Medicaid Reimbursement For Mental Health Services

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How To Choose Mental Health Insurance Companies For Credentialing

Deep cuts to Medicaid could cause mental health care providers to reduce services

Choosing which companies to apply to depends on a number of factors but can fall cleanly into three buckets:

  • Increasing caseload
  • Increasing revenue per appointment
  • Working with a specific demographic
  • For the best possible guidance, try to pick only two of these three possible options and weight their significance to you in your current private practice.

    Are you looking to increase the number of sessions you do? Work with lower paying but higher supplying networks like Medicaid.

    Want higher income per client? Look at the Blue Card network .

    And if you dont even know what Blue Card programs apply to your state or you need a free customized quote thats specific to your needs, we are happy to help. You can reach out about that at our mental health credentialing services page.

    For Over 50 Years Medicaid Hasn’t Covered Long

    Medicaid was established in 1965, a time when the United States government was encouraging states to build networks of community mental health programs as alternatives to hospitalization. Due to these historic circumstances, Medicaid excluded coverage for long-term inpatient care in psychiatric hospitals.

    Many professionals and advocacy groups are pushing for Medicaid to change this policy. Medicaid has already updated its coverage to include short-term hospital stays and has recently started allowing states to apply for waivers to cover hospital stays of up to 30 days for the treatment of mental health and substance use disorders.

    Indian Health Service Rate

    The Indian Health Service rate is an all-inclusive rate reimbursed to IHS and tribal facilities by CMS for Medicaid-covered services. Billing is per encounter, not per specific service.

    • The IHS rate is mandated by the Department of Health and Human Services and is published yearly in the Federal Register. See the 2021 rate information.
    • Allowable services vary by state

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    Top 4 Insurance Companies For Established & High License Level Providers

    Best suited for LCSWs, PsyD, PhD, and MDs:

  • Blue Cross Blue Shield
  • Investigate which companies are paying the most in your State by asking your colleagues.

    Tip: You will probably need to establish a separate legal business to work with these companies so expect to create an E-IN for your new practice to get paid the best rates.

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    Most Competitive Insurance Companies For Mental Health Providers:

    Medicare Supplement New Jersey: How To Qualify For Medicare In Nc

    The following links go to each companys credentialing website:

    To sum things up, the Blue Cross and Blue Shield network across the United States is one of the highest reimbursing and most competitive plans to work with.

    Inquire about your local BCBS within google by typing in Blue Cross Blue Shield + your states name. Each state runs their BCBS in their own way so ask colleagues as well.

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    Legislation May Dramatically Increase Access To Mental Health Services For Medicare Patients

    Pending legislation could usher in the ability for older and disabled Americans to access hundreds of thousands more behavioral health care providers.

    Experts say outdated policies currently limit many Medicare policyholders behavioral health care options because swaths of clinicians have remained ineligible for reimbursement for decades. But that could all change thanks to a bill introduced this year.

    The Improving Access to Mental Health Act of 2021 proposes amending the current law that prevents these clinicians from billing Medicare for behavioral healthcare. If passed, the bill would allow clinicians to bill for 75% of a psychologists rate. The bill would also increase the reimbursement rate for clinical social workers from 75% to 85% of this physician fee schedule and allow them to bill Medicare for mental health care they provide to skilled nursing facility patients.

    A lot of Medicare beneficiaries would be unhappy to know that their choices are limited, explained Dr. Heather Jelonek, a Dr. of Behavioral Health and former insurance company network developer.

    The Improving Access to Mental Health Act was introduced to the House of Representatives in March. Since then, a steady stream of cosponsors has cosponsored the bill, mostly recently Democratic Representatives Tom Malinowski , Jamie Raskin , and Ann Kuster on Sept. 3rd.

    the largest mental health crisis of our lifetime

    Id be paying more out of pocket for similar services, explained Jelonek.

