Advocacy & Policy Updates (2023)
CMS (12/27/23)
As previously reported in the November 29 APC Update, the 2024 CMS Physician Fee Schedule Final Rule was announced on November 2, 2023.
Click here to read the APA article from the Office of Healthcare Financing.
Some article highlights:
1. CMS is finalizing its proposal to raise the work values of codes for psychotherapy and health behavior assessment and intervention (HBAI) services by 19.1% over a 4-year period. APA Services will continue to advocate for work value increases for the psychological and neuropsychological testing codes.
2. CMS is adopting an active payment status for CPT codes 96202 and 96203 for Caregiver Behavior Management Training (CBMT).
3. CMS will implement paying claims for telehealth services, including audio-only, using POS 10 (services provided in the patient’s home) at the nonfacility rate. APA staff have confirmed that this is a permanent change. Claims for telehealth services using POS 02 (location other than the patient’s home) will be paid at the facility rate.
4. The codes for psychological and neuropsychological testing (96130–96139) will have provisional status on the 2024 Medicare Telehealth List, so will be covered through 2024.
5. Providers can continue to use their currently enrolled practice location instead of their home address when providing telehealth services from their home. Looking ahead, CMS is requesting comments on the issue of including a practitioner’s home address as a practice location.
Click here to view the CMS Announcement November 2, 2023 Fact Sheet.
Click here to see the Final Rule was published in the Federal Register on November 16, 2023.
Aetna (12/20/23)
1. Telemedicine coverage clarification
The December 2023 OfficeLink Updates newsletter contains a "telemedicine coverage clarification". Effective December 1, 2023, Aetna is not going to cover some telehealth codes/modifiers. Providers are instructed to log on to the Availity portal to see more specific information.
Click here to read the update.
2. SHP
"You must be an Aetna participating provider in the Choice POS II network to be in network for NC State Health Plan members starting 1/1/25."
CPP Open Enrollment Period
Aetna has announced that the CPP open enrollment period is from 11/1/2023 through 5/31/2024 for 1/1/2025 participation.
Click here to learn more on the Aetna SHP provider page.
Click here to read the Aetna CPP FAQs.
NC Medicaid Behavioral Health Services Rate Increases (12/20/23)
From the NC Medicaid Division of Health Benefits November 15, 2023 announcement:
"The North Carolina General Assembly appropriated $220 million in recurring funds in the Current Operations Appropriations Act of 2023 (SL 2023-134) to increase Medicaid reimbursement rates for providers of mental health, substance use disorder (SUD) and intellectual/developmental disability (I/DD)-related services. The Divisions of Health Benefits (DHB) and Mental Health, Developmental Disabilities and Substance Use Services (DMH/DD/SUS) analyzed which services were priorities for the increases and what forms the increases might take, and calculated them at the service level to fully allocate the available funds. The rate increases will be effective Jan. 1, 2024."
Click here to read the full article.
Aetna and the SHP (12/13/23)
Effective January 1, 2025, Aetna will be the third party administrator (TPA) for the SHP. According to Aetna, you must be an Aetna participating provider in the Choice POS II network to be in network for NC SHP members starting 1/1/25.
Click here to view the NC SHP Provider page has many helpful resources related to the upcoming transition.
The following Aetna resources are included on this SHP provider page:
2025 NCSHP Network Participation Agreement
2025 NCSHP Network Rate Schedule
2025 NCSHP Network Professional Fee Schedule
2025 NCSHP Network FAQs
BCBSNC (12/6/23)
"Effective January 1, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is transitioning its Medicare Advantage and Medicare Supplement claims operations to the Facets system, which will enable Blue Cross NC to utilize one system for all members."
Click here to read more.
Click here to learn more about the Blue Cross NC updated Medicare Advantage Quality Incentive Program (MA QIP) Policy for 2024.
NC HIEA (12/6/23)
Click here to read the November 2023 update.
APA (11/29/23)
2024 Physician Fee Schedule Final Rule Released - Click here to view
KFF (11/29/23)
Understanding the Health Insurance Marketplaces webpage
Includes a link to the article "What to Watch in the 2024 ACA Open Enrollment"
BCBSNC (11/22/23)
Narrow Network Changes Effective January 1, 2024. Click here.
NC HIEA (11/22/23)
Click here to read the October 23 Update.
NC Medicaid (11/22/23)
Expansion FAQs - Click here
NC Psychology Board (11/22/23)
Click here to read "The Bulletin Board" Fall newsletter.
Medicaid (11/15/23)
See the NC Medicaid Telehealth, Virtual Communications Policy dated June 1, 2023.
Medicare (11/15/23)
Read the latest guidance on billing and coding Medicare Fee-for-Service (FFS) telehealth claims here. . .
Billing and Coding Medicare FFS Claims - Click here
Telehealth Policy Changes after the Covid-19 PHE - Click here
Medcost (11/15/23)
See the Telehealth- Providers section for updated information - Click here
Tricare (Humana Military) (11/15/23)
See the Telemedicine for Providers page, including a link to Telemedicine FAQs - Click here
UHC/Optum (11/15/23)
Optum: Behavioral Health Telehealth Billing Quick Reference Guide dated October 1, 2023:
UHC Covid-19 Telehealth page, including Medicare Advantage and Medicaid, updated April 2023 - Click here
Spotlight On: Online Practice Toolkit (11/15/23)
NCPA members at the ECPro or Investor level and above have access to the Online Practice Toolkit. This Toolkit contains information and resources covering 24 major practice areas and is consistently updated by the Advocacy and Practice Committee (APC).
We have recently updated the Insurance page of the Toolkit. The page is divided into two sections. The first section includes resources related to general insurance topics such as provider contracts, billing codes, claims denials, and reimbursement. The second section lists both government and commercial payors and includes links to resources for each, such as the provider home page, clinical policies, documents and forms, and newsletter updates.
Aetna (11/8/23)
Office Link Updates newsletter (September 2023)
"When the public health emergency ended on May 11, 2023, we continued coverage for the liberalized telemedicine procedures/modifiers. Beginning December 1, 2023, we’re modifying our policy to no longer cover some of the liberalized telemedicine procedures/modifiers." Read more here.
BCBSNC (11/8/23)
The June 12, 2023 update "Telehealth Policy for 2023: Corrected Claims, Modifiers, and Reminders" contains information regarding the telehealth policy, POS codes, and modifiers. Click here to see the update.
Cigna (11/8/23)
Commercial plans: "Individual providers and outpatient clinics may permanently use telehealth for outpatient therapy, applied behavior analysis (ABA)*, medication management, and Employee Assistance Program (EAP) services. The expiration of the PHE does not apply to these telehealth services." Click here to see the full webpage, including billing information.
