Beware of Success

Historically, the “overhead” component (practice expense, PE) of the formula for pricing psychotherapy in Medicare has averaged 21% from 2000 to 2020. As a reminder, the national price of a service in Medicare is determined by three components, work, practice expense, and malpractice, which are then moderated by geographic location to produce the local values. …

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If You Are A Psychologist, What Are You Waiting For?

In the current context, an active discussion I have encountered is the supposed meagerness of the emergency refunds being paid to health care professionals by Medicare. I did a quick analysis. In 2017 (the most recent year for which data appear to be publicly available*), Medicare paid psychologists $490,497,820 for the diagnostic and treatment services …

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Update: Medicare National Values For Health and Behavior Assessment and Treatment Procedures

For interested readers, I’ve been able to extract the Medicare National Payment Amounts for the Health and Behavior (H&B) codes in 2020. An Assessment or Re-Assessment (96156) will be valued at $99.97. Sixty minutes of Individual Intervention (96158 + 2 x 96159) will be valued at $115.85. These are the National values, without geographic price …

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Psychotherapy In Medicare Update – As Predicted, 10 Million+ Sessions Were Provided For The First Time In 2017

In June 2018 I wrote here, “The exact 2017 numbers are not available yet, but it is all but certain that, for the first time, more than 10 million psychotherapy sessions were provided to Medicare beneficiaries in 2017.” The data are now available: 10,089,575 psychotherapy sessions were provided to Medicare beneficiaries in 2017 (source: https://data.cms.gov/), …

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Pay raise for psychologists?

Psychologists were recently apprised of a “huge win” in advocacy in relation to Medicare, resulting in “rate increases (which) are strong evidence that CMS recognizes the importance of addressing the psychological factors that affect patients’ physical health problems (and) will make it financially more sustainable for psychologists to provide HBAI [health and behavior] services and …

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The Medicare Opt Out Rate is Decreasing Among Mental Health Clinicians

Despite a flattening of reimbursement rates and other concerns about mental health care in Medicare, not only is the feared and/or believed flight of mental health clinicians from Medicare not occurring, but the the actual trend is clearly in the opposite direction. The number of mental health clinicians opting out of Medicare has reached its …

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Psychotherapy In Medicare Update – 10 Million+ Sessions Likely Provided For The First Time In 2017

The exact 2017 numbers are not available yet, but it is all but certain that, for the first time, more than 10 million psychotherapy sessions were provided to Medicare beneficiaries in 2017. The 2016 data are available: 9,866,628 therapy sessions were provided that year. Given the rate of increase in recent years, the 10 million annual …

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Update On Brief Session Psychotherapy In Medicare

Brief session psychotherapy showed a 3.9% increase in use in 2016 relative to 2015, the first increase in 3 years, to nearly the same level of use in 2013. 2.13 million brief sessions were provided in 2016. With a National Payment Amount of $64.09 in office settings and $63.73 in facility settings in 2016, a …

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Outliers in Psychotherapy Revisited

ProPublica named names in its recent analysis of “highly unusual billing patterns” for office visits to MDs within Medicare. This reminded me of the 2016 analysis I conducted of billing patterns for 53+ minute psychotherapy sessions. I thought it was time to provide an updated analysis for the most recent data available, 2015. I won’t …

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Psychological and Neuropsychological Testing in Medicare

I’ve previously reported here about provision of psychotherapy to the Medicare population. Another valuable service psychologists and other health professionals provide to those with Medicare is diagnostic psychological and neuropsychological testing. These assessment methods can help clarify diagnoses, formulate treatment plans, measure recovery or progress of conditions, and effects of treatment. To what extent are …

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