How to Claim Retroactive 5% Medicare Increase

The health care reform act that became law on March 23 retroactively reinstated the 5 percent increase in Medicare payments for a number of psychotherapy codes (90804-90819 and 90921-90824) that had been in effect in 2008 and 2009. This year, as anyone who bills Medicare is well aware, the fee schedule has been a moving target, with Congress passing corrections for only months at a time to the fee-schedule decreases demanded by the sustainable growth rate formula.

By June 1, all Medicare carriers and contractors should have been paying fees that reflected the 5 percent increase. In July, APA sent a letter to the Medicare medical directors asking them how they were going to handle payment of the 5 percent increase for claims filed before June 1. All of the responses, including one that came on September 13, stated that the Centers for Medicare and Medicaid Services had not released any instructions about issuing payment for the 5 percent owed retroactively for claims filed prior to June.

What this means to psychiatrists who want to recover that money is that they must request claim reopenings for each claim for which they are due the 5 percent. Of course, it's possible that even when a claim is reopened, it may be months before a payment is made.

If you want to reopen a claim, you should check your Medicare contractor's Web site or call its customer service number for information on how to proceed.

If you need additional assistance, contact APA's Managed Care Help Line at (800) 343-4671.