Medicare Advantage: Click here to see the Billing and Authorizations Guidelines document (telehealth guidance begins on page 9)
Humana (11/8/23)
Claims Payment Policy- Telehealth and Other Virtual Services - updated April 2023.
Click here.
Spotlight On: Online Practice Toolkit (11/8/23)
NCPA members at the ECPro or Investor level and above have access to the Online Practice Toolkit. This Toolkit contains information and resources covering 24 major practice areas and is consistently updated by the Advocacy and Practice Committee (APC).
We have recently updated the Insurance page of the Toolkit. The page is divided into two sections. The first section includes resources related to general insurance topics such as provider contracts, billing codes, claims denials, and reimbursement. The second section lists both government and commercial payors and includes links to resources for each, such as the provider home page, clinical policies, documents and forms, and newsletter updates.
BCBSNC Pricing Policy Update Effective January 1, 2024 (11/1/23)
"Blue Cross NC has modified its pricing policy language to change from using the first published file from the Centers for Medicare and Medicaid Services (CMS) for each calendar year, to the latest published file as of January 15 of each calendar year. This allows us to include CMS updates to the published file that follows the first published file."
Click here to read more including links to specific updated policies.
NC HIEA (11/1/23)
NC HealthConnex Teletown Hall November 15 12-1 PM
Click here to learn more and register.
"How to Connect" WebEx meeting November 27 12-1 PM
Click here to learn more and register.
CMS (11/1/23)
CMS is conducting a study to help us improve your experience with Medicare program and billing resources.
Click here to learn more.
APA Call for Comments (10/25/23)
The APA seeks comments from all interested individuals and groups – including psychologists, health care professionals, researchers, clients/patients and their families, APA governance members, and the general public – on the draft Clinical Practice Guideline for the Treatment of Chronic Musculoskeletal Pain in Adults.
Click here to read more.
Palmetto GBA (Medicare) (10/25/23)
Medicare Deductible, Coinsurance, & Premium Rates: CY 2024 Update
Click here to read the update.
Lunch and Learn: Improving Your Palmetto GBA Customer Experience Webinar: November 30, 2023
Read more and register here.
CMS Medicare Administrative Contractor (MAC) (10/18/23)
"A Medicare Administrative Contractor (MAC) is a private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries. CMS relies on a network of MACs to serve as the primary operational contact between the Medicare FFS program and the health care providers enrolled in the program. MACs are multi-state, regional contractors responsible for administering both Medicare Part A and Medicare Part B claims."
Click here to read more.
Palmetto GBA is the "MAC" for Jurisdiction M Part B providers, including North Carolina and three other states. Click here to see the home page.
The website has an Events and Education page: "The Provider Outreach and Education department (POE) educates providers and their staff regarding the fundamentals of the Medicare program, national and local policies, procedures, new Medicare initiatives, significant changes to the Medicare program, and issues identified through data analysis. Palmetto GBA offers education to providers through online, teleconference or live and in-person events."
Click here to learn more about these educational events.
APA Mental Health Parity Advocacy (10/11/23)
From the desk of Katherine B. McGuire, MS, Chief Advocacy Officer, APA Services...
Dear Colleague:
Please take 2 minutes to strengthen crucial proposed rules that would improve how insurance companies cover mental health services. Recently, the Department of Labor proposed new rules aiming to strengthen mental health parity standards and enforcement. While this proposal is a big step in the right direction with provisions we support, we have also identified provisions that need improvement. Help ensure these concerns are heard loud and clear by submitting a pre-written message today.
By participating in this campaign, you will inform key policymakers on important problems in insurance coverage of mental health services compared to medical services, including:
- Desperate patients are unable to find timely and appropriate care through their insurance network.
- Unfair/deceptive limits on patient’s mental health coverage.
- Unreasonable limits on the length or type of mental health treatment the insurance plan will cover, even though the treatment is medically necessary for the patient’s care.
- Burdensome administrative requirements such as retroactive denials after preauthorization, prepayment audits, and hours-long hold times with provider representatives.
With your help, we have a chance to make needed strides towards covering mental health services on an equal footing as physical health services. There is a limited window of opportunity to act – the new deadline is October 17. Please seize this moment and advocate for more equitable treatment in mental health care!
Center for Connected Health Policy (CCHP) (10/11/23)
"The Center for Connected Health Policy is a nonprofit, nonpartisan organization working to maximize telehealth’s ability to improve health outcomes, care delivery, and cost effectiveness. Our expertise in telehealth policy was recognized in 2012, when we became the federally designated National Telehealth Policy Resource Center."
Home page - click here
North Carolina state policies page - click here
The National Telehealth Policy Resource Center "Billing for Telehealth Encounters" July 2023
click here
Fact Sheet About Mental Health Parity (10/4/23)
Click here to view the fact sheet.
NC HIEA (10/4/23)
Click here to read the September 2023 Update.
The Trust (10/4/23)
"Traditional Continuing Education (CE) usually refers to more formal classroom experiences such as workshops, seminars, and formal classes where an expert teaches certain concepts or skills. Continuing Professional Development (CPD), in contrast, is considered a broader concept than traditional CE and encompasses a wider set of experiences that contribute to the competency of a professional." Click here to read the full article.
APA (9/28/23)
From the desk of Katherine B. McGuire, MS, Chief Advocacy Officer, APA Services...
Dear Colleague:
Please take 2 minutes to strengthen crucial proposed rules that would improve how insurance companies cover mental health services. Recently, the Department of Labor proposed new rules aiming to strengthen mental health parity standards and enforcement. While this proposal is a big step in the right direction with provisions we support, we have also identified provisions that need improvement. Help ensure these concerns are heard loud and clear by submitting a pre-written message today.
By participating in this campaign, you will inform key policymakers on important problems in insurance coverage of mental health services compared to medical services, including:
- Desperate patients are unable to find timely and appropriate care through their insurance network.
- Unfair/deceptive limits on patient’s mental health coverage.
- Unreasonable limits on the length or type of mental health treatment the insurance plan will cover, even though the treatment is medically necessary for the patient’s care.
- Burdensome administrative requirements such as retroactive denials after preauthorization, prepayment audits, and hours-long hold times with provider representatives.
With your help, we have a chance to make needed strides towards covering mental health services on an equal footing as physical health services. There is a limited window of opportunity to act – the deadline is October 2nd at 11:50pm EDT. Please seize this moment and advocate for more equitable treatment in mental health care!
PsyPact (9/28/23)
"The PSYPACT® Commission has proposed changes to Rule 4 and Rule 5 with the addition of 4.13 and 5.13. The additions serve to clarify who "authorization" applies to as an authorization holder under PSYPACT®." There will be a public hearing on 11/16/23. Read more here:
Click here to visit the Public Comment page.
Click here to visit the Meetings page.
BCBSNC (9/27/23)
Providers asked to verify taxonomy codes - Click here to read.
Taxonomy Codes when billing for out of state members - Click here to read.
