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APAPO Federal Regulatory Affairs Officer Kimberley Moore finds Medicare regulations fascinating, which is great news for APAPO members who need her help

by Communications Staff

September 30, 2010 — Having worked in provider payment policy since 1996 for various member associations, Kimberley Moore has been the federal regulatory affairs officer for the APA Practice Organization (APAPO) for more than six years. Originally from Wayne, PA, a small suburb of Philadelphia, Kim moved to Washington, DC, to attend graduate school at American University and become involved in politics. Her interests in health coverage and advocacy make her a natural fit for her role with the APAPO. 

Kim answers members’ questions about Medicare regulations including coding, billing and reimbursement. She enjoys learning the nuts and bolts of how fees are established, and the intricacies of Medicare payment processes and insurance coverage policies.

Kimberley MooreKim also coordinates with staff for Medicare Administrative Contractors to resolve payment problems that psychologists are experiencing. She serves as staff liaison to the Current Procedural Terminology (CPT®) Editorial Panel, which is administered by the American Medical Association and the Relative Value Scale Update Committee (RUC). The CPT Editorial Panel develops the codes that are used to identify professional services provided by psychologists and other health care professionals and the RUC assigns work relative values for each CPT code.

“Some people’s eyes glaze over when I explain to them how the CPT and RUC processes work.” Kim said. “I’ve always found them fascinating.”

Along with other staff and members, Kim was instrumental in establishing and implementing new Medicare codes for psychological and neuropsychological testing. She has worked extensively to teach members and insurance companies how the new codes should be utilized. She has also worked with the CPT Editorial Panel to answer the payment questions that arose as part of the process, which lasted more than two and a half years.

Right now, Kim is working on the RUC’s five-year review of psychotherapy work values. The process is complex and has involved surveys and research in conjunction with multiple provider organizations, including social work, nursing and psychiatry. Results of the survey are expected to be published in 2011.

Though Kim observed that some coworkers might liken her position to watching paint dry, she enjoys the intricacies of navigating complex Medicare issues and aiding psychologists in resolving coding and billing concerns. One of the biggest things Kim appreciates about her position with the APAPO is the “variety of personalities among our members and the questions that I get from them.”

Kim enjoys the challenge of helping members address unique billing situations. Some of her more interesting and challenging member inquiries involve providing coding assistance in a situation where a psychologist’s patient needed care not typically provided, and assisting psychologists with submitting bills properly for patients who had become eligible for Medicare but did not realize it.

In one instance, a member called because the compliance office at the hospital where he worked realized he was not providing psychotherapy, but rather physician treatment plan services to cardiac rehabilitation patients. The employer was considering letting the member go because of uncertainty about how to bill for his services. After reviewing the situation, Kim realized that the health and behavior codes fit the services the member had been providing. At the end of the conversation, the member said Kim may have just saved his job! 

One thing Kim has come to appreciate in her time at APAPO is how devoted member psychologists are to their patients. She wants to help members learn billing rules and resolve coding concerns efficiently so that they can focus on providing care to their patients.

Somewhere between her daily responsibilities at the APAPO, exploring her passion for writing and photography, raising two wonderful sons (ages 6 and 8) with her husband Steven, and chasing after a new puppy, Kim finds time to coordinate and run the Alexandria, VA, St. Patrick’s Day Parade and various associated festivals and fundraisers. She also serves on the Board of Directors for the Adoption Center of Washington, an international adoption agency located in Alexandria, VA.

Members with questions about the APAPO member activities mentioned in this article may contact Ms. Moore by e-mail or call 202-336-5889.

Members with questions about billing and coding of the APA Practice Central website are encouraged to visit Practice Central, the APAPO’s website for members.

Current Procedural Terminology (CPT®) copyright 2010 American Medical Association.  All Rights Reserved.