It’s Easy For A Payer To Spot An Outlier

How easy? The following information is based on the 2013 “Medicare Data” (Data.CMS.gov). Can you spot the outliers? That’s right. It’s easy to see that the overwhelming majority of clinicians provided 1000 or fewer 53+ minute sessions in 2013. A few obviously break away from the pack providing 1-2,000 such sessions, fewer still between 2-3,000, …

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45 Minutes is The Most Common Therapy Session Length

53+ minute psychotherapy sessions can hardly be called ‘outlier’ or ‘atypical’ session lengths, as some insurers may now be asserting. However, 53+ minute sessions are not necessarily the most commonly employed increment for treatment visits. Here’s a look at the 2013 numbers from the large Medicare population (approximately 52 million in 2013). Source:  https://data.cms.gov/. *Number of …

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53+ Minute Psychotherapy Sessions Remain a Standard of Care

Reports are emerging that insurance companies are directly or indirectly pressuring clinicians to decrease their use of CPT Code 90837 (for a psychotherapy session 53+ minutes in length), or outright refusing to reimburse for these. Clinicians are once again alarmed about potential bias against coverage of reasonable lengths for psychotherapy sessions for appropriate conditions. I …

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Back To The Future Of Reimbursement For Psychological Services

In February 2014, I estimated that the national average for third party reimbursement for a diagnostic interview could stabilize at around $137 for doctoral providers from 2019-2023, that 45 minutes of psychotherapy would stabilize at about $88 during that same time frame, 60 minutes of psychotherapy at about $131, and psychological testing in the $82-$83 …

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Further Insights from the “Medicare Data”

Initial analyses of “What the Medicare data reveal about mental health services” were previously reported here. Watch this page for updates on information developed from the “Medicare Provider Utilization and Payment Data: Physician and Other Supplier” data released by CMS April 9, 2014. The data allow insights into health services provided to Medicare Beneficiaries in 2012 …

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What the Medicare Data Reveal About Mental Health Services

Associated with a great deal of fanfare, particularly in the popular press, on April 9 Medicare released data about how much it paid physicians and other suppliers in 2012. Popular reporting quickly focused on the “top billers” to Medicare for health services, including setting up “look up your own doctor” type of search websites. Who …

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The Fix Is In: Medicare May Soon Become the Most Stable, Predictable Payer

Modern Healthcare is reporting that a bipartisan deal has been struck that will fix the Medicare SGR problem. The proposed solution will replace the SGR with a 0.5% annual increase in reimbursement from 2014 through 2018, and then move toward an incentive payment model that will incorporate  the current PQRS system, value-based payment and “meaningful …

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ACO Growth and Coverage of Medicare Beneficiaries

On 12/23/2013, Medicare announced 123 new Accountable Care Organizations, covering approximately 1.5 million more Medicare beneficiaries. The list of new ACOs may be found here: ACOs with start date 1/1/2014. Lists of ACOs previously announced are here: Start date April 1, 2012 (27 ACOs, ~375,000 beneficiaries in 18 States) Start date July 1, 2012 (87 ACOs) Start date January 1, 2013 (106 ACOs) With the …

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How much should your therapist be charging for your services?

By and large, health professionals are not supposed to talk to each other about how much they charge. In theory, this is because they might “conspire” with each other to only charge a certain amount. The supposed risk to consumers is there will be no “competition” among health professionals, that prices will be driven up, …

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Medicare reimbursement for mental health services compared to inflation

Now that Congress has finally decided what doctors will be earning this year when they see Medicare beneficiaries, here is a look at what is happening to reimbursement for mental health care. The following graphs show actual changes in reimbursement for psychologists to perform initial evaluations, to provide 45 to 50 minutes of therapy, and …

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