PsyPact News (9/27/23)
PsyPact Commission Releases First Annual Report. Click here to read.
Current Map of PsyPact Participating States. Click here to view.
Action Alert (9/20/23)
From the desk of Katherine B. McGuire, MS, Chief Advocacy Officer, APA Services...
Dear Colleague:
Please take 2 minutes to strengthen crucial proposed rules that would improve how insurance companies cover mental health services. Recently, the Department of Labor proposed new rules aiming to strengthen mental health parity standards and enforcement. While this proposal is a big step in the right direction with provisions we support, we have also identified provisions that need improvement. Help ensure these concerns are heard loud and clear by submitting a pre-written message today.
By participating in this campaign, you will inform key policymakers on important problems in insurance coverage of mental health services compared to medical services, including:
- Desperate patients are unable to find timely and appropriate care through their insurance network.
- Unfair/deceptive limits on patient’s mental health coverage.
- Unreasonable limits on the length or type of mental health treatment the insurance plan will cover, even though the treatment is medically necessary for the patient’s care.
- Burdensome administrative requirements such as retroactive denials after preauthorization, prepayment audits, and hours-long hold times with provider representatives.
With your help, we have a chance to make needed strides towards covering mental health services on an equal footing as physical health services. There is a limited window of opportunity to act – the deadline is October 2nd at 11:50pm EDT. Please seize this moment and advocate for more equitable treatment in mental health care!
APA Health Information Exchanges (9/13/23)
What psychologists need to know about Health Information Exchanges.
Click here to read the article.
BCBSNC BetterDoctor (9/13/23)
"Currently, Blue Cross NC individual providers can ONLY submit directory attestations through Quest Analytics BetterDoctor. This is a correction from our previously posted communication stating providers could use the Council for Affordable Quality Healthcare (CAQH) to attest. Blue Cross NC is NOT currently partnering with CAQH for providers to attest. (Please note only credentialing is done through CAQH).
Click here to read the full announcement.
NCHIEA (9/6/23)
Click here to read the August newsletter.
APA Simple Practice Terms of Service (TOS) (9/6/23)
Simple Practice Terms of Service (TOS)
From Deborah C. Baker, JD, APA Director, Legal & Regulatory Policy:
"As you may have heard, SimplePractice updated their explanation of their Terms of Service (TOS) yesterday. Based on feedback from APA, they clarified several points to be more transparent, explained the legal language in certain sections of their Terms of Service (TSOS), and gave users who had not yet signed the TOS additional time to review. You can find their update here: SimplePractice’s Latest Update
The substance of what SP clarified boils down to the following:
- New state privacy laws in many states required SP to update their TOS (happening across the industry) to make things more explicit.
- They are observing all HIPAA, BAA, HITRUST regulations. We would expect them to do this.
- They do not provide AI with access to practitioner or client data.
- They are not selling any PHI or personal user information. We would expect them not to do this.
- They do analyze de-identified data for their business purposes (marketing, new products, etc.). Business purposes can be very broadly defined.
- They do not co-opt forms users put on their system and then repackage them and sell them. The legal language in their TOS implies that they could do this; however, the language in their TOS has not changed with this recent update.
- They do not currently sell de-identified data and have no plans to do so; they state that they will let their users know transparently if this changes in the future.
- They have clarified how to opt out of arbitration if you wish to do so.
We understand that members may ask you for advice on whether they should sign or not. Members may still have legitimate concerns about how de-identified data sets may be used, even if PHI is being protected. It is incumbent upon members to conduct their own review of any terms of service and to be comfortable with what they are signing. The decision will come down to a member’s risk tolerance, their analysis of their business needs, and their understanding of the technology industry and current business models in the industry. Having said that, based on our review, we do think that it is a legitimate and valid choice to STAY with SP and it is a legitimate and valid choice to LEAVE. We hope you find this information helpful.
Disclaimer: Please understand that APA cannot provide legal advice to its members, and members are encouraged to consult with a licensed attorney in private practice for such business and compliance decisions."
NCPA (8/30/23)
NCPA submitted a letter to provide comments on the proposed rule on the Calendar Year (CY) 2024 Medicare Physician Fee Schedule (PFS) released by the Centers for Medicare and Medicaid Services (CMS) on July 13, 2023. Along with other recommendations, NCPA advocated that CMS:
- Support telehealth access by permanently paying claims for telehealth mental health services provided in patient homes at the non-facility rate
- Improve reimbursement for behavioral health services by increasing the work values for psychotherapy codes, psychological and neuropsychological testing services, and the Health Behavior Assessment & Intervention (HBAI) services
- Support substance use services by increasing reimbursement for psychotherapy services in the substance use services bundle
- Ensure access to evidence-based behavioral health interventions by activating reimbursement for caregiver behavior management training services
- Work with APA Services and other medical societies to develop new codes for brief interventions and safety planning for patients at risk of suicide in the emergency department and other settings
Click here to read the full letter, including all recommendations.
Action Alert: CMS CY24 Physician Fee Schedule (8/30/23)
Dear Colleague:
We ask everyone representing the field of psychology – including practitioners, researchers, students and educators alike, as well as our allies in the health care field – to show a unified front in promoting greater access to and equity in the delivery of mental health care.
We need you to contribute your voice to our campaign asking the Biden Administration to invest in key psychological services. This includes reimbursement for telehealth services, interventions for clients at risk of suicide, treatment for substance abuse disorders and other services. Right now, many communities remain critically underserved, such as many rural communities, racial and ethnic minority communities and LGBTQA+ communities. Stronger funding for and flexibility around how these services are delivered will help reduce those disparities by making it more financially viable for professionals to stay in and enter mental health professions across the nation, including participating in Medicare, thus strengthening the healthcare system’s ability to meet community needs.
The Centers for Medicare and Medicaid Services (CMS) issues an annual proposed rule – the Medicare Physician Fee Schedule – that has serious implications across the health care field. It sets the benchmark for how other insurance programs cover and reimburse for specific services. It also sets the standard for what kind of services are covered, including new and emerging forms of treatment. We are weighing in because this year’s proposed rule includes promising provisions that need your support to become a reality (e.g. supporting telehealth in clients’ homes), and provisions that need improvement (e.g. the current proposal is not sufficiently inclusive of psychological testing services). You can learn more about those provisions in our action center.
This proposed rule is coming at a time when federal agencies – including CMS – are facing Congressional pressure to reduce spending. Now more than ever, it is important that psychology be represented in the public response to this proposal, to stress the need to preserve funding and strengthen access to mental and behavioral health services. Please do not sit this campaign out – take action today!
Sincerely,
Thema Bryant, PhD
APA President, 2023
BCBSNC (8/23/23)
August 18 update: "We are pleased to share that through measures taken to improve the process, we are currently enrolling new providers on a 60-day timeframe." Click here to read the full update.
