CMS cautions providers not to resubmit psychotherapy claims

The health care reform law (The Patient Protection and Affordable Care Act or PPACA) extends the Medicare mental health services restoration payment of five percent through December 31, 2010 for psychotherapy services (section 3107).

Many practitioners are now awaiting retroactive payments for the difference owed them on claims paid before the five percent restoration was implemented on June 1, 2010. Staff from the Centers for Medicare and Medicaid Services (CMS) are working to prepare instructions for the Medicare Administrative Carriers (MACs) regarding how to make adjustments for these claims that have already been paid.

CMS staff are emphasizing that providers should not resubmit claims already paid. As there is no way to indicate on a claim that you are asking only for the difference in reimbursement now owed you, rather than duplicating a claim already filed and paid out , CMS will consider your claim a duplicate of the one already paid and reject it.

History of the Restoration Payments

In 2007, the CMS reduced Medicare Part B reimbursement for mental health services in a “five-year review” rule. Congress substantially restored these payments through the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), but this restoration expired on December 31, 2009.

The new health care reform law enacted on March 23, 2010 restores this payment, retroactively to January 1, 2010. The APAPO is seeking a further extension through 2011.