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Medicare and Medicaid...

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KathyG:
Could anyone tell me how to find the "reasonable & customary" fee-for-service rates for LCSW's, psychologists, and psychiatrists under Medicare and Medicaid?  All I could find on the CMS website was that HORRIBLE formula!!!  it's way too complicated for my brain ???

Thanks!

Kathy G. 

Michele:
Are you trying to develop a fee schedule for them or are you looking to see what Medicare actually allows?  If you go to the Medicare website for the area (not CMS) they have their fee schedules posted.  For example, for NYS you would go to www.ngsmedicare.com, click on the appropriate region, and then click on fee schedule.  If I'm helping develop a fee schedule I take the Medicare allowed amount and go between 130 - 150%.

Hope that helps!

KathyG:
I LOVE this forum!   :-*

Michele, could you expand a little more on this for me?  I know nothing about Medicare/Medicaid.  I am actually trying to help a physician set his fees, as I think they're too low compared to what I've seen, and I believe practitioner fees are calculated according to the M/M allowable rates.  I think Highmark handles M/M for NJ...so I went to their site and found an area where you can put in the procedure code and it comes up with a rate for you, broken down by "Par - $164.03," "Non-Par $155.83," and "Limiting Charge - $179.20" for a 90801 code.   (Actually, I didn't realize you could bill M/M if you're non-participating.)  To make a long story short, could you help me determine how one sets a fee off of one of these numbers? I have lots to learn in the area of M/M.  Am I correct that out-patient mental health would fall under Part B?  Please keep in mind that math isn't one of my strong points, so please spell out your response so a 5-year-old could understand it? :-[  LOL!

Thanks so much...

Kathy G.

rdmoore2003:
mental health if set as office it would be medicare part b

KathyG:
Thank you, Regina :)

Kathy G/

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