MEDICARE

Rate cuts have been averted, and co-pays will be equalized

Prodded by angry health care providers, Congress overrode a presidential veto of a Medicare bill, averting a 10.6% rate cut that officially went into effect July 1. And as the bill became law, there are two other pieces of good news for practitioners:

1. Another rate cut for 2009--this one 5.5%--has already been dropped. Instead, there will be a 1.1% increase next year.

2. Behavioral health co-pays will be brought in-line with the rest of Medicare. Until now, the practical co-pay for mental health has been 50%, as opposed to 20% for medical services. This change will be effected gradually, with full parity coming in 2015.

The vote, which came hours after the veto on July 15, 2008, was 70-26 in the Senate and 383-41 in the House.

The problem now is how claims submitted between July 1 and July 15 will be handled. According to Jean Thoensen, a mental health biller and consultant in Virginia, some clinicians have been holding back claims pending resolution of the issue. If you’ve been holding them, she says, submit them now.

Claims already submitted for care provided during those two weeks may be paid based on the 10.6% cut--but that isn’t yet clear.

As always with the federal program, the devil is in the details. So we’ll be following up with specifics--on the co-pay issue, as well as other aspects of the new law--in the months ahead.

Contacts: 1) Laura Groshong, Director, Government Relations, Clinical Social Work Association, 4026 NE 55th St., Ste. C, Seattle, WA 98105 (206) 524-3690, email: lwgroshong@comcast.net; 2) Jean Thoensen, PsychBiller, Centreville, VA, (866)475-8612, www.psychbiller.com.