Medicare

Latest news:

Reminder: As of January 1, 2015, Medicare and Medicaid will no longer pay for MOO64, the code for a brief office visit for medication management. Encounters solely for medication management should now be coded for using the E/M code that corresponds to the complexity of the patient's presentation. In terms of value, 99213 is the equivalent of the deleted 90862 for established patients.

For your 2015 Medicare Fee Schedule go to your contractor's website.
View the Contractor Directory (available for APA members) here.

Summary of Key Provisions in 2015 Medicare Physician Fee Schedule Final Rule:

Avoid the 2016 PQRS Medicare Claims Penalty:
To avoid being penalized 2% on all of your 2016 Medicare claims, you must have reported the necessary quality measures pertinent to psychiatry for at least 50% of your eligible patients by December 31, 2014. If you did not fulfill the PQRS requirements for reporting on quality measures in 2013 (only one measure needed to be reported that year) you will receive a 1.5% downward adjustment on all of your Medicare claims in 2015.

Received a Revalidation Request Letter? Now What?
Have you received the yellow envelope containing a request to revalidate?

  • Prevent payment hold and deactivation of billing privileges by responding timely.
  • Submit a completed revalidation application as soon as possible, but no later than 60 days from the postmark date on the revalidation request letter.

Do you want to revalidate using the quickest and easiest method?

  • Use PECOS and submit your revalidation via the Internet-based secure Provider Enrollment Chain & Ownership System (PECOS) rather than a CMS-855 paper application. The process is as easy as verifying your information in PECOS, making changes where needed, uploading supporting documents, and signing the application electronically.
  • For details and helpful tips, visit the Enrollment section of your Medicare Administrative Contractor's website. (links are available on the MAC Directory]

So you have never used PECOS or haven't accessed PECOS lately?

  • Get started and revalidate in PECOS.

2% Sequestration Medicare Fee Cut:
As of April 1, 2013, Medicare fees were effectively cut by 2% as part of the overall federal cuts required by sequestration. For participating providers, patients will still be required to pay the same copay they paid before sequestration (even though the percentage of the total will be slightly higher than it was since the amount received from Medicare will be lower), but the provider will receive 2% less from Medicare. Nonparticipating providers may continue to charge patients the limiting charge for the service, and the 2% will be subtracted from the reimbursement they get from Medicare.


Medicare was created in 1965 as part of the Social Security Act.  The program was divided into two parts.  Part A is hospital insurance and helps to pay for care provided in a hospital, skilled nursing facility, nursing home, or hospice.  It covers the room, board, and ancillary charges billed directly by the facility.  Part B covers the professional services of physicians and nonphysician healthcare providers and a variety of outpatient services including x-rays, laboratory work, and durable medical equipment. Since 2006 there has also been a prescription drug benefit that Medicare beneficiaries can buy into known as Medicare Part D.

Practice help is available to Members through the Practice Management HelpLine by phone [800.343.4671] or email us at hsf@psych.org.

Medicare Participation: Know Your Options

Enrollment in Medicare

PQRS

Electronic Health Records Meaningful Use

Medicare e-Prescribing Program

Medicare Fee Schedule

Medicare Part D

Troubleshooting Medicare

Medicare vs. Medicaid


Information on Medicaid


More online/print practice resources supported by OHSF:

Quick Practice Management Guides – Documents exploring common practice management issues encountered by psychiatrists.

Practice Management for Psychiatrists: The Basics   The  e-book is posted both as a single document download and as a chapter-by-chapter download for ease of printing. Free online to Members.

Information on Mental Health Parity can be found on the APA website www.psych.org under Managing A Practice or on the APA co-sponsored site www.parityispersonal.org.