Evolutions and revolutions in Medicare policy and reimbursement of geropsychology services.

Abstract

The purpose of this chapter is to advocate for mental health services needed by older adult patients and patients with disabilities and to instruct the reader in ethical and successful reimbursement standards in a geropsychology practice. These ends can be accomplished only through knowledge of Medicare policies and laws, which regulate who is entitled to mental health benefits and how, when, where, and why the services may be delivered. Unfortunately, graduate training in psychology usually does not include training in how to manage the business of a psychology practice and even overlooks the subject of ethical billing practices in mandatory ethics courses. Most psychologists enter the field not knowing how to bill and not understanding the many rules and laws that regulate reimbursement. As a result, they inadvertently make billing mistakes that either cost them income or earn them income they should not have been paid. Worse, this lack of training may cultivate aggressive attitudes about billing, attitudes that might otherwise be diminished with rigorous ethics training.This chapter is aimed at early career geropsychologists, psychologists with a general practice that includes only a small portion of older patients, and seasoned specialty geropsychologists. Even this latter specialized group sometimes has gaps in its knowledge and understanding of reimbursement rules and regulations. Moreover, reimbursement is a moving target, difficult to keep up with because of the constant evolution of new laws and policies.This constant flux makes the writing of this chapter challenging. Inevitably, some of this material written in mid-2013 will be out of date by 2014. To address this challenge, the strategy is to provide enough resources for readers to know how to continue to stay abreast of rules and policies (see Appendix 3.1). Just as geropsychologists are responsible for staying current on standards of clinical practice, they are accountable for staying up to date on rules of correct and ethical reimbursement.In this chapter, I focus on outpatient services in multiple settings (e.g., offices, nursing homes, assisted living residences, hospice care settings) because they are where the vast majority of geropsychology services are delivered. Medicare payments for care in psychiatric hospitals and units and partial hospitals are fixed per diem payments for bundled services; thus, geropsychologists are not typically involved in direct billing for inpatient services. Readers who want more information on Medicare' s coverage of inpatient psychiatric services can find this in the booklet Mental Health Services (Medicare Learning Network [MLN], 2013b). A brief note, Medicare beneficiaries have coverage for psychiatric inpatient hospitalizations (in both psychiatric hospitals and dedicated psychiatric units in general hospitals) and partial hospitalizations, although there is a 190-day lifetime limit on psychiatric hospitalizations to prevent Medicare from paying for long-term custodial care for patients with mental illness.To ...

Intervention, consultation, and other service provision: A foundational geropsychology knowledge competency.

“…A brief overview of key issues below serves as a basis of knowledge. The reader is referred to Norris (2015) for detailed guidance on Medicare policy and reimbursement of geropsychology services.…”

“…Medical necessity refers to providing psychological services that are reasonable and necessary for the diagnosis or treatment of an illness or injury (Centers for Medicare & Medicaid Services, 2021). Components of medical necessity include diagnoses that support the need for the service, the type and level of service provided, and clearly defined expected outcomes (Norris, 2015). To optimally provide documentation to support the medical necessity for psychological services, documentation should include the results of clinical assessments, symptoms associated with the diagnoses, treatment plan, prognosis, and progress made to date.…”

“…Graduate training in psychology usually does not include a focus on managing the business of a psychology practice and many psychologists enter the field without awareness of the many rules and laws that regulate reimbursement for geropsychological services (Norris, 2015). Licensed Psychologists need to become familiar with the credentialing process for various payor sources of their potential clients.…”