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Jennifer Shephard / Jennifer Shephard for NBC News
Psychologist Marc Milhander, 54, says he's weeks away of having to close his Niles, Mich., counseling center after delays and denials in insurance payments caused by an overhaul of treatment codes.
Published at 4:45 a.m. ET: Marc Milhander conducted more than 100 psychotherapy sessions in the first few weeks of this year, treating patients ranging from the mildly anxious to the severely depressed and the 24-year-old with antisocial personality disorder who really wants to get his hands on a gun.
But Milhander, 54, a psychologist who co-owns a busy Niles, Mich., counseling center, is getting pretty anxious himself.
He’s among a growing number of U.S. mental health professionals who say their insurance claims have been denied -- and their payments have been withheld -- because of problems resulting from nationwide changes in psychotherapy treatment codes that took effect Jan. 1.
“I’ve been paid for five hours of work for the month of January,” said Milhander, who supports a staff of four and oversees 300 patients a month. “I just wrote a big, fat check out of my personal bank account to keep us afloat.”
Worse, Milhander and others say systemwide delays and outright denials of payment could last for months, jeopardizing not just the nation’s 500,000 providers, but also access to care for millions of mentally ill Americans. Federal estimates suggest that nearly 20 percent of the adult U.S. population has some form of mental illness.
“So far, it’s chaos,” said Randy Phelps, deputy executive director for the American Psychological Association, who says hits to the coding section of the APA's website have topped 300,000 in the past month. “It’s hard to evaluate how widespread this is.”
The problem comes amid growing demands for better interventions with the mentally ill in the wake of shooting massacres in Aurora, Colo., and Newtown, Conn.
“Compliance with treatment is a sketchy thing to begin with,” said Sam Muszynski, director of the office of health care systems and financing for the American Psychiatric Association. He fears that financial fallout may force some providers to disrupt care, leaving mentally unstable patients on their own temporarily -- or longer.
“All it takes is one missed appointment,” he added.
The trouble stems from the first overhaul since 1998 of the codes used to describe -- and bill for -- mental health treatment. They’re among some 8,000 to 9,000 CPT, or current procedural terminology, codes used for all types of medical procedures.
The codes, produced by the American Medical Association, are updated each year, usually with no problem, experts say. But this year, changes to a mere 30 codes that affect mental health services have thrown a huge glitch into the system.
“There are some systems that aren’t even ready to begin accepting claims,” said Nina Marshall, director of public policy for the National Council for Behavioral Health.
She has been flooded with calls and e-mails, not only from providers confused about how much to charge and when they’ll get paid, but also from patients worried about care.
“I have heard from consumers saying that their providers can’t provide the services,” she said. “They’re reaching out to me with real concerns.”
The psychiatric codes were updated after vigorous lobbying by mental health care providers, who argued they weren’t being paid enough to treat today’s medically complex or seriously ill patients.
“What has come out of managed care in mental health is they go in for three days, they’re on meds, they’re barely stabilized, and being treated by outpatient providers,” Phelps said. “Nobody had reevaluated these codes for 30 years, but the world had changed tremendously.”
Payers unprepared
But the implementation has been difficult, at the very least.
Payers, including the federal Medicare and Medicaid programs, admit they weren’t prepared for the switch.
Some providers have used the new codes incorrectly -- or not at all, a violation of federal law. Some government contractors logged extra "edits" into the codes, invalidating scores of submissions, Medicare officials told NBC News. Three weeks into the new system, federal officials had to send directives reminding everyone of the changes, said Brian Cook, a spokesman for the Centers for Medicare and Medicaid services.
“As soon as we became aware of the problem that some of our Medicare contractors were having, we immediately took steps to fix it and instructed the contractors to re-process the incorrectly denied claims," Cook told NBC News. "We also informed Medicaid State Agencies and private insurers to prevent any widespread problems.”
The nation’s largest private insurers have had problems, too.
“The amount of changes and the work involved was much bigger than … the folks involved anticipated,” said Helen Stojic, a spokeswoman for Blue Cross Blue Shield of Michigan, where Marc Milhander practices.
Stojic couldn’t say how many Michigan claims had been denied or how many providers had been affected, but she acknowledged that many had not received payments in January -- and that there was no firm date when they would.
“We’re going to do everything possible to get some dollars to them,” she said. “We certainly apologize for the inconvenience.”
For Milhander, the issue is far more than an inconvenience. He says worried about keeping the doors open with so little money coming in.
“Right now, we’re working for free,” he said.
Steven Perlow, president of the Georgia Psychological Association and a psychologist in private practice, says he hasn’t received January payments from private insurers, either.
He, too, has heard from dozens of frustrated colleagues worried not just about cash flow but also about code changes that shave more off of insurance payments. One change, for instance, trims a typical therapy session to 45 minutes and cuts reimbursement by $1 each time.
“It’s just $1 less, but nonetheless, we’re being asked to take less,” said Perlow, who sees about 45 patients a week.
The biggest worry, though, is that the coding chaos will affect care for vulnerable patients fortunate enough to have some form of insurance coverage.
'A really large job'
About 46.5 million adults in the U.S. -- or nearly 20 percent of the population -- suffer from some form of mental illness, according to government statistics. About 11.5 million suffer from serious conditions.
It’s not clear how many actually have access to care, but many do not, and anything that jeopardizes existing support is a problem, experts say.
“We are ethically bound not to leave patients hanging,” Perlow said. “I will personally see people for a sliding scale … there have been situations where I’ve seen people for free.”
Milhander said he, too, would continue to treat patients -- including the most severely ill who require medication management -- as long as possible.
“My staff are understandably panicked, fearful that they won’t have the financial resources to get through this,” Milhander said. “I’m letting them know I will carry them through this period financially, for as long as I’m able.”
How long the denials and delays may last is anyone’s guess. Medicare officials say they’ve begun reprocessing claims that were denied in the first weeks of the year. But for some Medicaid programs, the problem is so complex that they may not be able to get up to speed to process claims until June, experts tell NBC News.
Private insurers are aware of -- and working on -- the problem, said Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry association.
“Implementing these codes is a really large job,” she said, noting that some plans are offering alternate payment processes until the problem is fixed.
Still, some providers may stop participating in insurance plans that delay too long, or cut fees, and others might be forced to close shop entirely, unable to go for weeks or months without income.
'How scary is this?'
That’s a frightening thought to the family of Milhander’s 24-year-old patient, who suffers from paranoid delusions and only recently has been stabilized under the psychologist’s care.
“Marc is the only person that he is able to talk to. This is his only release,” says a family member, who asked not to be identified, even broadly, for safety reasons.
The young man suffered a head injury as a teenager. He has threatened to burn the house with people in it, threatened to get a gun, threatened to "come back and haunt" family members after his own death.
“We hear about these scary things that happen. How scary is this, now that the insurance is having these issues?” said the family member. “How many people are going to be left untreated out there?”
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I code for a living. This was not a change that just happened on Jan 1. There was warning to the insurance companies so that they could change their programing. No one took the time to go ahead and run simulations so that the glitches were taken care of.
But on the brighter side, the insurance companies are making loads of cash and have lowered their costs with this glitch.
Plus they are earning interest on the monies they are not paying out but still collecing premiums. The ins. companies knew this was coming don't tell me they don't have the staff to program in the new codes. Just another way for ins companies to screw us all.
