“Thank you all for coming to learn how to use CPT coding to maximize your reimbursements. Oh, before I forget to mention this later, I just wanted to note this will minimize you not getting reimbursed at all, because that is what insurers want to really try to get away with. So, sit back and try not to either laugh too hard or fall asleep…”
Dr Steven Roy Daviss wrote the following article for the Clinical Psychiatry News magazine we as psychiatrists get monthly, why the title of the article in the mag is different than the internet version I don’t understand, but,
Ok, at the risk of annoying Dr Daviss and his colleagues over at Shrink Rap (http://psychiatrist-blog.blogspot.com/), I just had to write about this here. What I don’t get in this CPT process is simply this: did the authors of this coding change really think this would improve billing issues by making separate codes for psychiatric med checks versus psychotherapy visits, if not both simultaneously? Oh, and why was it insurers were allegedly not aware of the CPT coding changes until well after the New Year? And to me, the biggest question is this: why did the APA, who colluded with this matter initiated by the AMA CPT behemoth, take it upon themselves to run seminars, that they billed participants to attend while alleging to be helping said providers, and make it appear this would be relatively easy to navigate??
Dr Daviss wrote a couple of things I want to echo:
“However, there are still many insurance companies that have either ignored the law, or, more malignantly, have taken advantage of the situation by paying patients and physicians even less money for needed mental health and addiction treatment than they did before Jan. 1. Many psychiatrists, state psychiatric societies, and the APA are fighting with the payers to correct this improper, even illegal, corporate behavior.
Psychiatrists across the country have been confused and angered by this behavior, some even blaming the APA for supporting the changes. However, most are now realizing that it is the insurance companies that are playing games. Well, the games are over, the gloves are off, and the complaints and lawsuits are beginning to fly.”
“We need to get lawsuits against this illegal behavior blossoming in every state. The best thing we can do is to complain to the payers, our state psychiatric societies, our state insurance administrations, and our elected officials. Add your voice to the strength of the APA by sending it your evidence of improper or illegal insurance discrimination. See the box for more information.”
The statements themselves are not what I have issue with, because when people do illegal or immoral things, they need to be held accountable for it. But that is exactly my point with the APA and AMA: why the hell did they even do this in the first place, basically put it into place with little notification (and I do not agree, telling psychiatrists about it after October of 2012 and not letting the matter be debated prior is just, well, irresponsible at least) and giving the illusion that insurers would be aware and cooperative with the changes?!
Yeah, you don’t have APA reps addressing that issue, at least anything I have read to now, and if Dr Daviss will come here and educate me to sources to show me wrong, please go ahead.
Look, I don’t have a problem with suing insurance companies for what amounts to a violation of the contract for services we (stupidly) agree to sign, but how long will this take to be resolved and back payments collected if such suit(s) won? United and Anthem Blue Cross are big insurers, they have deep pockets, and they will not allow suits to get public attention until proven otherwise.
And what if these suits lose? What precedence does that set for others who have agreed to this to now? Wow, Pandora’s Box is now getting cracked open, and I do not think people are going to like what is inside!
Another road paved with psychiatric blood, er, good intentions. How’s that ride to hell, colleagues?! You know, when they tell you it is a two way street, as the Frasier character in “Cheers” appropriately replied, “yeah, and you get run over both ways!”