Medical Billing Forum

General Category => General Questions => Topic started by: Tifsmom1 on April 24, 2014, 06:52:07 AM

Title: Mental Health/Medicare
Post by: Tifsmom1 on April 24, 2014, 06:52:07 AM
Is it required that a Medicare client see the MD for there first appointment? Am I reading the guideline correctly the they must see the MD first and the MD must write the treatment plan and be a on going part of the treatment? Is it ok for the clinician to write the treatment plan and have the doctor sign off on it? Thank you so much for your help in figuring these things out. I am new to my position and have been reading and trying to understand much of this however when I find something and ask questions to the staff who have been doing this for years their reply is always we have been doing it this way for years. I was put into a position when I can make changes and I want to be sure that I am making the right changes. If you have information and any documentation to provide it would be much appreciated as I will have to prove all my findings before they will change anything.
Title: Re: Mental Health/Medicare
Post by: PMRNC on April 24, 2014, 08:19:41 AM
No, if that were the case in many places people would certainly be waiting forever for an appt. Medicare patients can go to a therapist, psychologist, etc. for their initial eval. If there are going to be medications, usually the non physician provider/therapist will refer the patient to a psychiatrist for the med management.
Title: Re: Mental Health/Medicare
Post by: shanbull on April 24, 2014, 10:15:49 AM
The other concept to make sure you fully understand is "incident to" services, whereby if certain conditions are met, a provider may bill for services under the name and ID of a doctor. The reimbursement in this case is higher, so some clinics are set up so that patients do see a doctor initially in order for the supervision requirements of incident to services to be met (psychologists are reimbursed 85% of the rate for doctors, so billing under the doctor increases reimbursement by 25%). Because higher reimbursement for mental health services in general has finally been approved by Medicare, this setup will probably become less common. But it is an option if you have a PhD on staff who is willing to be the supervisor. Our clinic does do this, we are fortunate to have so many mental health providers that patients can be seen right away.

Here are some good articles about the incident to services provision: ( (
Title: Re: Mental Health/Medicare
Post by: PMRNC on April 24, 2014, 01:34:53 PM
You also should know MOST carriers will not reimburse for more than one visit per day so if you see a clinic where there is both MD and non MD (therapist, LCSW, psychologist, etc) the carriers will only authorize ONE visit. A lot of patients don't understand that and will opt to see the therapist and then down the hall, across town or whatever go have a med management visit. Carrier will only pay for one per day.