Lobbyists for professional mental health organizations are
scrambling to prevent a 10.6% Medicare cut that will take effect
July 1 unless legislation can be passed by Congress and signed by
President Bush.
Psychologists and clinical social workers were spared drastic
cuts at the start of 2008, as Congress passed a last-minute
reprieve, putting off the day of reckoning for six months.
Jim Finley, senior government relations associate for the
National Association of Social Workers (NASW), believes the
upcoming cut may be avoided, or at least put off for another
six months.
"We’re very active on this issue--the entire health care
profession is," Finley tells us. "I expect it to be fixed for six
months because they can’t cut provider fees right before the
election."
The NASW and American Psychological Association (APA) are also
pressing for mental health parity in Medicare. That would mean a
20% co-pay--the same as in medical services--rather than the
current effective 50% co-pay. "We’re optimistic we’re going to get
it this time," says Finley.
Congress ended up approving a miniscule half-percent Medicare
increase at the end of 2007, but some clinical therapists ended up
seeing a slight decrease in reimbursement nonetheless. That was
due to changes in how the government calculates the amount of work
performed. The formula for Relative Value Units (RVUs) varies from
region to region.
Jean Thoensen, a mental health care biller in Centreville, VA,
recalls, "When the first claims started coming back for 2008
services, I thought, ‘What the heck is this? I’m getting paid less
than last year and I was supposed to get a half-percent
increase.’"
For example, one clinical social worker we heard from took a $3
per session hit starting in January despite the pay boost. Rates
were cut in 2007, but not as drastically as announced at the end
of 2006.
"Now, unless Congress does something, the hammer’s really going
to drop," Thoensen says. "Anybody who can will quit Medicare.
"The other thing about Medicare cuts is that insurance
companies look at them. TriCare Standard lowered their rates to
match Medicare. The big fear I have is that there could be a
follow-the-leader effect. Social workers in my area (Virginia) and
in Dallas are already getting $60 for a 90806--and that hasn’t
changed in six years." If you knock 10.6% off of that, you get
$53.64.
Finley believes that ultimately the Medicare payment structure
needs a major overhaul. For one thing, he says, there’s too much
money being funneled into Medicare Advantage programs that benefit
insurers. Savings in that area could be used to prop up provider
reimbursement. But none of that is likely to be addressed during
election season.
Contacts: 1) Jim Finley, NASW, Washington, DC,
(202)408-8600, email: jfinley@naswdc.org; 2) Jean Thoensen,
PsychBiller, Centreville, VA, (866)475-8612, www.psychbiller.com.
