Medicare News and Tips: (Just to Make Things a Little More Complex...)

If you do not submit any claims to Medicare within a 12-month period, your enrollment may be deactivated, and you must contact your Medicare carrier or Medicare administrative contractor (MAC) and recertify that the information on file for you is still correct. If any new requirements have been put in place since your original enrollment, you must meet them. For instance, you must sign up to have your Medicare claims paid by electronic funds transfers (EFTs), just as you would have to do if you changed any information on your enrollment application (see item below). You also must submit a valid Medicare claim, which shouldn't be a problem since you probably wouldn't be worried about reactivating your enrollment unless you wanted to submit a claim.

Medicare is trying to convert all its provider payments to EFTs to your bank account. If you are currently receiving checks from your Medicare carrier, you will be able to continue getting checks as long as nothing in your practice changes. However, should you need to submit any changes to your Medicare enrollment (see below for more about reporting changes), you will be required to fill out a CMS-588 form authorizing payment through EFTs.

A rule that went into effect on January 1 states that newly enrolled Medicare providers may file claims retroactively for only a period of 30 days before the filing date of their accepted enrollment application. Previously, providers could file retroactive claims for services rendered up to 27 months before filing their enrollment application. Providers who are enrolled in Medicare still have up to 27 months to file claims for services they've provided.

Another new requirement for 2009 is that providers must report any changes in their practice that differ from what was reported on their Medicare enrollment application within 30 days of the change using form CMS-855I, which is posted at<www.cms.hhs.gov/CMSforms/downloads/CMS855I.pdf>. Previously providers had 90 days to report this new information, which includes changes in ownership, changes in location, changes in general supervision, and final adverse actions that have been taken against the provider. The penalties for failing to meet the 30-day requirement are revocation of Medicare billing privileges back to the date of the change and return of payment for claims paid after the date of the unreported change. Providers are urged to report changes as soon as possible to avoid penalties.

The Medicare Improvements for Patients and Providers Act of 2008 mandates the elimination of Medicare's discriminatory copayment for outpatient psychiatric treatment. While Medicare has reimbursed for all other outpatient medical services at 80 percent, with the patient responsible for the remaining 20 percent, outpatient mental health treatment has been reimbursed at only 50 percent. (Psychiatric evaluations and inpatient psychiatric care have always been paid at the 80 percent rate.) APA lobbied for decades to have this inequity corrected, and its efforts were finally rewarded.

It is important to understand, however, that the correction is being phased in gradually, and that for 2009 the reimbursement rate will continue to be 50 percent. In 2010 and 2011, the rate increases to 55 percent. In 2012, the rate will be 60 percent; in 2013, it will be 65 percent; and, finally, in 2014, it will be the full 80 percent.

While this change will not affect the amount that psychiatrists are reimbursed—that is determined by the fee schedule—it will permit Medicare beneficiaries to receive psychiatric care under the same copayment system that covers their other health care and perhaps encourage more individuals to seek psychiatric care. ▪