Simple Practice - TOS Update (8/23/23)
APA update: On August 16, we received the following update from Deborah Baker of the Office of Legal and State Advocacy: "Marnie Shanbhag from the Office of Independent Practice and I had a collaborative and productive meeting with SimplePractice leadership and they were very amenable to hearing our concerns. They again reassured us that any user data that “lives on” beyond a customer’s account termination is completely non-identifiable and part of larger aggregate data sets, and that SimplePractice does not sell personally identifiable information (from the practitioner) nor PHI (from the client/patient) or provide AI with access to practitioner or client data. In response, they have extended their acceptance date to Sept 1st, 2023, and are going to take another look at their terms of service to see if there are areas they can make clearer. We look forward to receiving their additional clarifications."
Action Alert: CMS CY24 Physician Fee Schedule (8/23/23)
Dear Colleague:
We ask everyone representing the field of psychology – including practitioners, researchers, students and educators alike, as well as our allies in the health care field – to show a unified front in promoting greater access to and equity in the delivery of mental health care.
We need you to contribute your voice to our campaign asking the Biden Administration to invest in key psychological services. This includes reimbursement for telehealth services, interventions for clients at risk of suicide, treatment for substance abuse disorders and other services. Right now, many communities remain critically underserved, such as many rural communities, racial and ethnic minority communities and LGBTQA+ communities. Stronger funding for and flexibility around how these services are delivered will help reduce those disparities by making it more financially viable for professionals to stay in and enter mental health professions across the nation, including participating in Medicare, thus strengthening the healthcare system’s ability to meet community needs.
The Centers for Medicare and Medicaid Services (CMS) issues an annual proposed rule – the Medicare Physician Fee Schedule – that has serious implications across the health care field. It sets the benchmark for how other insurance programs cover and reimburse for specific services. It also sets the standard for what kind of services are covered, including new and emerging forms of treatment. We are weighing in because this year’s proposed rule includes promising provisions that need your support to become a reality (e.g. supporting telehealth in clients’ homes), and provisions that need improvement (e.g. the current proposal is not sufficiently inclusive of psychological testing services). You can learn more about those provisions in our action center.
This proposed rule is coming at a time when federal agencies – including CMS – are facing Congressional pressure to reduce spending. Now more than ever, it is important that psychology be represented in the public response to this proposal, to stress the need to preserve funding and strengthen access to mental and behavioral health services. Please do not sit this campaign out – take action today!
Sincerely,
Thema Bryant, PhD
APA President, 2023
NCHIEA (8/16/23)
Click here to read the July newsletter.
Simple Practice (8/16/23)
NCPA is aware of concerns that have been raised regarding the new Terms of Service (TOS) for Simple Practice. APA is also aware of these concerns. On August 11, we received the following message from Marnie Shanbhag, PhD, Senior Director, APA Office of Independent Practice: "Deborah Baker, JD from the Practice Legal and Regulatory team and I are meeting with the leadership of Simple Practice next week to address your concerns. In the meantime, they have extended their deadline for returning the signed terms of service (TOS) to I believe 9/1/2023. They are assuring us that they do not access PHI outside of HIPAA guidelines nor do they not keep PHI after termination of customers’ accounts. Regardless, we will be discussing areas of contract language in the TOS that appear to give broader access among the other issues raised." NCPA will share additional information in future Updates.
APA (8/9/23)
"The Centers for Medicare and Medicaid Services (CMS) CY2024 Physician Fee Schedule (PFS) Proposed Rule was released on Thursday July 13, 2023. APA Services, Inc. (APASI) is very pleased to see positive results from our advocacy efforts and responsiveness from CMS."
Click here to read the article.
APA Advocacy (8/9/23)
The proposed rule still needs advocacy from all psychologists!
CMS Proposed Rule for the 2024 Physician Fee Schedule. Click here to read.
After reading, click here to share your voice.
BCBSNC (8/9/23)
Directory Attestations:
"Currently, Blue Cross NC individual providers can ONLY submit directory attestations through Quest Analytics BetterDoctor. This is a correction from our previously posted communication stating providers could use the Council for Affordable Quality Healthcare (CAQH) to attest. Blue Cross NC is NOT currently partnering with CAQH for providers to attest. (Please note only credentialing is done through CAQH)"
Click here to read the full update.
Annual NCQA Provider Directory Assessment
Adjustment of commercial plans' length of stay guidelines
APA (8/4/23)
CMS Proposed Rule for the 2024 Physician Fee Schedule. Click here to read.
After reading, click here to share your voice.
APA (7/25/23)
Calling on Congress to tie Medicare payment rates to inflation. Click here to read the article.
NC Psychology Board (7/25/23)
Click here to read the Summer 2023 issue of the "Bulletin Board".
988 One Year Anniversary (7/19/23)
July 16 marked the 1-year anniversary of the three-digit 988 Suicide and Crisis Lifeline.
Click here to read the APA article.
APA Call for Comments (7/19/23)
Comments Being Accepted for the 2014 Edition of the Standards for Educational and Psychological Testing, (AERA, APA, NCME):
In anticipation of the document’s upcoming revision, comments are being accepted for the 2014 edition of the Standards for Educational and Psychological Testing, American Educational Research Association (AERA), the American Psychological Association (APA), the National Council on Measurement in Education (NCME) at https://commentinggov.apa.org/. Closing deadline for comments is 5:00 p.m. EDT on August 14, 2023. Psychologists may contact Marianne Ernesto (APA Director of Testing and Assessment) at mernesto@apa.org with any questions.
PsyPact (7/19/23)
There are currently 38 PsyPact participating states. Click here to see the updated map.
NC Health Information Exchange Authority (HIEA) (7/12/23)
Click here to read the latest newsletter.
NCPA Spotlight: Online Practice Toolkit (7/12/23)
NCPA members at the ECPro or Investor level and above have access to the Online Practice Toolkit. This Toolkit contains information and resources covering 24 major practice areas. We've recently updated the following section:
Risk Management (including Audits): In this section, members will find resources related to Risk Management topics such as record keeping (detailed versus lean records), social media, and client termination. Both in and out of network providers can find articles about responding to an audit request. Also, we've recently added resources with updated information regarding CMS topics such as Comparative Billing (CBR) reports, the Targeted Probe and Educate (TPE) program, and Additional Documentation Request (ADR) letters.
NC DHHS Delayed Launch of Tailored Plans (7/12/23)
"The Department of Health and Human Services is delaying implementation of the Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans. Tailored Plan launch was scheduled for Oct. 1, 2023, but will now go forward at a date still to be determined."
Click here to read more.