Another benefit to the insurers is that untreated psychopaths will get guns and go out and kill people who have medical insurance and make claims.
The implementation was all off anyway.
Any time you have these types of coding changes that have an effect on an entire industry or subsection of medicine you make payers compliant FIRST. Then you let providers submit the codes voluntarily over the course of a couple years. Then you make the use of the codes mandatory. It allows a steady progression and lets real data and real situations dictate where the problems are. Not something someone thinks up in a controlled environment. So simple yet so hard for our regulatory agencies at the same time, they do this type of crap quite often.
Insurance companies do do it often. It happened in Radiation Oncology a while back. They were denying codes that were changed and not allowing modifiers and bundeling codes etc. Took awhile to get it straight. it was a hot mess.
Actually, the insurance companies will have to pay interest on claims they process wrong. I bill medical claims for a living, and any claim that takes longer to 60 days to process is owed interest.
What a bunch of crap. We should do away with the a.m.a. and the health insurance industry,then most people could afford to pay for thier own medical care. Those that can't would belong to the church.
Having worked at an insurance company as a bill reviewer let me set you straight. Problems with medical codes are almost always due to the provider using incorrect codes or inflating their bills. Medical bills come with medical reports, if the report doesn't substantiate the claimed treatment it's sent back to the provider. I've reviewed bills from one provider who correctly coded and billed $320.00 and another from a different provider who billed $19,000.00 for the very same procedure.
So if you've ever wondered why healthcare in the U.S. is so expensive don't just look at the insurance company, greedy medical practitioners seeking to add a million dollars or more a year to their bank accounts are the biggest problem.
and we think this is just a mental health related issue: think again.
CHANGES of hundreds of codes happen each and every year set out in October...NOT JANUARY...WHICH means they had the time to make changes (they: insurance criminals..errr companies) The reason given in this piece is not the truth. The fact is Obama gave America away to insurance companies and now they call the shots on everything in our lives, we are hostages now. The "systems" are easily fixed and as a part of HIPPA title II it is LAW for these systems to be able to accept changes made. In fact PMP or PMS are designed to easily make changes with the codes and updates.
I cannot trust that our government knows what they are doing. I do not trust them to handle affairs not related to taxes or laws....period, they have shown time and time again they do not have the people interests, but only the payouts for the lobby they paid for...in other words, this country does not belong to the people, but instead belongs to a corporation (INSURANCE, aka thin air) willing to do anything to control the people and the peoples income. sick
Rick - You are spot on.
I would concur. I believe a large number of these individuals can be found reading the NBC news web site for their current events information and then posting their opinion on the vine.
So here is where all of the O followers cry that it was Bush's fault and that this was happening before Obamacare...etc. Seriously, at what point will you all wake up and look at the state of the US? When you are the victims right? Because that is when you will all cry "UNFAIR" and "STOP AND HELP ME"! Sickens me daily, bunch of lemmings, seriously. You get what you deserve because you voted in the person that will make the record books for destroying what our forefathers worked so hard to try and achieve.
I dont think that O created all of the mess we are facing but he has cause and created most of what is happening today and continues to do so..... where are are answers and paperwork to Benghazi? What about Fast and Furious? AMericans died for no reason and others keep perishing....and the lemmings still follow. Once you wake up, it will be too late because then the damage will be done and none of us will be able to recover. So feel proud that your vote counted all right, which means you are also responsible for the state of the US. Be proud of that fact while the rest of us that are trying to survive are clawing our way to ensure our familys are fed and scrambling to find work. Good job
Rick, you are absolutely correct regarding the medical billing practices within this country. This is why all hospitals and practices should have prices listed like at a supermarket or auto mechanic's shop. The cost of an MRI is a couple hundred dollars. What doctors bill and insurance companies charge are in the thousands. Prices should be fixed for all procedures and medicines. Then you can decide to pay cash or go through an insurance claim like auto insurance or home owners insurance.
But the article is about changes in code affecting people with mental illness. People with paranoid delusions and mental illness don't get treated because they don't think anything is wrong with them. That is the problem with mental illness. And in many cases, drugs don't work or only work for a short period. And then they go on a mass murder spree.
Adam Lanza attempted to obtain a gun but was denied because he didn't want to wait for a background check. So many things are very wrong here:
1) A man attempts to buy a gun but doesn't want to wait 14 days for a background check. No red flags. No police follow-up. No questioning of the person attempting to obtain a weapon.
2) A man with a history of mental illness is considered dangerous by friends and family and doctors. Too dangerous to own a gun... but family members have guns AND the dangerous, mentally unstable man is allowed to walk the streets, as if his compulsive nature would simply not drive him to find another means of obtaining a gun.
3) Adam Lanza was treated for his mental illness... how did that work out? Doctors aren't miracle-workers. People are cars or computers that can be fixed by swapping out a fuel pump or hard drive. In most cases, mentally ill people cannot be treated. So why are they released to prey upon us?
4) Passing more laws regarding assault weapons or hand guns won't make a difference. Adam Lanza was denied a gun by Connecticut law but obtained several and went on a killing spree. Even if you ban guns now, there are a hundred million guns in the US that will be found and used by crazy people that are driven to kill.
prices really doesn't matter if you have health insurance. It depends on the contract your hospital or doctor has with the insurance company and if they are in or out of network. I can bill $1800 for an MRI but if my contract with BCBS is $330, that is what I get. I have to write off the rest. Yes there are doctors that care more about the money. I hope that they are a few. But Insurance Companies definately do not care for a patient. They care about keeping their money also. Don't deny it.
or the truly deranged will vote Democrat.
It looks like another scape goat! This guy looks a little under the weather himself. I would like to know the return on invest these pseudoscience are actually having on society. How many people they
have helped or helped cause more issues or that they are just stringing along to make a buck. Send them to the Samaritan Counseling Center isn’t it free. And they probably will do a better job without drugs.
I code for a living and work in the industry. These codes did not just change on Jan 1, that is correct. But they were only announced near the end of October, a mere couple months before they were implemented. And no, roadlesstraveled that isn't adequate time to make changes like these, you are clearly just biased against the industry based on paranoia. These changes took most of the industry by surprise, particularly with how sudden it was done. That left such a short time to analyze and assess the impact these changes would have, that affect potentially millions and millions of lines of code between hundreds of thousands of state and federally required reporting and structure needed to house all of the information, it was completely ridiculous. Changes of this magnitude should have been announced at least a year in advance to give providers and insurers adequate time to plan for and implement the changes necessary. The AMA really screwed this up, and now everyone across the industry from providers to insurers are scrambling to try and keep up with a rushed half-_ssed decision by them to push these codes out without a proper amount of time to actually implement it all.
The answer is really simple. Forced treatment or institutionalize. Plain and simple. There is rarely a cure and meds only mask the problem. Once a patient feels they no longer need to take the meds, they go off them and then the madness begins. Put every diagnosed mental defective in institutions and protect the majority of society against the minority crazies and there deluded advocates. I would rather restrict the rights of a few who cannot control their impulses than place society as a whole in danger thanks to ridiculous, liberal progressive ideas that look to protect the rights of those who would do harm, and then have the nerve to blame it all on the illness and not the individual who refused to follow treatment. Lock them all up and end this madness.