    How Your License Impacts Your Insurance Reimbursement Rate For Psychotherapy

    In most states, mental health therapists are initially licensed as an LPC or LMHC or LPCMH or LCPC or LPCC , depending on your state. While its safe to assume you already know your license for your state, you can also check this PDF document here to confirm your license and whats required.

    With this license comes, normally, the lowest or entry level rates for working with insurance companies providing mental health services.

    Youve just been licensed and youre ready to begin working on your own in private practice. Expect rates insurance reimbursement rates for psychotherapy to be in the lowest tier of payment.

    45 Minute Individual Therapy

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    New Medicaid Option Promotes Enhanced Mental Health Substance Use Crisis Care

    Additional Funding Available for State Mobile Crisis Intervention Services

    The Department of Health and Human Services , through the Centers for Medicare & Medicaid Services , is working with states to promote access to Medicaid services for people with mental health and substance use disorder crises. Authorized under President Bidens American Rescue Plan , states have a new option for supporting community-based mobile crisis intervention services for individuals with Medicaid. Mobile crisis intervention services are essential tools to meet people in crisis where they are and rapidly provide critical services to people experiencing mental health or substance use crises by connecting then to a behavioral health specialist 24 hours per day, 365 days a year. This new option will help states integrate these services into their Medicaid programs, a critical component in establishing a sustainable and public health-focused support network.

    “The Biden-Harris Administration is committed to tackling behavioral health challenges relying on proven methods,” said HHS Secretary Xavier Becerra. “Thanks to resources provided by the American Rescue Plan, states now have an opportunity through their Medicaid programs to expand behavioral health support in their communities. Where needed, behavioral health experts, not law enforcement, should be the first responders to mental health and substance misuse crises.”

    People Who Qualify For Medicaid Typically Require More Intensive Services

    Telehealth Visits Now Reimbursable By Medicare, Medicaid And Most Private Insurance

    People on Medicaid have higher rates of mental illness than people in the general population and use mental health services at a higher rate than people who have other types of insurance. They also have high rates of comorbid medical disorders.

    Medicaid Statistics

    The following statistics are all provided by the Medicaid and CHIP Payment and Access Commission . According to MACPAC:

    • About 10 percent of people on Medicaid have serious mental illness, relative to 3 percent of people with private insurance and 5 percent of people with no insurance.
    • About 24 percent of people on Medicaid received mental health treatment in the past year, relative to 14 percent of people with private insurance and 10 percent of people with no insurance.
    • About 44 percent of people on Medicaid had fair or poor health status in the past year, compared to 13 percent of people with private insurance and 24 percent of people without insurance.

    This means that Medicaid is an important link that connects essential medical and mental health services with the people who need them most.

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    What Needs To Change

    While we know that patients with BH diagnoses drive total healthcare costs, studies are starting to demonstrate that there is potential opportunity to bend the cost curve by focusing on the impact of BH on the total cost of care.

  • BH service line leaders must work with their organizations managed care leaders to prioritize the negotiation of rates and reimbursement structures that are aligned with the care model investments being made to increase access to BH services. This will also likely include the need to lobby state Medicaid and managed Medicaid payers for the inclusion of BH care management codes.
  • Payers need to use their claims data to not only understand the downstream savings opportunity associated with OP BH services but also to justify shifting reimbursement dollars so that investments can be made in expanding access to care settings focused on prevention and treatment.
  • Without those investments and incentives, inpatient and crisis management care will continue to be the primary treatment options.

    CHANGEIN PEDIATRIC MENTAL HEALTH STARTS AT THE TOP.

    Heres how Rady Childrens Hospital developed an integrated behavioral health/primary care model.

    Psychotherapy Reimbursement Rates For Private Insurance

    It cannot be stated enough: the following information is not direct information from each of these insurance companies but rather is an average of fee schedules based exclusively on contracts with these companies. These insurance reimbursement rates for psychotherapy vary by state, by license, taxonomy, and other factors.

