22 July 2024 Source: Herz, G. & OpenAI. (2024). ChatGPT (Version 4.0) [Large language model]. Retrieved from https://www.openai.com/chatgpt. Notes: Enrollment numbers add up to more than 334 million, the estimated U.S. population at the time of this post, due to those with multiple coverage such as Medicare+Medicaid. Adjusting for overlap in coverage, …
The following are prices listed for the six behavioral health services required to be provided by hospitals in a consumer-friendly “shoppable services” search. Prices were retrieved 15 January 2022 on review of these three hospitals and related locations. Location Service SSMHealth St. Mary’s UnityPoint Health Meriter UW 30 Minute Therapy NF PC $154 45 Minute …
As with prior updates (e.g., 2019 and 2018, CMS data releases related to utilization tend to be 2 years behind the year of service provision. Data for services in 2019 became available at the end of August 2021, at Data.CMS.gov. The following analyses are for individual therapy sessions only (HCPCS 90832, 90834, and 90837). Psychotherapy plus medication, …
Continue reading ‘2021 Update – Psychotherapy In Medicare’ »
Background As of January 1, 2021, hospitals must comply with the “Hospital Price Transparency Final Rule,” requiring them to make their standard charges available to the public. Charges must be provided in two formats: “1. A comprehensive machine-readable file that includes all standard charges for all hospital items and services; and 2. A consumer-friendly display …
Recently I’d tweeted this data-supported proposition and asked to be proven wrong. So far, no one’s done so. There is no American insurance company that has kept up with or exceeded the rate of inflation for reimbursement of any health care service. Especially mental health care. Prove me wrong. pic.twitter.com/c8j5iRsCXO — Gordon I. Herz PhD …
Continue reading ‘No American Insurance Company Reimbursement Keeps Up With Inflation’ »
I have previously reported about provision of psychotherapy in Medicare, most recently in 2019 and 2018. CMS data releases related to utilization are always at least 2 years behind the year of service provision. Data for services in 2018 became available early in February 2021, and the following analyses are based on those data, available …
With the passage of the Consolidated Appropriations Act December 21, 2020, signed into law six days later, the Medicare Physicians Fee Schedule received an unexpected pardon from the planned, unprecedented 10.2% reduction in the Conversion Factor governing all fees. Instead, the CF was increased from 32.4085 to 34.8931. An additional $3 Billion was allocated to …
Continue reading ‘Update #3 Medicare 2021 – “Final” Reimbursement For Psychological Services’ »
“NPA” = “National Payment Amount.” This will vary based on your geographic region. “RVU” = “Relative Value Unit.” This value is the total of the Work, Practice Expense (PE), and Malpractice components that make up every procedure that Medicare pays for. RVUs used to be objectively determined, but the process to determine these has become …
Continue reading ‘2021 Medicare Prices For Psychological Services’ »
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. …
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 …