@ djo_34:
People with paranoid delusions and mental illness don't get treated because they don't think anything is wrong with them. That is the problem with mental illness. And in many cases, drugs don't work or only work for a short period. And then they go on a mass murder spree.
Would you please provide the statistical evidence that you apparently have to support these claims? Oh, wait, you are unable to do that, because these claims are unfounded and are nothing more than examples of black and white thinking. People with mental illness don't think anything is wrong, drugs don't work, and then the afore mentioned people kill others. How often do you suppose this happens? 100% of the time? 50%? Or is the number more like fractions of a percent, an amazingly low percentage given the number of people estimated to suffer from mental illness?
Furthermore, your insistance that people with mental disorders be shut away ( In most cases, mentally ill people cannot be treated. So why are they released to prey upon us?), is so facist that my jaw almost dropped. Why don't you time travel back to nazi Germany and take your ignorant, scare mongering diatribe with you?
Rick-911527
And don't forget to take a look at a system that makes it so easy for the crooks to overbill. 60 billion per year in medicare fraud alone.
Yes there are greedy doctors out there, but how many doctors are making $10 Million plus a year? Look at how many times a doctor has to spend hours on the phone trying to get coverage for a patient to have a procedure or gets quoted one rate on the phone and then gets reimbursed another and is told you can appeal. Looks like the health insurance shills are now out in force doing marketing work on Newsvine.
Lets look at the numbers and see where the real greed is, also the numbers below don't even reflect the fact that most of these companies have numerous executives making millions of dollars. So don't give me the poor insurance company and it's the greedy provider BS.
Treatment for the sociopathic/psychopath is next to impossible. They live in a dark world and to them it's normal. In their minds treatment is unnecessary unless of course they have other problems like bipolar or delusion or depression...yikes!
Radical partisanism strikes again. You would think they might have something better to do.
The thing that bothers me about this article is in the first paragraph. "a sociopath wanting to get his hands on a gun". First doesn't that smack of violation of patience doctor privilege, second, even if not, has this dr reported the potential threat, and third again more of MSN's propaganda machine against the 2nd amendment as that statement was totally unnecessary to the subject of the story itself. Do they think that all of us are so crazy that we cannot see through such blatant ploys. Course then again, there are a lot of folks out there that buy into the herd.
Glad this topic came up.
Something I just recently experienced and was wondering if anyone was aware of emergency room doctors not being contracted with insurances so they may charge the patient whatever they choose, and patients being unaware and not told, until after they receive the bill.
This sure doesn't seem ethical. Is this common practice?
Mike_P
Mymomdidnotraiseafool
You think insurance companies BENEFIT from paying out claims??? So is your screen name a reference to one of your siblings??
The AMA updates CPT, not the federal government and certainly not the White House or Barack Obama.
Again, for you crackpot denialists, THIS HAS ABSOLUTELY NOTHING TO DO WITH OBAMACARE OR THE FEDERAL GOVERNMENT. This has everything to do with mental health insurance companies and healthplans who are completely unprepared to conduct their own business, through every fault of their own. Because THEY choose to be unprepared, both patients and mental health providers will suffer.
Nor is the AMA to blame for this. The AMA has endless committees and review panels and allows public discussions of changes years in advance of making the changes official. The final changes and codes are made public October 1st, with the "go-live" date of January 1st. There is ZERO reason for insurance companies not to get their *%$! together and 1. participate in discussions to change CPT if they really want to and 2. actually implement the changes in their systems during the three month period between October 1 and January 1.
Entire sections of CPT are updated each year, often with changes MUCH more encompassing than the 30 codes changed in the mental health section this year. For example, the coronary stenting codes were completely re-worked for 2013 for the first time in over 20 years, and the changes are much more significant and involved than these codes.
Stop blaming the federal government (regardless of the president in office) for everything wrong in the world. Start doing some research and learning about a topic before you spout drivel.
No, it does not.
Dom, it wasn't liberal progressives who defunded the mental health care institutions and put all the crazies right out on the street. It was Ronald Reagan.
>Dick.. But those companies are not sitting on billions of provider's dollars because they are dragging to update their computer systems or withholding life-saving care from patients to increase their bottom line.
Dick what in the world does Ralph Lauren have to do with medical coding.
WARNING!!! TO ALL POSTERS!!! If you want to be heard, DO NOT USE NEWSVINE ON NBCNEWS.COM!!! Their policy of allowing posters to "collapse" comments they do not agree with amounts to censorship!! The vast majority of "collapsed" comments are those that receive the most votes. This is a popularity contest, not a blog! BOYCOTT NEWSVINE! If you want to be heard use blogs on CNN or any other news online. The "collapsing" by the community is allowed no matter which side you represent. This is NOT the way to host a blog!! Check out all the comments "collapsed by the community" on this article. DO NOT USE NEWSVINE if you want to be heard!
I always wondered why comments could be collapsed just because people don't like what someone has to say. It's the same as religious groups "shunning" a member.
Apparently (according to CNN) the Healthcare plan (ObamaCare) has the backing of the NRA. Not to mention the fact that it was endorsed by Big Pharma and Hospitals. As a manager of a Pediatric solo practice I can tell you medicaid (90% of our income) has dropped funding more than 50%. example: (pre-March 2012 we made 65K a month Gross, had 10 staff. post-March 2012 we made 32K a month Gross, 3 staff) Does this affect the economy? You bet it does. This is a reason why most doctors are in groups or employed by hospitals (in which they have a quota in how many patients they see a day) As for phychiatrists, 2 have left our city, and only 1 remains and he augments his salary by moonlighting at the VA Hospital just to pay the bills at his own office. The big mistake was when TMHP (Texas Medicaid Health Plan) split into 4 different insurances. Of which are United, Molina, Superior, and Driscoll. when that change occured it was a DRAMATIC drop in payout, many doctors filed for bankruptcy. What you will see is more deaths occuring that could be prevented and longer wait times in the ER. I don't know if this move is just in our State or that it is happening across the nation. Hopefully, it isn't.
alkpaz
Sounds more like you have a problem with Rick Perry and the state of Texas then obamacare. You know that less government thing he talks about so much.
Again, an insurance company glitch causing a dramatic drop in payout. Can you say fraud?
Insurance company promises to cover your illness and then fixes it so that it doesn't.
The doctors need to stop taking patients until the insurance companies and the governemnt get thier Sh!t together. It is the doctor's problem that they don't get their money. They have bills to pay. If my insurance does not pay, they doctors expects me to pay and then submit the claim to the insurance company myself. I once had an insurance company that was always so late that my doctors stop submitting cliams and I had to pay out of pocket and submit and wait for my reimbursements. My employer finally got fed up with the complaints and even thought the insurance company promised to fix the issue, never did so they were fired. Maybe the doctors should fire the insurance comapnies and make the people pay up front. Or charge the insurance companies late fees like I get charged for paying my bills late.
and we should just pray the patients don't go out and buy guns to solve their problems. Sounds like a great solution.
insurance companies do have to pay late fees or interest for being late. True story.
Medicaid subsidising is mandated by the state. Your state of Texas allowed for the subsidies to cut back on what it costs to do it themselves. You can also thank Bush not Obama for that one. When the Medicare reform act allowed for the insurance companies to replace Medicare, states jumped in and opened it up for more commercial third party companies to take over Medicaid. The cuts in pay out etc has always been in the books. Happens every year regardless to who is in office.
