its inception, is in his sixth year of solo practice, claims to be going strong, and expecting even better days ahead. He asserts that the self-pay market he so intensely advocates keeps gaining converts, and that those who have long insisted the […]

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  • Fear Of Rising Claims By Employer, Insurance Companies Have Not Materialized, GAO Reports

    The dire financial predictions made by insurance companies and employers about complying with the 1996 Mental Health Parity Act have not materialized, says a new report by the General Accounting Office (GAO). In fact, 60 percent of employers responding to a survey to determine compliance with the new law, “did not know whether compliance with […]

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  • Psychologist thought it was a scam when Blue Shield tried to get $38,000

    When Steven R. Cohen, Ph.D., a practicing psychologist in Philadelphia, received a call in 1999 from Pennsylvania Blue Shield, he was told to prepare to be audited for “overuse.” The audit would focus on CPT Code 90844, which has since been changed to 9086 denoting 45-50 minute individual therapy sessions. Endless letters and phone calls […]

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  • Magellan eliminates half its debt by filing for bankruptcy

    Recommendations cited for psychologists, other mental health providers Magellan Health Services, the nation’s largest managed behavioral mental health company, eliminated half its $1 billion debt when it filed for Chapter 11 bankruptcy in March. Magellan’s reorganization plan calls for holders of half of the company’s debt to trade it for nearly all the stock in […]

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