APA Advocacy (7/5/23)
Advocacy Priorities Webpage - Click here
Medicare Reimbursement and Access - Click here
Washington Update newsletter page - Click here
APA (6/28/23)
Click here to view the webpage dedicated to "Information and tools to help you navigate the health care system with numerous pointers for billing and working with commercial insurers and government payers"
NC Psychology Board (6/28/23)
The Board has a dedicated "Advisory Statements" page where psychologists can find documents about topics such as "Decision Making Regarding Record Keeping Upon Death", "Medication Recommendations" and "Using Current Tests and Norms".
Click here to visit the page.
NC Medicaid (6/21/23)
Click here to view the Ombudsman home page.
What is a Local Management Entity-Managed Care Organization (LME-MCO)?
Click here for the LME-MCO Directory
Implementation of Tailored Plans targeted for October 1, 2023- click here to read the press release.
Understanding the Transition to Managed Care FAQs.
APA: The CMS Physician Fee Schedule (6/14/23)
Click here to read the June 7 update.
APA: Changes Coming To Psychology Practice After COVID-19 (6/14/23)
Click here to read the June 9 article.
Spotlight On: NCPA's Practice Toolkit (6/14/23)
NCPA members at the ECPro or Investor level and above have access to the Online Practice Toolkit.
This Toolkit contains information and resources covering 24 major practice areas and is consistently updated by the Advocacy and Practice Committee (APC). For example:
1. Patient Resources: This section includes references and links to a wide variety of websites, books, TED Talks, videos, and podcasts that psychologists may wish to use in their work. Topics covered include anxiety, depression, stress, grief, relationships/marriage, parenting, ACOA, divorce, resiliency, autism, and many more.
2. North Carolina General Statutes: Here, members will find links to psychology-related statutes covering topics such as provider directories, credentialing, mental health parity, and the "record copy fee" statute, which outlines what psychologists may charge for copying records.
BCNSNC (6/7/23)
"Blue Cross NC individual providers can ONLY submit directory attestations through Quest Analytics BetterDoctor." Read more here.
NCHIEA (6/7/23)
Click here to read the May 2023 newsletter.
NCGS 58-50-61 Utilization Review (5/31/23)
"An insurer shall provide the clinical review criteria used to make the noncertification to any person who received the notification of the noncertification and who follows the procedures for a request. An insurer shall also inform the covered person in writing about the availability of assistance from Health Insurance Smart NC, including the telephone number and address of the Program."
Read the full statute here.
NC DOI (5/31/23)
Prompt Claim Payment Guidance page
"N.C.G.S. § 58-3-225 requires an insurer within thirty calendar days after receipt of a claim to either pay a claim or send a notice to the claimant. The notice must state all the specific good faith reason or reasons for the denial, including benefit limitations, coordination of benefits, lack of eligibility, or lack of coverage for the services provided." Click here to learn more.
Smart NC for consumers
"Smart NC can assist you with filing a complaint with your insurance company if you are covered under the North Carolina State Health Plan for Teachers and State Employees or any other self-insured company. A self-insurance company is typically a large business that pays an insurance company to administer health benefits for its employees but the company funds its own insurance program." Click here to learn more.
US DOL ERISA plans (5/31/23)
"The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans." Click here to learn more.
APA - Medicare Billing Post PHE (5/24/23)
Dr. Marnie Shanbhag, APA Practice’s Senior Director for the Office of Independent Practice, shared a document addressing Medicare billing post PHE. Contributors included Diane Pedulla, JD, and Stephen Gillaspy, PhD from the APA's Office for Healthcare Financing.
Click here to read the document.
APA Record Retention (5/24/23)
APA generally advises Medicaid and Medicare providers to maintain their records for a minimum of 10 years in order to avoid potential liability and ensure they can properly defend themselves against all False Claims Act cases. This advice is based on:
1. The federal False Claims Act (FCA) which "provides a way for the government to recover money when someone submits or causes to be submitted false or fraudulent claims for payment to the government, including the Medicare and Medicaid programs." more info here (including a brief video):
https://oig.hhs.gov/newsroom/oig-podcasts/false-claims-act/
2. A 2019 US Supreme Court decision (Cochise Consultancy, Inc. v. United States ex rel. Hunt, 139 S. Ct. 1507). The Court held that the statute of limitations for an action brought by a private party or whistleblower on behalf of the government may be up to 10 years, regardless of who initiated the action. More here:
The False Claims Act applies to federal monies. Medicare managed plans are federal programs, so the 10-year retention period also applies.
For private insurance or self-pay patients, NC General Statutes 90.270-148 says the Board may take action against any psychologist who:
"Except when prevented from doing so by circumstances beyond the psychologist's control, has failed to retain securely and confidentially the complete case record for at least seven years from the date of the last provision of psychological services; or, except when prevented from doing so by circumstances beyond the psychologist's control, has failed to retain securely and confidentially the complete case record for three years from the date of the attainment of majority age by the patient or client or for at least seven years from the date of the last provision of psychological services, whichever is longer; or, except when prevented from doing so by circumstances beyond the psychologist's control, has failed to retain securely and confidentially the complete case record
indefinitely if there are pending legal or ethical matters or if there is any other compelling circumstance" https://www.ncleg.gov/Laws/GeneralStatutes
These record retention laws are minimum periods of time that providers are required to keep records- records can certainly be kept longer.
Spotlight On: NCPA’s Online Practice Toolkit (5/24/23)
NCPA members at the ECPro or Investor level and above have access to the Online Practice Toolkit. This Toolkit contains information and resources covering 24 major practice areas. For example:
- Record Keeping, Retention, and Destruction page: in addition to resources mentioned above, members will also find APA’s Record Keeping Guidelines and resources related to record creation, maintenance, and proper destruction.
- Sample Forms and Policies page: here, members will find resources such as: APA Model Forms specific to North Carolina; links to sample forms and information from sources including the APA, The Center for Ethical Practice, The Trust, and US DHHS; and original documents created by NCPA committee members addressing specific practice areas.
The Toolkit is updated consistently by the Advocacy and Practice Committee (APC).
NCPA - SHP Survey (5/17/23)
Recently, NCPA sent a survey to all members asking about the State Health Plan (SHP).
Click here to see a summary of the survey responses.
BCBSNC - Changes to Professional Fees (5/17/23)
In mid-April, NCPA received the following information from Anne Winefordner, the Director of Provider Contracting at BCBSNC:
While many of the professional fee schedules at Blue Cross NC update each year on April 1 based on a percentage of CMS rates, we routinely collaborate with providers to account for special circumstances to identify any opportunities to best support providers in our network… since 2009, our pricing policies have applied reimbursement percentages established through provider contracts with rates published by the Centers for Medicare & Medicaid Services (CMS), and therefore updated fee schedules may reflect increases or decreases in provider reimbursement rates based on CMS changes.
I am pleased to let you know that we will be updating contracts for independent behavioral health providers to increase the percentage of Medicare applicable to reimbursement rates for the important services they provide. We are targeting next week for communications to Providers on this increase.