    No one ever has access to contracted rate information until an EOB is issued for out of network providers OR youve been accepted as in-network and theyve given you your fee schedule.

    Here is a sample of psychotherapy reimbursement rates for private insurance by major mental health insurance brand:

    Low
    86%

    Heres an image version that might be easier to read!

    In summary, some private insurance companies reimburse mental health therapists for far more than others. A great way to quickly learn which companies pay the most is to simply ask your colleagues about their experiences with different reimbursement rates for private insurance companies.

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    Coverage Expansion Increases Behavioral Health Provider Capacity

    Coverage expansion also contributes to increased access to behavioral health services by increasing behavioral health provider capacity. The more likely providers are to receive adequate reimbursement for their services, the greater their capacity to accept various forms of coverage. For example, providers of specialty mental health treatment were more likely to accept Medicaid after their states expanded eligibility under the ACA. And while much work remains to be done to ensure adequate reimbursement rates for providers of SUD treatment, evidence from states that increased Medicaid rates in recent years shows that these increases also contributed to greater provider participation in Medicaid. The more providers that accept Medicaid, the easier it is for enrollees to get the services they need when and where they need them. Closing the Medicaid coverage gap would benefit not only low-income patients but also the under-resourced providers that support them.

    Medicaid Mental Health Reimbursement Rates For Individual Therapy

    Increases in Behavioral Health Screening in Pediatric Care for ...

    Below is a table showing the rates that have been determined by Medicaid for these differing license levels for commercial insurance polices:

    45-50 minutes
    Practitioner Level 5 $75.64

    Now you must be wondering: What??!! Medicaid doesnt pay that much!!! And youre right.

    These are the rates that they established as averages nationally based on a huge survey of insurance policies by their relative license. These are the commercial insurance reimbursement rates for psychotherapy determined by Medicaid.

    Medicaid mental health reimbursement rates differ in that medicaid reduces these rates to providers at Practitioner Levels 2-5, which cover all licensed mental health providers except MDs.

    So, take the above charts and then reduce their numbers and you can expect to get payment more like the following:

    45-50 minute therapy session

    Again, these are the rates that have been determined as average payment rates by insurance based on research done by that States medicaid program, in this case Mississippi.

    These rates get reduced but these are useful to look at to see what they believe are the average reimbursement rates by procedure code.

    This information does not take into account the effect of the license or practitioner level on total reimbursement rate.

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    Featured Interviewee: Tiffany Leturno Clinic Administrator At Benson Health Clinic

    Tiffany Leturno is the clinic administrator at Benson Health Clinic in Eugene, Oregon. Her background includes time spent at other clinics, offices, and practices in the Lane County area in similar executive or administrative roles. In her role at these facilities she acted as office manager and site administrator.

    She is a graduate of Lane Community College, from which she holds an associates degree in the arts.

    More Difficult To Bill Insurance Companies For Mental Health Providers:

    The following links go to each companys credentialing website:

    Many Medicaid polices are subcontracted out to lower paying organizations. This can skew data downward in comparison to brands that to not facilitate a Medicaid plan in that State.

    Likewise, EAP sessions have far more hoops, billing nuance, and prior-to-session manual labor involved in billing. Other EAP plans require their own unique form.

    Simplify Your Practice Tip: If you are busy enough, consider dropping new EAPs.

    Its worth noting that none of these are impossible to bill but each company has particularities about their claims filing process, operational speed, and subcontracting policy, which can lead to a higher likelihood of problems and a longer claims and revenue cycle.

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    Reliable & Dedicated To Customer Service

    Our mental health insurance billing staff is on call Monday Friday, 8am-6pm to ensure your claims are submitted and checked up on with immediacy.

    We understand that its important to actually be able to speak to someone about your billing. Every provider we work with is assigned an admin as a point of contact. Youll always be able to get in touch.

    Why Is Medicare Hard To Bill For Mental Health Providers

    Will this waiver on Medicaid boost access to mental health and addiction services?