Alkpaz, that's what you get for living in Texas and voting for tea baggers like Perry and Bush.
Jen 3.5
....yeah, but Obama has the power now, and what is he doing?
um, he doesn't have the power to control this and nothing to do with this. This is done every year in every specialty of practice. The information is released in October. The insurance companies knew it was going to happen.
not a darn thing is Obama doing but making us citizens get health insurance even though people like our family cant afford it cuz the rates of insurance. we would like many others pay the premium price and that means over half my husbands paycheck would go to insurance, cant afford it. not only that, the insurance companies dont think of mental illmess as a medical issue, when in fact it is. when are they going to understand?? never also now Obama has done this thing with a tax company that they ask if u have insurance and if not they can fine u 95 bucks thru your tax refund. pretty stupid if u ask me.
If you have the money to buy a gun the you should pay the doctor.
The article didn't state the reason for denials. Are the "insurance" companies denying the procedures as non-covered under the policy or are they denying the procedures as invalid codes?
Without knowing why the claims are being denied, it is hard to formulate a complete opinion of the true issue.
Here's the bottom line....your insurance is a contract between YOU and your insurance. Doctors file your insurance claim as a "favor" to their patients, at a large cost to them, I might add. It is your responsibility to stay on them to pay your claim, not your doctor. If they fail to pay, it is your resonsibility to pay your health care bill! Stay on big insurance people!
" If my insurance does not pay, they doctors expects me to pay and then submit the claim to the insurance company myself."
The problem with this in this instance is that the insurance carrier will state that the claim is being rejected due to a coding issue which is up the practitioner's office to handle and you are not responsible for the bill. The physician sending you a bill that your insurance rejected due to a coding issue would be a breach in their contract with the insurance carrier, this is especially true for Medicare.
Jen, your going in two different directions. Your first post says this:
and then your second post says this:
so did how did Bush have that power, and not Obama? is only one of your lenses rose? I don't remember Bush wanting personal healthcare to be his legacy, yet the one guy that does, you claim has no power to change it?? wow really...could this possibly be the issue with this country?
Read my statement again. I was referring to the Medicaid that was mentioned having split into different groups in Texas per Alkpaz. That was a result of the Medicare Reform Act. You probably do not remember because life was dandy 8 years ago. No? Bush did that. Allowed commercial companies come in to replace Medicare. States jumped in and did the same at full force with Medicaid. Go look it up. Healthcare is always brought up in every presidency. HIPAA also changed under Bush. He inacted the PHI policy under HIPAA. Go look it up if you don't believe me. It happens. But these are laws. It was brought up and I was trying to give insight on that. Again, not a direct reflection of Obamacare.
AMA controls the changes in coding. It happens every year regardless to who is in office. I went through this a few years back with Radaition Oncology saw a huge cut in revenue and changes in processing and coding. For example, you can have 15 xrays of your foot at one time, but we're only going to get paid one. Or bundleing codes saying they are interacted with each other. Then there was the changes in office visits. AMA gathers information from Medicare to find out what codes are abused and not abused and develop new coding rules. These are done by a group of doctors, nurse, and other medical personel. A few years ago they changed the coding process for office visits with Medicare and then it gradually effected other insurance companies. Why? Because doctors were not coding consults correctly. They would code the highest form of the office consult vists but their dictation for that visit did not reflect that of a level 5 visit and was more like a level 3. That is why Medicare and many insurance companies do auditing. They take that information and find ways to make improvements. What is baffeling is that these changes are requested and gathered by insurance companies. Then they can't follow them and blunder them when the new year begins? It happens EVERY year.
Now to answer the other question, the only thing that the president has control of is blocking the changes in Medicare cuts and fees and that is done through the house. The president proposes the changes or to hault the changes and then Congress and the Senate have to vote. The president puts it in their hands. Learn the process of our government please. Obamacare passed that way. HIPAA provisions are passed that way. Laws are passed that way. Coding is done by medical professionals. Not done by the government.
I will also add, these coding mistakes wouldn't happen if offices regularly audited their charges every month on their own. It may limit coding changes as well. But that's a whole other issue and article.
Rick Perry has been in bed with the big Pharma for years. Remember his mandatory HPV vaccination for all girls in TX? That was a pay backto Merck for millions of $ campaign contribution to get him elected as governor. Perry has said all along that he will not implement Obamacare in TX and you guys re-elected him. I practiced medicine in TX when Bush was the governor; it was one of the most corrupt medical system I have ever seen. No wonder most good doctors have left TX. Florida has the same crazy/sleazy governor with the same first name.
A lot of folks have stated that they believe that firearms buyers should have to undergo, at their own cost, a psychiatric evaluation before they are allowed to take delivery of a firearm.
Now, with as many mental health professionals having a rough time making it as we have, and knowing that people who purchase firearms (which cost hundreds or thousands of dollars each) usually have money to spend, how many mental health professionals do we suppose would start specializing in evaluations of firearms enthusiasts, waiting with cash in hand, at the expense of treating the chronically broke people who really need the services of a psychiatrist?
Sometimes the cure is worse than the problem.
I would prefer a massive coding issue which will be fixed as apposed to millions of people simply being denied.
they will be denied....and people will not get help.....the article said the claims are being denied...which means the patient is responsible for 100% of the treatment....have you ever met a rich mental health person....most cant even get out of the house let alone get a stable job....now what? they starve causing more harm to their already unstable condition....
that is sick...our country is ill
If they know the claims will be paid, why are the providers making the patients pay anything.
Many practices don't bill immediately after the services are performed and insurers can take up to 30 days (depending on state statute and provider contracts regarding prompt payment). Today is February 7, which means claims received on or after January 7 may not have been paid or processed.
There seems to be an agenda to this article as not all the information seems to have been presented.
agree, something is missing
in recent changes, medical offices are asking their patients to pay up front and then have the insurance reimburse them, even though the supposed "standards" say that is not good business...its still how they need it because these physicians know it will become almost impossible to get insurance to cover claims anymore.
I am a private practice psychiatrist. I have several federal workers comp patients and have already had 3 claims by the U.S.Dept. of Labor denied due to use of new codes. They told my office manager they weren't using the new codes. The use of old deleted codes is a violation of HIPAA. The AMA has set up a website to lodge complaints against insurers. And this has NOTHING to do with Obama, the Affordable Care Act or "Obamacare." It takes twice as long to document this change as previously but the idea is sound. Psychiatrists should be paid the Evaluation and Management codes which are supposed to compensate more for "cognitive labor." The harder, more complex the case, the more data you have to sift through should pay more. One of the behavioral health companies announced it is paying the same for 3 of these E/M codes, eliminating the entire spirit of progressively complex encounters.
Then no longer accept this insurance company. Everytime my employer changes insurance companies, I have to verify my existing doctors and medical suppliers accept the new insurance company. Some do, some don't. It usually has to do with the payment history of that insurance carrier to the doctor or provider. I have to change doctors or providers accordingly. If a doctor does not like an insurance provider, they are under no obligation to accept it. It happens all the time. The patient will just have to find another doctor willing to put up with that insurance provider. Just like I have to.