Please know that Blue Cross NC is committed to a whole-person approach to care, and we understand that good health depends on good mental health. Thank you for your help in communicating this important upcoming change for independent behavioral health providers.
In follow-up communication with Ms. Winefordner, NCPA has been informed that:
1. The State Health Plan (SHP) was excluded. Since the SHP rates update annually based on CMS changes, providers may have seen decreases for that line of business. BCBS reports that the “increase in multiplier” was applied to all other commercial lines of business.
2. Notification will only be sent to providers who are on fee schedules that update annually with Medicare.
3. BCBSNC updated their commercial rates effective 4/1 and they are reprocessing all impacted claims. Providers do not need to contact customer service regarding these claims.
4. BCBSNC also has “more current fee schedules” that may be “a positive change for certain providers depending on their current contract rates”. BCBSNC would need to review those contracts on an individual basis; providers can call the dedicated provider line at 800-777-1643 to request a contract review. The request will be routed to the appropriate team member based on county assignment, to be worked in order of receipt.
The Covid-19 Public Health Emergency (PHE) expires at the end of the day today, May 11, 2023.
Along with the resources listed below, members can refer to
the APC Update of April 26 for information about the end of the PHE.
US DHHS Fact Sheet (5/11/23)
Click here to view the End of the Covid-19 Public Health Emergency (including information about Medicare, Medicaid, and telehealth)
CDC: End of the Federal Covid-19 PHE Declaration (5/11/23)
Click here to view the declaration.
NC DHHS (5/11/23)
Click here to view the Covid-19 web page.
Click here to view the Health Care providers page.
NCPA Advocacy- Aetna and the State Health Plan (SHP) (5/10/23)
On April 4, Martha-Turner Quest (ED) and Cristin Saffo, PsyD (DPA) met with three Aetna representatives: Jim Bostian, NC President; Linda Cecarelli, Executive Director, Network Strategy and Operations; and Michael Driscoll, head of the support team managing the SHP transition. One of the primary goals of the meeting was to begin a dialogue addressing the 2025 transition to Aetna being the third party administrator (TPA) for the State Health Plan (SHP).
Key points shared by Aetna staff:
1. Confirmation that Aetna will continue to support and administer the Clear Pricing Project (CPP). Administering the CPP was a requirement of the application to become the TPA for the SHP.
2. Aetna providers currently enrolled in the CPP will continue to receive CPP rates when Aetna becomes the TPA in January 2025. CPP providers who are already in the Aetna network will need to “re-select” the CPP on the Aetna portal (more instruction will be forthcoming). The CPP will be an amendment to the Aetna Participating Provider Agreement.
3. Providers who are neither currently credentialed with Aetna or enrolled in the CPP will need to join the Aetna network first and then apply to the CPP during its next open enrollment period; these cannot be done at the same time. It will not be an option for providers to join the CPP network but not the Aetna network.
4. Aetna plans to reach out to all out of network providers later this year, inviting them to join the Aetna network.
Key points of NCPA advocacy:
1. NCPA survey data showing that fewer members are in network with Aetna than with BCBSNC, the current TPA for the SHP (survey results will be shared in a future APC Update)
2. Reimbursement rates- discussion of Aetna, Medicare, and CPP rates
3. Issues related to network adequacy and patient access to care
Both NCPA and Aetna agreed to continued collaboration to address general issues as well as the SHP transition- we will keep members posted.
NC HIEA (5/3/23)
Click here to read the April 2023 Update.
NC Department of Insurance (5/3/23)
Click here to view the home page.
Click here to visit the provider complaints page.
Click here for Smart NC- for consumer complaints.
US DHHS Office of Civil Rights (OCR) (4/26/23)
The Covid-19 PHE is scheduled to end on May 11, 2023. During the PHE, OCR exercised HIPAA enforcement discretion and did not impose penalties on providers for noncompliance with the HIPAA Rules (in other words, for using non HIPAA-compliant technology). An HHS press release dated April 11 states:
"OCR is providing a 90-calendar day transition period for covered health care providers to come into compliance with the HIPAA Rules with respect to their provision of telehealth. The transition period will be in effect beginning on May 12, 2023 and will expire at 11:59 p.m. on August 9, 2023. OCR will continue to exercise its enforcement discretion and will not impose penalties on covered health care providers for noncompliance with the HIPAA Rules that occurs in connection with the good faith provision of telehealth during the 90-calendar day transition period."
Click here to read the press release.
In this press release, Melanie Fontes Rainer, OCR Director, states: “OCR is continuing to support the use of telehealth after the public health emergency by providing a transition period for health care providers to make any changes to their operations that are needed to provide telehealth in a private and secure manner in compliance with the HIPAA Rules.”
Click here to see the HHS website page related to HIPAA and Telehealth.
Click here to see the HHS Guidance page on HIPAA and Audio-only telehealth.
BCBSNC Documentation and Coding: Substance Use Disorders (4/19/23)
A quick reference guide to assist with accurate, complete documentation and coding that reflects the true nature of a patient’s current health status at the highest level of specificity.
BCBSNC Partnership with BetterDoctor (4/19/23)
BCBSNC has partnered with Quest Analytics BetterDoctor to coordinate 2023 CAA Directory Attestation.
BCBSNC Directory Facility Attestation Deadline extended to April 28 (4/19/23)
Federal Trade Commission (FTC): BetterHelp broke its privacy promises (4/19/23)
APA: What psychologists need to know about online therapy services (4/19/23)
APA (4/12/23)
New Psychology Licensing Exam Expands - Click here to read more
The National Psychologist (4/12/23)
Click here to read the article about subpoenas and requests for advocacy letters, written by The Trust's risk management consultants.
BCBSNC (4/5/23)
Documentation and Coding for Bipolar, Delusional, and Personality Disorders
UHC (4/5/23)
Click here for April Network News.
Cigna (3/29/23)
Interim Billing Guidance for Providers
Click here to see Provider FAQs: Virtual Care Services for billing information.
UHC (3/29/23)
NC Medicaid: HealthChoice/CHIP Alert - Click here to read the details.
Humana Military/Tricare (3/29/23)
Click here to view updates to telemedicine POS and modifier.
Help Us Advocate: Complete the SHP Survey (3/29/23)
In January 2025, Aetna will begin to serve as the Third Party Administrator (TPA) for the self-funded State Health Plan (SHP). At this time, the NCPA Advocacy and Practice Committee does not know whether the SHP will use an Aetna network, or will maintain a separate network (currently the Clear Pricing Project, or CPP) to serve the clinical needs of their employees. The committee plans to use the results of this survey to 1) inform Aetna and the State Health Plan Board about how behavioral health providers are thinking about their participation in the networks and 2) advocate for providers and their patients.
