Author Topic: Medicare Part B Mental Health reimbursement  (Read 1098 times)

evans1035

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Medicare Part B Mental Health reimbursement
« on: October 11, 2010, 11:28:32 PM »
Ok, I saw this from a post back in 2/10, but I still can't reconcile what Medicare Trailblazer automated system says is approved amount with what was paid, or what fee schedule shows.
  90806 non-facility - fee schedule shows 93.69
                              automated system says 64.41 approved, $51.53 pd
    Questions:
      1)Pt. should owe difference between $51.53 and $93.69, correct?
      2) Why does automated MC system say approved 64.41, then?
      3) Also have an LCSW - ok, if MC allows 70.27 on 90806 (75% of the 93.69) and then pd 38.65, am I correct to show pt responsible for $31.62?
        Thanks.
Also thanks to the post from 2/10 that mentioned that Mental Health is reimbursed at 55%. I've been going around in circles trying to figure out where the amounts pd were coming from. All this time I was thinking it was 50% of the allowed, and didn't realize that it was being reimbursed at 55% now.
   

PMRNC

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Re: Medicare Part B Mental Health reimbursement
« Reply #1 on: October 12, 2010, 06:16:14 AM »
It's a part of mental health parity, by 2014 Medicare will reimburse for mental health as all other illnesses. for 2010 and 2011 it is 55%.  They reimburse based on the "fee schedule"/ Allowable

Reimbursement for certain psychiatric services differs from the usual Medicare reimbursement rules. Medicare Part B generally reimburses doctors at 80% of the approved amount; the patient pays the remaining 20% coinsurance amount. Before 2010, When a claim was for mental health services, Medicare made an initial deduction of 37% before paying 80% of the charge. As a result, the Part B reimbursement was on average, about 50% of the charge. The coinsurance for mental health claims was therefore 50 percent, which was more than for other Part B-covered services (usually 20%).

Beginning in 2010, however, Medicare began to increase the percentage that it will cover for mental health services as follows: 55 percent of expenses incurred in 2010 or 2011; 60% in 2012; 65% in 2013; 80% (the amount reimbursed for other Part B claims) in 2014 or in any subsequent calendar year.  for more information, see http://www.medicareadvocacy.org/Print/2008/Reform_08_09.18.MIPPAKeyProvisions3.htm
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