I work in billing. An insurer I deal w/ was right up-to-date w/ the change. However, they're only allowing a limited number of the new codes. They only want to pay for the most routine things and nothing really in-depth - the 'complex cases' you mentioned. This is on top of an ongoing problem where they're taking longer and longer to process claims. The group of clinics I bill for has had to scale back behavioral health services over the years because it brings in so little money. At one time the medical services made enough to cover the difference, but not so much lately and if the other insurers are playing the same games w/ allowed charges Behavioral Health won't be able to stay open. Sure that helps the clinics - they could switch that space over to medical services, or dental - but what happens to the patients?
those codes are not just used for payment, they are used for:
I realize you are talking about procedure codes (CPT) and not so much (ICD-9) but they are both used for things other than just payments to the physicians.
But I don't understand why they would do that, since clearly the level of care is different. My text book says "based on the nature of the physician's work such as type of service, place of service, and patent's status." (Fordney, 2012). So it does not make any sense why these would cost the same since they are not the same level of treatment. This should be challenged because it encourages abuse and/or fraud, which also leads to other issues that don't add up. HIPPA, or part of HIPPA is designed to cut down on fraud and also we have recently put out government "regulations"/committee to combat fraud and abuse...but these actions (E/M paying out the same on different levels) seem to encourage it...or give a good reason for it...which i do not recommend. This just begs for physicians to find fancy ways to upcode...I seriously would look into this if I were you.
hmmm.
Just to clarify Tom, Lane specified that these were department of Labor federal work comp cases. For example, a postal worker is attacked and assaulted by a crazy person on their mail route and they are diagnosed with PTSD. This is a workers' compensation claim that is paid by the Federal Govt which is self-insured. Typically, if the provider is familiar with the US DOL process there are no issues getting paid since they have very specific procedures to follow. Work comp is totally different from group health/medicaid/medicare. I'm actually surprised that this issue was even happening with US DOL, and thanks to the comments above, I'm going to check with my billing staff to make sure our US DOL claims with the psych are paid. Interesting.
The Obama media blitz and war on guns. now comes the truth of a serious failure in addressing the care for the unstable with mental illnessnes.
It's easier to attacks inanimate guns while potential killers are fall through the cracks. The silence and inaction of anti-gun proponents in the White House and Congress are deafening while they have intentional tunnel vision.
then answer me this. why doesnt the insurance companies recognize mental health as a medical problem because it is.
As a person who has seen much in the area of management personnel and their
implementation of large databases and tracking systems used for the provision
of medical and legal services, I see the enormous problems with this
VERY BASIC FAILURE TO ANTICIPATE FUTURE CONSEQUENCES when
doing the nitty-gritty dirt-under-the-fingernails work of creating and MANAGING
new codes, new procedures, new software AND new computing hardware.
This is a FAILURE of hospital/doctor management AND the insurance industry
which SHOULD have implemented such systems on a geographically isolated basis
rolling out such new systems and codes on a county-by-county basis instead of ALL at once!
If you bite off more than you chew, you choke on the excess and this is what has happened
in terms of the mental health AND other medical services coding/payment systems.
They tried to implement a BIG system ALL AT ONCE and are now gagging because
of the lack of FRONT-LINE SOFTWARE SYSTEMS/PROGRAMMING STAFF and LACK
of TRAINING on the new coding system implementations for medical providers.
I personally would have picked a SINGLE surburban area to start with.
Then implement the new codes for that ENTIRE AREA BUT I would have
had SOFTWARE SYSTEMS STAFF visit EACH medical office on a
rotating basis over a period of 60 to 90 days to TRAIN the medical staff
on what codes do what and which NEW codes replace OLD codes.
Then once I see the OBVIOUS IMMEDIATE KINKS, I'd be able to use
that information to PRIORITIZE a list of bugs and fixes into THREE CATEGORIES:
Immediate-Fix, Important-But-Can-Wait-30-days and then NICE to HAVE fixes.
After the initial 90 day implementation period I would KNOW what's important
and then do ANOTHER 60 day update and fix cycle....ONLY THEN would I have
gone to implement the new system in other urban and suburban areas on
a county-by-county basis with EACH new rollout separated by 30 to 60 days
to give staff and trainers time to get acclimated to the new system in each
geographical area...YES this seems to take a long period of time.
BUT in my industry, I'd rather have a SINGLE SMALL-AREA of New System Rollout
that can be EASILY ISOLATED upon failure rather than have a new system be rolled
out on a WIDE AREA BASIS that could fail CATASTROPHICALLY EVERYWHERE!
This is just BAD computing systems management which is now affecting TENS
of THOUSANDS of mental health and general medicine providers, all because some
ivory tower guy/gal thought that A BIG SYSTEM could be implemented in a single month!
AND NOW the patients and doctors are PAYING for that BIG
COMPUTING SYSTEMS ROLLOUT MISTAKE!
And while we wait this snafu puts more mentally ill at risk of shooting up places and people since they do not have access to the drugs and doctors that deal with their illnesses but this is better than the alternative as Dome mentioned.
Yea, like that is really going to happen. Gee some doctor is treating a patient out patient and has advised the authorities that this guy can't buy a gun. He is mentally unstable and is REALLY going to listen to the fact that he cannot own a gun. Sure he cannot buy one legally but if he is hell bent, will get one. If they are that much of a threat then they need to be locked up. But the criminally insane have rights, but not his victims.
There's a difference between mentally ill and mentally unstable. Not everyone with a mental illness is mentally unstable or a danger to themselves or others.
Someone who can't get out of bed because their depression is serious is no threat to you. Most people with a mental illness are not violent.
I suggest you take the time to learn about mental illness instead spouting off myths and stereotypes, because that doesn't help anyone.
the stigmas that remain regarding mental illness make it that much harder for those with complicated disorders to believe they will ever have a place in this world. stigma leads to people abandoning formerly close friends who are diagnosed with mental illness. family members who don't understand pull back or, worse, think the person who is ill is weak or lying. it's a lot for a young adolescent or 20-something to cope with being ill as it is, and then they are shunned. please learn before you judge. support instead of generalizing and withdrawing. the person suffering needs you, and their family needs you, too.
@ geowil and tom:
Why do you assume that the first thing a person with a mental disorder will do is get a gun and shoot people? Did you not read the article? Around 20% of the US population is estimated to suffer from a mental illness. How many shootings have there been? Not enough to warrant punishing the many for the sins of the few.
La,
not assuming that at all. But seeing as that the past four massacres have all been carried out by people with mental deficiencies who were under the care of either parents that were not attentive enough or that were living alone but had been known to have mental issues it does not take a leap of logic to equate the possibility of having more of these gun massacres while the problems are being dealt with that may have been prevented if the problem had not occurred.
Is this the ICD - 9 codes? I'll try to ask my dr. today.
No, CPT are for procedures. ICD-9 is for diagnosis coding and those codes will change to ICD-10 in 2014. That will be a MUCH larger change for all providers of all specialties.
Probably is, ICD-10 implementation has been postponed, again. Wait until that takes effect along with Obamacare. We ain't seen nothing yet!!!!! People want to blame the insurance companies. However, in all fairness it is not their fault. We must remember, that they are for profit companies and want to get paid!!! The problem is all the redunancy and unnecessary confusion and paperwork that is involved. I am sorry, but healthcare just isn't that complicated!!!!!
