What the New Medicare Act (S. 1830) Mean for Private Practice?
Do you accept Medicare Part B in your private practice? If not, it’s probably because you didn’t think you could, and you may be right. Currently, Medicare Part B is closed to thousands of mental health care professionals. However, there’s a new bill that hopes to change that soon.
Last summer, a bill was introduced to the Senate that has the power to change the way mental health care is administered to the elderly. That bill is called S.1830 Seniors Mental Health Access Improvement Act of 2015.
Because this bill can drastically change the way you operate as a private practice, we’re devoting an entire post to it. Below, we’ll help you navigate what the bill is and what it could potentially mean for your private practice.
Let’s start with the basics first:
What is Medicare Part B?
Medicare Part B is medical insurance provided to senior citizens aged 65 and older. It covers services (such as routine checkups, surgeries, and lab tests) and supplies (such as wheelchairs) that are medically necessary to treat a condition or disease.
Medicare Part B also covers preventative services. These include flu shots, mammograms, prostate cancer screens, and more.
In addition to inpatient treatment services, Medicare Part B pays for outpatient mental health services including depression screening, family counseling (if it helps with treatment), and diagnostic tests. Here’s the full list of covered outpatient services paid for by Medicare Part B (from the Medicare.gov site):
One depression screening annually – This screening is done at the primary care doctor’s office or primary care clinic to allow for follow up treatment and referrals, if needed.
Individual and group psychotherapy – This therapy is administered by doctors or state-certified licensed professionals.
Family counseling – This type of counseling is only permitted if its main benefit is to help with the beneficiary’s treatment.
Psychiatric evaluationDiagnostic testingMedication managementPrescription drugs – These are drugs that must be administered by a health care professional (such are injections).
Partial hospitalizationA one-time “Welcome to Medicare” preventive visit – This visit also reviews the potential risk factors for depression.
One wellness visit annually – This visit allows the health care provider to evaluate changes every year.
While Medicare Part B does cover many mental health services and visits, it currently only does so when these services are provided by an assigned health care provider. This list includes:
Psychiatrist or other doctor
Clinical social worker
Clinical nurse specialist
At this time, licensed mental health counselors do not qualify for Medicare Part B assignment.
What is S. 1830?
In short, S. 1830 is a bill that seeks to amend title XVIII of the Social Security Act under Medicare Part B. If passed, this bill will grant licensed marriage and family counselors and licensed professional counselors the ability to see Medicare Part B beneficiaries. Licensed professional counselors will also be able to bill and receive reimbursement by Medicare Part B for their services.
Currently, Medicare Part B only covers psychologists and licensed clinical social workers but not licensed counselors.
This bill was originally introduced and sponsored by Sen. Barrasso, John [R-WY] on July 22, 2015. Since then, the bill has received bipartisan support from the following 13 cosponsors (in order of sponsorship):
Sen. Stabenow, Debbie [D-MI]* (original cosponsor)
Sen. Franken, Al [D-MN]
Sen. Ayotte, Kelly [R-NH]
Sen. Tester, Jon [D-MT]
Sen. Carper, Thomas R. [D-DE]
Sen. Gillibrand, Kirsten E. [D-NY]
Sen. Schumer, Charles E. [D-NY]
Sen. Collins, Susan M. [R-ME]
Sen. King, Angus S., Jr. [I-ME]
Sen. Blumenthal, Richard [D-CT]
Sen. Bennet, Michael F. [D-CO]
Sen. Brown, Sherrod [D-OH]
Sen. Shaheen, Jeanne [D-NH]
Benefits of S. 1830
This act will expand access to mental health care for an often-forgotten segment of society: the elderly. Currently, senior Americans can only access mental health care from a select group of service providers. These providers are often located in major cities, which leaves those in rural or small towns without adequate access to mental health services.
If passed, those with Medicare Part B will have the ability to seek mental health care from over 120,000 licensed professional counselors across the country, many of which are located in underserved areas.
This is good news because senior Americans are much more vulnerable to mental illness, especially depression. The Centers for Disease Control (CDC) found that depression in the elderly, when left untreated, could exacerbate other chronic diseases, such as diabetes.
If this bill is approved, it’ll mean that more patients will get access to mental health counseling.
Under this new bill, services will expand to include marriage and family counseling. Currently, those enrolled in Medicare Part B do not have access to such counseling services.
Cautions of S. 1830
One of the biggest concerns many small practices face with Medicare Part B is slow reimbursement. Unlike self-pay clients, Medicare Part B does not pay immediately. It can take months (sometimes years) to receive payment for provided services, especially if there’s an error in the line.
As a small private practice, that may not be a headache you’re willing to suffer through.
You may also open yourself up to not getting paid at all. File the wrong code and Medicare Part B can reject your claim completely.
Fortunately, if you do decide to accept Medicare Part B, we can help you. Our TheraNest software is continually updated with the newest codes to make sure that you file right the first time.
If you haven’t already, try TheraNest for 21 days now.