    Medicare subcontracts out to many different subcontractors like Noridian or Palmetto or Novitas or NGS or WPS or FCSO.

    Each contractor has their own electronic claims submission enrollment requirements, forms, and process. Each system is clunky and the enrollments take quite some time. Most clients also have a secondary insurance company to bill alongside their Medicare coverage.

    We take care of this enrollment process and secondary claims submission and follow-up for our providers at TheraThink.

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    How Your Location Impacts Your Mental Health Reimbursement Rate

    Your location has an enormous impact on your contracted rate.

    If you live in San Francisco, Los Angeles, Seattle, or many cities with high levels of education, there tend to be an abundance of mental health providers serving those locales.

    On the other hand, if you are only one of a small handful of providers in a town, city, or state, you may see a significantly higher insurance reimbursement rate for psychotherapy.

    Want to make the most money per session? You could move to Alaska.

    Your location is one of the least flexible aspects that decides your contracted rate with insurance companies but it has a serious impact on your reimbursement rates for psychotherapy.

    Consider this a business strategy question youll need to answer before settling on an office location.

    The closer you are in proximity to under-served locales, the higher you can expect your rates to be priced.

    If you are struggling to pick the right companies to increase your caseload, consider working with our mental health billing service to get these sorts of questions answered, along with all your billing, with way less headache along the way.

    Medicare Reimbursement Rates For Psychotherapy

    Please see our updated Medicare Rates:

    CPT Code
    $42.17 $25.30

    The reduced rate here isnt the exact amount Medicare pays out but represents a rough estimate of the suggested reduction to expect from Medicare. In our experience, Medicare over-estimates the contracted rate for most private insurance companies so their total reduction, while large, still leaves providers with a modest but much higher earning than Medicaid.

    Part of the reason why is Medicare is more selective with their network.

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    Medicares 2023 Fee Schedule: Cuts In Reimbursement Expanded Payments For Behavioral Health

    Physician groups warn cutbacks could reduce access to care

    Doctors likely will see a 4.4% reduction in Medicare reimbursements under the 2023 Physician Fee Schedule and could face cuts as high as 8.4% when other cuts are factored in. .

    Th Calendar Year 2023 PFS Final Rule, released November 1, includes a $1.55 decrease in the PFS conversion factor, from $34.61 to $33.06. The Centers for Medicare & Medicaid Services uses the conversion factor as tool in determining Medicares reimbursement rates for medical services and procedures. The new fee schedule will take effect January 1, 2023 unless Congress intervenes.

    In addition, doctors could be facing a 4% fee reduction because of PAYGO sequestrations. Congress had suspended the sequestrations at the start of the COVID-19 pandemic, but they are due to resume at the start of 2023 absent Congressional action.

    Physicians groups are expressing strong opposition to the updated PFS. The rate cuts would create immediate financial instability in the Medicare physician payment system and threaten patient access to Medicare-participating physicians, American Medical Association President Jack Resneck, Jr., MD said in a statement. Unless Congress acts by the end of the year, physician Medicare payments are planned to be cut by nearly 8.5% in 2023which would severely impede patient access to care due to the forced closure of physician practices and put further strain on those that remained open during the pandemic.

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    Why Is Medicaid Hard To Bill For Mental Health Providers

    Tools &  Resources for Mental Health Month

    For the same reason that Medicare is hard to bill, except that each state has their own contract instead of each region . As such, your states Medicaid policy is up to them.

    Each state may have their own system that they have built that might be slow and require many enrollments as well, or they might contract out the insurance coverage to existing commercial insurance companies.

    Example: What you think is UHC is actually Medicaid via UHC and while youre in-network with UHC, youre out of network with their Medicaid network your claims get denied.

    Make sure you understand exactly which Medicaid panels you are enrolling with, including if youre in-network with their commercial or Medicaid or HMO or PPO or EPO plans.

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