This is CPT codes - but always remember that ICD-9 or 10 have to support what ever CPT code(s) is used. My guess is that maybe part of the problem. Also this is not new - it happens quite off in medicine as code changes are posted usually every October to go into effect the 1st of the next year. Fee Schedules are published by the feds Medicare.gov or through the Center for Medicare & Medicaid. again in October for the following year. Carriers as well as Medicare & Medicaid don't always update their systems quickly enough which creates back log of claims the 1st of each year. For those that don't know ICD-9 codes (which has recently changed to ICD-10) are diagnostic codes (which is why you go to the doctor.) CPT codes are what the doctor does, these are actually revenue codes and $ are attached to these codes. The Medicare Fee Schedule is published by Medicare but are the sole property of the AMA. These codes are used by doctors to set their fee schedules and communicate with the carriers and Medicare & Medicaid. ICD-9 codes are published by the World Health Origination and modified for the US.
Lets see...Ban Codes! Or limit them to 10 maximum! Codes are harming our children!
You Right Wing loons suck at both wit and analogies. Try again.
As opposed to left wing loons?
The Obama administration is getting their hands dirty in the gun violence debate. Setting loose cannons out on the street. Yeah, this is exactly whats going on, you gov'ment dependent homo's just can't get over it this morning.
bmw Idiot! The Obama administration has nothing to do with ICD-9 or CPT codes.
Your racism is showing.
maybe bmw needs to see a psychiatrist. You sir should not be allowed to own fire arms and i hope you don't.
@ bmw, need a psych referral for your paranoia?
These coding changes (I code for a living) are discussed, open for comments, and published in advance. Providers and payers both need to pay attentions to these changes and implement them. This process happens every year, nothing new. There was a large overhaul of the codes for mental health, that is true, if people were doing what they were supposed to, there would only be minor glitches. There was also a massive overhaul of molecular pathology codes, don't here any grief from pathologists and genetic counselors. This has nothing to do with Health Care Reform, the American Medical Association owns and updates this coding system and has done so for years. Medicaid often does not update in a timely manner; this isn't new. Other insureres don't have much of an excuse as they need to comply with the updates as every other provider, payer, facility and billing agency must. Their inaction should not result in providers not getting paid but it has in the past and it will in the future.
The insurance companies didn't change the codes. The codes are call ICD9 codes or International Statisical Classificaton of Diseases. These clowns knew the changes were coming the majority of them were not prepared on Jan 1st and now they're complaining. The U.S. is the only major country that hasn't made the switch to the new ICD10 codes simply because the AMA has their heads up their butts. Stop blaming everything on the government and the insurance companies.
I forgot to mention that the billing codes the mental health providers use are called CPT4 codes, Common Procedural Terminology. They are also NOT controlled by the insurance companies.
The new billing codes may not be controlled by the insurance companies, but they are exploited by the insurance companies. I friend of mine with PhD in psychology said her practice ran an experiment with claims to Cigna. They sent in several claims using the old codes, and these were rejected because they were out of date. They sent in an equal number of claims using the new codes and these were rejected because their system was not yet ready to handle the new codes. Insurers have absolutely zero incentive to pay claims now, and as their billionaire CEO's get richer, the public has been so worn down by their greed and recalcitrance that most are throwing their hands up rather than trying to make things better. Sometimes that includes me, depending on what kind of day I'm having.
chucklehead you have the right idea but ICD9 codes are for diagnosis. Mental health providers use those too. CPT4 are procedures and all providers use those. And HCPCS are also univerally used (mostly drug codes). Just an FYI. AMA controls the coding, Medicare "guides" the fee schedules for all the insurance companies and negotiates with the providers. You're on the right track any way. :)
The AMA controls the coding, who controls the AMA? Answer: specialists whose interest is to increase their own earnings and control their market share. This is the main reason why primary care physicians are being paid peanuts while they are the ones who work the hardest so their patients won't end up seeing the specialists.
I withdrew my AMA membership in 1994 after I had enough of their BS. I am a specialist, even I got fed up seeing some of my greedy colleagues running the show at AMA.
This is not ICD-9, it is CPT. AMA owns and updates CPT, they do so every year. Has nothing to do with Healthcare Reform. Everyone involved get advance notice of changes and although timeslines are tight, they need to do what must be done and adjust their systems accordingly. Medicaid is often late to the party. There were extensive changes to other parts of CPT as well, again, this sort of activity happens every year. This coding section was way overdue for an update.
Yes, you are right. They knew these changes were coming in October.
I attend CPT coding seminars every year to keep myself up to date. I seldom see other physicians at these seminars. It's easy to point fingers at the insurance company but you need to know what you're billing for before you take on the insurance company. I do agree that we should not let the insurance company dominant our healthcare but that's another on-going battle.
I worked for a Home Health Care Agency in Cleveland, OH in the 1980's when the ICD-9 codes started. You had to have training to understand them. Funny how it's 2013 and I find doctors offices that still do not understand them.
Training has been thrown at the wayside in healthcare. I was a manager of training an operation just thrown in without any guidance. Working with the doctors in this position I constantly had to explain the use of 4th & 5th digits on ICD9 codes, as well as add on codes for CPT. If they just picked up the book they could see that these digits were required, but why spend the extra time to correctly code a claim for a diabetic? When you can just B!tch at the billing office for not getting paid.
Very true! It's really entertaining because soon they are going to change to ICD10 and that's going to cause a bigger mess.
Doctors didn't go to school for many years to learn coding; the focus of a doctor is on medicine and HELPING people get better, not to learn business strategies. The coding that they recieved was basic and not at all in-depth. The medical schools do NOT teach coding to doctors. Even if a doctor went to a billing conference, they will not recieve CME credits for it. :P
Sounds as if Mr. Milhander needs a therapist himself. Why in the world would a change in coding cause you to lose your business? Hire a consultant until you can become well versed yourself!!
As a counsultant I highly endorse this post!
MMoore, it's because the changes are independent, and many times in error. What may be the code of 1234 for a diagnosis may be entered in the receivers database of 1243, and the error won't align (or vice versa). The information kicks out, and it's not paid. Medicaid and Medicare are extremely particular about the exactness of the codes. Also, some of the old codes no longer exist, but are still being used. Some of the newer codes don't have the same information. Some of the old codes have new definitions. It's a giant mess. Depending on where the errors or misinformation originate, whether sender or receiver, a consultant won't really help (if it would be so easy!) Too bad (a batch of) someone(s) didn't take the time to test out these issues before putting them on the front lines.
(Isn't it so true that testing has gone by the wayside. I can't tell you how many times we've been dumped on with this problem. Wouldn't it be nice if the installers/creators actually asked the people using the programs what they needed or how they used a program before saying, "Here it is. It's all yours, now."? Yeah, right. Dream on.)
@zapper45701 most transactions are completed electronically when it comes to billing now. So erroneous entries are fewer and further between. The coding changes were given to everyone back in October. If providers and their staff did not take the time to educate themselves and implement the changes starting 1/1/2013 then they have to take responsibility for that. The mental health codes are similar to the old codes. The main difference is the addition of the evaluation and management codes that mental health providers were not allowed to bill in the past. The concept for determining which is appropriate is complex and most providers are having difficulty grasping this. A consultant who is a CPC would be of great help to any practice for this reason.
