Teamwork helps fix Medicare payment glitch in Georgia

Psychologists in Georgia recently noticed that they were being reimbursed by Medicare at a much lower rate than usual, but were able to speedily resolve the issue with the help of APAPO staff

by Communications Staff

March 27, 2008 — A Medicare reimbursement glitch in Georgia was fixed quickly, thanks to psychologists in that state working with government relations staff for the APA Practice Organization (APAPO).

In early February, psychologists in Georgia noticed that they were being reimbursed by Medicare for certain services at a much lower rate than usual. They brought the matter to the APAPO's attention and provided relevant documentation.

Upon investigation, staff for the APAPO discovered that Cahaba, the Medicare carrier for Georgia, paid for all psychological testing and diagnostic interviews conducted in the state in January according to outpatient mental health limitation rules. Under these rules, Medicare reimburses at only 50 percent, increasing the beneficiary's co-pay to 50 percent. In fact, Medicare payment policy considers these services medical procedures; therefore, the carrier was responsible for paying 80 percent of the billed amount, with the beneficiary accountable for 20 percent.

The problem arose when 2008 payment rates for Medicare providers in Georgia were loaded into the computer system at Cahaba. The formula that applies the outpatient mental health limitation was erroneously set to go into effect for too many codes. Once the government relations staff for APAPO contacted Cahaba, the issue was swiftly resolved.

APA Practice Directorate Interim Executive Director Randy Phelps, PhD, credited Georgia psychologists for making APAPO aware of the problem and providing important information. "We rely on our grassroots members to help us identify and tackle issues facing practitioners in the field," said Phelps. "The experience in Georgia is an excellent example of what we can accomplish by working together."

Any member psychologists in Georgia who are still experiencing difficulty with this Medicare reimbursement issue can contact our Government Relations Department by calling 202-336-5889.