Medicare News

Discriminatory Copay Begins Phase Out

Starting on January 1, 2010, Medicare will begin reimbursing providers for outpatient psychiatric services at 55 percent, while the patient copay will drop to 45 percent from the current 50 percent copay. Mandated by the Medicare Improvements for Patients and Providers Act of 2008, the new rates are the first step in the gradual elimination of the discriminatory copayment rate for outpatient mental health treatment. In 2012 the reimbursement rate to providers will increase to 60 percent, in 2013 it will be 65 percent, and in 2014 it will be 80 percent—the same as for all other medical services.

Reminder About Retroactive Billing

Please note that you don't have less time to do retroactive billing for Medicare than in the past. Here's the new rule: If the service occurs in the first nine months of the year, you have until December 31 of the following year to file your claim. Thus, if you see a patient on or before September 30, 2009, you must file the claim for that service before December 31, 2010, or the claim will be denied automatically. If the service occurs in the last three months of the year, you have until December 31 of the second year after the service occurs to file the claim. Thus, claims for services provided from October through December 2009 must be filed by December 31, 2011.

NPI Reminder From CMS

When writing prescriptions, be sure to use your provider NPI rather than your practice number.