Hey, SanDiego, as a consultant, I'm overworked with this crap. Insurance companies had time, Medicare and Medicade had time, Feds had time, Docs got hit with changes that they didn't understand and there was really no training. I love it, making money enough to pay my consultants better, pay all their insurance costs, and so on and on.
By the way - wherre the hell is Carmen? ROFLMAO
But the way I understood this article, his office was ready for the change and submitted the correct coding. Its the insurance companies that were not compliant.
My daughter is a coder, these were things she was explaining to me, and her whole system at the hospital is a disaster.
Oh look at all the nice. I just hope the theoryologist don't take advantage of the situation. because of a few misguided individuals and start making un warrented statistics.
If we want to see positive, realistic changes to the way mental health issues are treated, we as citizens need to do a little bit of research about whom we are electing to office, both at the state and national levels. Any politician who has ties or investments to the insurance industry and Big Pharma should be avoided, and those already in office need their feet held to the fire to DO THEIR JOBS and represent the citizens FIRST or face doom at the polls. That includes state legislators and Congress conducting an investigation(s) into how and why the American Medical Association makes various coding changes and the financial interests of those making the changes. Insurance companies should be forced to pay penalties, with interest accruing, if reimbursements are not timely paid. They can hide behind a smoke screen of lack of notice, or technical errors, etc. - the fact of the matter is for everyday an insurance company is able to hold onto a dollar, they can make a TON of interest, far more profits than an individual medical provider getting payment.
I've dealt with the insurance industry for 20 years, and the stall tactics insurance companies use to slow or deny payments are disgusting. Take away their lobbying privileges and we might begin to see some real change. In the meantime, I would urge anyone with a loved one dealing with mental health issues to start looking into any available alternatives of treatment. I'm afraid this is going to get worse before it gets better; it's an ugly thought, but my fear is with all of the people who have mental health issues falling between the cracks because they have no access to treatment, compounded with new numbers of people joining them because of this fiasco, a significant jump in the number of crimes and injuries blasting our senses in the news will be the only thing to jump start a correction of the problem.
The whole lobbying thing should be abolished. Only special interests are served and the public at large is who suffers. The banking industry lobbies our Congresspeople, and who caused the current economic conditions? We have a revolving door when it comes to lobbyists and political office.
Also we need to change the laws in regard to donations to campaigns. The Congress gets sold to the highest bidder. The government should pay for the campaigns, even $ amounts for qualified candidates, and whoever MANAGES their money the best....well that person (who is entrusted with OUR money) would be elected. Even playing ground, even contests....not who has the richest friends (or lobbyists). Congress NEVER addresses REAL campaign reforms.
As for the insurance industry, a few penalties for slow payment should be in place. Like paying interest to the insured person who is unjustly denied coverage...to start. It is all about the $$$ for these industries...if they were made to pay, they would make the changes.
AMEN! to both of you Cathy and Vickie, I can not add to your thoughts and you are both right on.
It's refreshing to see comments from individuals who actually understand the article and issues with coding changes. Every year there are coding changes, but next year will be even more complex with the transition from ICD-9 to ICD-10 (these are diagnosis codes that are required on ALL claims).
EVERY other industrialized country is a single payer system, EXCEPT the US (blame that on all the lobbying from the insurance companies); what this means from a coding standpoint is that starting in 2014 diagnosis codes will quadruple compared with countries with single payers (not multitudes of insurers like in this country). The reason we have so many more codes than other countries is that here we have to figure out which insurance company is the PRIMARY payer in situations where more than one insurance may be liable for payment (situations where someone has medical payment insurance and an accident takes place in a business or other person's home, car accident, or dual insurance situations, etc). The cost to those paying insurance premiums and to this country to not go to a single payer system is a HUGE amount of money.
When coding changes occur, Medicaid and private insurance companies are notorious for not having their systems ready to go when those changes are implemented... Medicare contractors are expected to update their systems to be ready to go on day one and if they aren't the DO pay INTEREST if it's a fault in their systems if claims can't be paid on first submission(s). Now if the provider bills these claims incorrectly, it's absolutely expected that provider's staff to get up to speed and be aware of changes to billing. Medicare contractors are required to educate medicare providers on changes to policy and billing and if a provider has a high error rate they will be targeted for education... and will be monitored until their error rate is the same as their peers. I'm a former Medicare educator and AAPC certified coder... hope this info helps increase a bit of understanding on the topic.
Btw, if anyone is looking for a career with some job security (keep in mind coding can be very mentally challenging), training usually takes about 6 months... there are week long 'boot camp' training courses available to prepare someone to take the American Academy of Professional Coders (AAPC) coding certification test, but that's a really tough way to go to get certified (by some miracle and a LOT of studying I passed the 5 hour coding certification test on the first try, but working for a Medicare contractor for 7 years had prepped me very well... ironically some of the nurses had to retake the test as they made the mistake of over thinking the questions... and these are very, very smart people).
I totally agree that lobbying and special interests have entirely too much influence on policy!!! If I had my way no insurance company, healthcare provider, or drug company should be allowed to be 'for profit'... nothing like making a very few people (CEOs and other execs) richer than God by taking advantage of other's misfortune AND raising premium rates at the same time... disgusting.
Only 20 percent of the adult population have mental problems? I thought it was like 80 percent.
In your case, it's 100 percent.
Give them time. There are many more things that are classified as medical conditions than there used to be.
"Restless Leg Disorder?" Give me a break!!
I believe it's actually "Restless Leg Syndrome" - different code than RLD. The syndrome presents primarily in adolescent males lacking or somewhat inept in certain social skills (i.e. how to pick up girls 101) the general cure is to treat the symptom, a practice best accomplished in solitude.
Well my GP told me the codes changed all over the place - Obamacare. And he said it sucks. Less pay less ability to charge for what you are really doing.
But it's too late now. You libbie idiots have less than a year to feel the full effect.
A year from now you liberals will be pulling off bumper stickers and finding ways to back out your comments to friends and family.
That's if we have not had WWIII by then.
If your doc is blaming the Affordable Care Act for coding changes, he's an idiot. Tell him to join his professional organization (the American Medical Association) which is responsible for the coding changes. BTW a patient with an idiot for a doc is an...oh well you get the idea.
Sorry reality is not a place you live. And anyone who lives in Cally and near the Border is a real moron. My doc hates the AMA and you idiot - they sold out to the King.
See you in the streets.
@guyfromsandiego you should be aware that MOST physicians do not belong to the AMA so call a doc an idiot for not belonging is an ignorant statement.
Maybe it's time for a new doc.
More to the point Guy, he's being manipulated. I've been a Project Manager for
multi-billion-dollar medical device manufacturers implementing ERP systems. In
the end, as well as 100% tracability (Six Sigma was an unacceptable failure
rate), I could account for every sheckle (usually to .o1 of denomination). In
one instance, after all costs and expenses were accounted for, a proprietary
catheter cost $62.10 to deliver for distribution. The sell price was at a minimum $1500.00 to distributors.
The maximum was $23,054.00 billed to patient that I saw.