Please complete the State Health Plan (SHP) survey, which should take approximately 3 minutes to complete.
The survey will close Thursday, March 30, 2023
APA - Bipartisan Legislation Introduced to Increase Medicare Patients' Access to Psychologists (3/22/23)
U.S. Senators Sherrod Brown (D-OH), Susan Collins (R-ME), Markwayne Mullin (R-OK), and Martin Heinrich (D-NM) have introduced the Increasing Mental Health Options Act to make it easier for Medicare patients to receive treatment from a psychologist.
Click here to read the full article.
NC DHHS - "Investing in Behavioral Health and Resilience" plan (3/22/23)
On March 8, Governor Roy Cooper released a comprehensive plan to invest $1 billion in addressing North Carolina’s mental health and substance use crisis.
Click here to see the press release.
NC Psychology Board Bulletin Spring 2023 (3/22/23)
Click here to read.
BCBSNC Upcoming Provider Webinars for new BCBSNC Behavioral Health Referral Services (3/22/23)
Click here to view.
CMS - Fact Sheet for Transition after PHE (3/15/23)
Waivers, Flexibilities and the Transition Forward from the Covid-19 PHE (updated February 27)
APA - Online Therapy Services (3/15/23)
What Psychologists Need to Know about Online Therapy Services (March 1)
APA - Expanding Access to Care (3/15/23)
Expanding Access to Mental and Behavioral Health Services in Medicare (March 10)
APA (3/8/23)
APA adopts policy in reaction to SCOTUS decision overturning Roe v. Wade.
Click here to read the policy.
BCBSNC (3/8/23)
Directory Attestation Deadline March 29, 2023 for Inclusion in Blue Cross NC's Online Provider Directory
Click here to read.
BCBSNC (3/8/23)
Update to New Provider Enrollment Delays.
Click here to read the details.
NC Health Information Exchange (HIE) (3/1/23)
Click here to read the February 2023 update.
CMS (3/1/23)
CMS Releases New Information to Help Health Care Providers Prepare for the End of the COVID-19 Public Health Emergency on May 11
February 23: To help health care providers prepare for the end of the COVID-19 public health emergency (PHE) on May 11, 2023, CMS published updates about how the Medicare, Medicaid, Children's Health Insurance Program (CHIP), and Marketplace programs will be affected at the conclusion of the PHE. CMS is taking these steps to keep health care providers informed as standards for compliance with CMS requirements are restored and other provider waivers will conclude as described in the updates. CMS’s approach aligns with the Biden-Harris Administration’s priority for an orderly, predictable transition leading into the close of the COVID-19 PHE.
Click here to read the update.
Public Health Emergency (PHE) (2/22/23)
On January 30, the Executive Office of the President issued a Statement of Administration Policy regarding the plan to end the Public Health Emergency (PHE) on May 11.
Click here to read the statement.
HHS (2/22/23)
On February 9, HHS released the following Covid-19 Public Health Emergency Transition Roadmap:
Medicaid Reverification (2/22/23)
The Centers for Medicare and Medicaid Services (CMS) requires that all Medicaid providers are recredentialed, a process also referred to as reverification. Since March 2020, CMS has allowed for the suspension of reverification due to the Public Health Emergency (PHE) brought on by COVID-19.
According to the Statement of Administration Policy published Jan 30, 2023,the federal PHE is expected to end on May 11, 2023. With the end of the federal PHE, reverification notices will resume to providers with approaching reverification due dates, as well as those whose reverification was suspended during the PHE.
Once the federal PHE ends on May 11, 2023, reverification is not optional. Providers who receive a notice of reverification are encouraged to promptly respond. Providers who do not complete the process within the designated timeframe will receive a Notice of Suspension via postal mail and in their NCTracks Message Center Inbox.
For more information, please see the Medicaid bulletin article regarding reverification here:
APA - 2023 Physician Fee Schedule Final Rule (Updated 2/15/23)
"The 2023 Physician Fee Schedule final rule, released by the Centers for Medicare and Medicaid Services, includes an expansion of telehealth services, new billing codes, and changes to “incident to” billing supervision requirements." Click here to read the full article.
UHC - Audio Only Telehealth (Updated 2/15/23)
From the February 2023 Reimbursement Policy Update Bulletin:
"Effective with dates of service on or after May 2, 2023, UHC will align with the American Medical Association 2023 CPT Professional Edition's Appendix T to define services appropriate to report as real-time, interactive audio-only telehealth...when appended with modifier 93."
Click here to read more.
Click here to view the American Medical Association's Appendix T (synchronous real-time interactive audio-only services).
APA - Care Dash Closure (Updated 2/8/23)
APA Services instrumental in closure of psychology "ghost network".
Click here to view the article.
APA - Call for Comments (Updated 2/8/23)
APA boards and committees, divisions, affiliated psychological associations, and other stakeholders are invited to review and provide comments on the 2023 Revision of Guidelines for Psychological Practice with Older Adults. Click here to see the full announcement and make comments.
CMS Medicare Temporary and Permanent Changes to Telehealth Policy (Updated 2/8/23)
The Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities authorized during the Covid 19 Public Health Emergency through December 31, 2024. For example, 1) patients can receive telehealth services in their home, and 2) an in-person visit within six months of an initial behavioral/mental telehealth service, and annually thereafter, is not required.
The Act also includes permanent Medicare changes, including the provision of behavioral health services using audio-only communication. Click here to read more.
BCBSNC (Updated 2/8/23)
BCBSNC will insource behavioral health referrals beginning April 1, 2023. Quartet has been notified of this change, and the transition process is underway. Click here to read more.
NC HIEA (Updated 2/8/23)
Click here to read the January 2023 newsletter.
APA (Updated 2/1/23)
"Beginning January 1, 2023, psychologists will be able to provide and report Caregiver Behavior Management Training (CBMT), a new group-based service administered to parent(s)/caregiver(s) of patients that have been diagnosed with a physical or mental health condition. CMBT codes allow psychologists and other providers to bill for services that involve training a patient’s parent(s) and/or caregiver(s) in interventions and strategies to help manage or treat the patient’s condition.
In the 2023 Medicare Physician Fee Schedule Final Rule, the Centers for Medicare and Medicaid Services (CMS) said that for Calendar Year 2023, they will not reimburse for CBMT services. APA strongly believes that CBMT is a distinct and reimbursable service, and we will continue to work towards making this a reimbursable service in Medicare...APA recommends that, in order to reduce the risk of your claim(s) being denied for reporting noncovered/noncontracted codes, you should check each commercial payer policy, as well as the list of codes included in your contract with each payer, to determine which codes are covered/reimbursed." Click here to read the full article.
BCBSNC MAQIP Policy Update (Updated 2/1/23)
BCBSNC has released the updated Medicare Advantage Quality Incentive Program (MA QIP) Policy for 2023: Click here.