One of the tenants of "Obamacare" is to reign in ludicrous profits in healthcare. I heard my Anesthesiologist debating whether to drive his Ferrari or Porche GT to work on the next sunny day instead of his Mercedes. If I were forced to make such decisions, I wouldn't want anyone screwing with the system that paid my check either.
Thanks for the JMP for explaining that.
But the reality of it is these coding changes for the love of God and all that is holy has nothing and I mean nothing to do with The Affordable Healthcare Act. Secondly, if my doctor did not belong to my local Medical or state association, then I would look for a new doc. Because usually that means that something isn't right (complaints etc). AMA does the coding. They have owned it for years. So get off your horse "bothpartiesarecorrupt". You're doctor is wrong.
I hate to be the one to tell you this, but your Doctor is probably upcoding your claims attempting to commit fraud with your insurance company. He doesn't care about your health just how fat his pocket gets. Worked in billing for over 20 yrs part of that as a manager for 20 phsyician's practices and here are a few of the examples of questions doctors had about their billing.
"Can I bill for a level 5 speciality visit when I've spent only the amount of time with the patient as a level 2 visit if my documentation appears that I have spent the full hour with them?" Answer: NO!
"If a patient with hypothyrodism (underactive thyroid) requests that I also treat their obesity can I bill a seperate office visit for each"Answer: No the two go hand in hand, treat the thyroid you also treat the obesity"
Not every doctor is actually a kind caring healer, some of them are greedy theives.
@BothParties. Doctors are not omnipotent. Quoting your doc is like quoting any single, personal source. He is guided by his own self-interests, and those interests are, in large part, financial. If he can persuade 10 patients to lobby in his behalf, he's just expanded his individual political clout.
Maybe your doctor should spend more time examining, diagnosing, and treating patients--not spending time discussing politics. I'm pretty sure there are no insurance codes for 'political hogwash' or 'patient brainwashing'.
flnobody;i agree with that.and to lanemcook i do feel bad there too,but thanks.by the way,anybody figured out how i could claim a 'rroyalty %' evan tiney-tiney as over last 25 plus i know i helped some get through college myself.hang in,all i can do too. ;)
The insurance companies and providers were warned some time ago about these upcoming changes from the ivory towers. Many diagnoses were eradicated or changed just to meet some little, small-minded and ambiguous twist of wording. (See Asperger's Syndrome for an example.) Only a fool couldn't have seen it coming. It goes back to the old saying, "Don't fix it if it isn't broken." Because of the careless handling of the problem, it's broken now. Congratulations.
Oh well, since when does anyone listen to me or anyone else when an obvious disaster is looming in our faces? Just one more failure of the powers that be.
I work in "Behavioral Health" and in November 2012 we had training, discussions, handouts, webinars, etc. about the code changes. We were told to get up to speed or else.
The insurance companies couldn't do the same???
Part of the problem in the US is that insurance is a for-profit industry, so they call the shots. We can change codes all we want, but if it's not going to change reimbursements, what's the point? That doesn't necessarily mean we need a one-payer system or socialized health care; but what we do need are some controls over insurance companies and to keep them out of bed with our politicians. Part of the reason hospital charges are so outrageous is that hospitals are happy to be reimbursed any percentage of what they charge--maybe they'll get 30%. Maybe
Switzerland has an effective system of not-for-profit health insurance where there is a free market, mandatory enrollment and deductibles, and thus universal coverage. Let me tell you, quality of life is much better there...but then again, the chocolate helps!
You are absolutely right about not-for-profit healthcare. As I've mentioned in another post, I've worked in medical business infrastructure internationally. When administered properly, the health and well-being of the populace in national healthcare programs far exceeds that of ours. In general, all claims I've heard to the contrary are flat out lies.
I work in a managed care setting for behavioral health for a NON-profit insurance company, a rather LARGE one at that. We have known about the codes, we implemented them rather seamlessly, and have had no problems processing claims nor has the insurance company had a problem paying them. Our providers have not complained and we haven't had any of the other problems people are complaining about. As with any large change in the system, there will be a few hiccups. However, the main problems I see on a daily basis is providers not education themselves on the changes and billing incorrectly. We have worked with any that will take our help in educating them on how the new changes work. I guess I am just lucky to work for an insurance company that has their sh*t together.
Medical codes are changing so "Big Pharma" can sell you more drugs.
Please don't comment if you have no intelligent thoughts on the topic.
psychotherapy sessions.....I know there are mentally sick people who really need help and there are lonesome people who just need friends. I know there are dedicated doctors who are committed to helping the mentally ill and there are doctors who are gaming the system. Maybe the new coding points to those abuses.
One word comes to mind.... CRAZY
Guns don't kill people, new codes do.
This has nothing to do with guns and everything to do with the healthcare system in place.
"The psychiatric codes were updated after vigorous lobbying by mental health care providers, who argued they weren’t being paid enough to treat today’s medically complex or seriously ill patients."
Now they aren't being paid at all, at least they were being paid. Who is going to suffer? Hmmmmmm.....
"Vickie"---That is easy--those of us without guns--- I assume you were thinking that too!
You see now we will not have many of the "wonky people" who has actually been evaluated--but that seems to be what some want, so the "sportsman stores" with all that FREEDOM by the gun can flourish!
At least in the Tennessee Valley, major insurers have not increased payments to therapists in twenty-five years. A quarter of a century. Several of them have decreased reimbursement. Of course, the costs of running a practice have not remained stagnant.
Therapists were not happy about these coding changes, yet were warned by insurance companies that they must comply by January first or not be paid. Now therapists have changed their systems to accommodate the changes, and it is the insurance companies who are behind, and withholding payments. The average therapist cannot see forty patients a week .... it is not possible to sustain that and have time to run the business end of the practice, and for most practitioners not sustainable emotionally. Those who do much more do so at the risk of quality of care, though there may be specifically energetic folk who manage an unusually high volume of clients without problem. But generally billable hours for a full time practice are roughly half of available working hours, minus sick leave, continuing education time, an occasional vacation (yes, those are good for everybody) hours. Out of the time that is left they must fund their own practice expenses, health care coverage, liability insurance, retirement planning, self-employment taxes, professional membership expenses and in what's left identify a paycheck somewhere.
So clients/patients risk being shortchanged, clinicians go unpaid, and yet insurance companies inflate the costs of patient premiums each year by numbers dramatically outstrip increases in the cost of living, and insurance companies increase deductibles so that patients are shouldering huge portions of their health care if not all of it themselves. Guess who doesn't suffer? Hmmmmm ......
Shame on you Helen Stojic of BC/BS and Susan Pisano of America’s Health Insurance Plans! These changes have been in the works for years. Private insurance companies have had months and months to prepare for these changes. I am a provider and we were told by APA and AMA back in late summer/early fall to be prepared; we were told that we would get notifications from private insurance companies how to handle the changes in claims by November. Any and all attempts to get that information about procedures, changes in fees and timeframes were ignored by private insurance companies. Not a word on their websites and no meaningful response to phone inquiries; just "we'll let you know." This is a issue of private insurance companies looking to bank money, reduce payments and dissuade members from seeking out services. Medicare payments for my colleagues have already begun to flow again. This has nothing to do with Obamacare; this is an example of private insurance being asleep at the wheel in order to benefit for themselves. I cannot make my mortgage payment this month for the first time in 27 years. I do not bill Medicare; I have NO money coming in.