BCBS Telehealth Claims (Updated 2/1/23)
Modifiers for telehealth claims can be found on page 14 of the BCBSNC Telehealth Commercial Reimbursement Policy (last updated 9/2022): Click here to view.
APA (Updated 1/25/23)
"Beginning January 1, 2023, psychologists will be able to provide and report Caregiver Behavior Management Training (CBMT), a new group-based service administered to parent(s)/caregiver(s) of patients that have been diagnosed with a physical or mental health condition. CMBT codes allow psychologists and other providers to bill for services that involve training a patient’s parent(s) and/or caregiver(s) in interventions and strategies to help manage or treat the patient’s condition.
In the 2023 Medicare Physician Fee Schedule Final Rule, the Centers for Medicare and Medicaid Services (CMS) said that for Calendar Year 2023, they will not reimburse for CBMT services. APA strongly believes that CBMT is a distinct and reimbursable service, and we will continue to work towards making this a reimbursable service in Medicare...APA recommends that, in order to reduce the risk of your claim(s) being denied for reporting noncovered/noncontracted codes, you should check each commercial payer policy, as well as the list of codes included in your contract with each payer, to determine which codes are covered/reimbursed." Click here to read the full article.
BCBSNC (Updated 1/25/23)
BCBSNC has released the updated Medicare Advantage Quality Incentive Program (MA QIP) Policy for 2023: Click here.
PHE (Updated 1/18/23)
The Covid-19 Public Health Emergency was renewed for another 90 days effective January 11.
Click here to read the renewal.
BCBSNC (Updated 1/18/23)
"In the coming weeks, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will begin collecting our members’ medical records for the annual Healthcare Effectiveness Data and Information Set (HEDIS®1) reporting requirements. HEDIS is required by The Centers for Medicare & Medicaid Services (CMS) for all Medicare Advantage organizations. It is used for the National Committee for Quality Assurance (NCQA) accreditation and quality initiatives."
Click here to read the full announcement.
UHC (Updated 1/18/23)
Reconsideration and appeals submission going digital - click here to read the full announcement.
APA Division 42 Community Conversation: Coding and Billing Changes for 2023 (Updated 1/18/23)
Please join Division 42, the APA Division devoted to issues that are important to Psychologists in Independent Practice, for a community conversation via zoom with Dr. Stephen Gillaspy, Senior Director of Health and Health Care Financing in the APA Practice Directorate. Dr. Gillaspy will provide a deep dive into recent coding and billing changes. Dr. Gillaspy’s team in the Practice Directorate and the Advocacy office has worked tirelessly to advocate with the Centers for Medicare and Medicaid Services (CMS) for practicing psychologists to establish new billing codes. These codes can be used by psychologists to bill for and get reimbursement for services that previously were not funded. Attend this community conversation to learn more about billing and coding changes that went into effect as of January 1, 2023.
Coding and Billing Changes for 2023
Stephen Gillaspy, PhD
Senior Director, Health & Healthcare Financing
APA Practice Directorate
Tuesday, January 24, 2023
6:00pm Eastern Time
(No Registration Required - Zoom Link Below)
Division 42 is inviting you to a scheduled Zoom meeting.
Topic: Coding and Billing Changes for 2023
Time: Jan 24, 2023 06:00 PM Eastern Time (US and Canada)
Join Zoom Meeting
https://us02web.zoom.us/j/86726138902?pwd=NkxUdXhSdXZuM3RZZS9Uc3JDUU5iUT09
Meeting ID: 867 2613 8902
Passcode: 301837
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NC Psychology Board (Updated 1/11/23)
Winter 2022 Bulletin - Click here to read the NC Psychology Board's Winter Bulletin
NC HIEA (Updated 1/11/23)
Comment Period for Proposed Ruling Changes to SUD Patient Records
The following is taken from the HIEA December 2022 Update which you can view here.
Comment Period Open for Proposed Ruling Regarding Changes to SUD Patient Records – Providers Encouraged to Respond
The U.S. Health and Human Services Department (HHS), the Office of Civil Rights (OCR), and the Substance Abuse and Mental Health Services Administration (SAMHSA) have proposed a rule change affecting the sharing of patient records for those receiving substance use treatment.
Patients receiving treatment for substance use disorder (SUD) often struggle with fears of discrimination or incarceration, preventing them from seeking treatment. Sharing of records for patients receiving substance use treatment in a federally funded program is prohibited under the Confidentiality of Substance Use Disorder Patient Records under 42 CFR part 2, known simply as “Part 2.”
While the regulations currently allow substance use disorder patients to designate an HIE as recipients of their Part 2 data, the NC HIEA's current policy is to prohibit this submission to NC HealthConnex. This is due to the inability to track and manage patient consent or to prohibit further disclosure to unauthorized recipients. Please see our Behavioral Health Sensitive Data Policy for more information.
The difficulty in sharing these records means that other health care providers may not have access to the information they need to effectively coordinate care for these patients. A primary care provider, for instance, could be completely unaware of the behavioral health care provider’s treatment plan.
The proposed ruling would allow behavioral health providers to share information more easily than they have in the past, improving whole-person care and coordination for patients undergoing treatment for SUD. The proposed rule would also increase protections regarding the unauthorized disclosure of patient records, helping patients feel secure in how their information is being used and shared.
The HHS is encouraging health care providers and other health care professionals to submit comments on the proposed changes during the 60-day comment period, which ends on January 31, 2023. Interested parties can read the Notice of Proposed Rule-Making (NPRM) document on Regulations.gov or the Federal Register website and submit comments. The HHS has also provided a fact sheet highlighting the proposed changes.
The NC HIEA will be reviewing the proposed rules to understand how the changes could impact substance use data sharing in North Carolina.
Center for Connected Health Policy (CCHP) (1/4/23)
"The Center for Connected Health Policy is a nonprofit, nonpartisan organization working to maximize telehealth’s ability to improve health outcomes, care delivery, and cost effectiveness. Our expertise in telehealth policy was recognized in 2012, when we became the federally designated National Telehealth Policy Resource Center." Learn more at their website, and look up state policies here: https://www.cchpca.org/
Mid-Atlantic Telehealth Resource Center (MATRC) (1/24/23)
"The Mid-Atlantic Telehealth Resource Center (MATRC) was established as a regional Telehealth Resource Center (RTRC) in September 2011 with the mission of advancing the adoption and utilization of telehealth and telehealth best practices within the MATRC region as a way to facilitate access to quality health care in rural and underserved communities and populations; and to work collaboratively with the other federally funded TRCs to accomplish the same nationally." Learn more here: https://www.matrc.org/
Medicare Physician Fee Schedule Lookup Tool (1/24/23)
Use this site to look up fees for specific CPT codes:
https://www.palmettogba.com/palmetto/fees_front.nsf/fee_main?OpenForm
