Neuropsychology Central

[drejb]

Given that the below situation may get worse if the legislators dont forestall a 20% plus cut scheduled for Jan 1, I'd suggest people re-read Dr. Woody's article.

Is the training, equipment and legal demands of neuropsychological assessment per hour worth only $7.00 more than psychotherapy?


Never mind the theory that we will get a 5% restoration of some old cuts or May avoid a 20% acrosss the board cut in Medicare – the following from APA is truly scary. Aside from a greater than 7% cut in therapy we have 17% or more cuts in neuropsych testing. This nonsense will also appy to BCBS rates as in Florida, the BCBS rates mirror the Medicare allowables.

I really dont have any other words right now,

Ernest J. Bordini, Ph.D.
www.cpancf.com
Gainesville, FL


Date: October 30, 2009

To: SPTA and Division Federal Advocacy Coordinators
APAGS Coordinators

From: Marilyn Richmond, J.D., Assistant Executive Director for Government Relations
American Psychological Association Practice Organization

Cc: Katherine Nordal, Ph.D., Executive Director for Professional Practice
SPTA Executive Directors
SPTA Directors of Professional Affairs
CAPP

Re: Medicare Payment Changes for Psychological Services in 2010



The Centers for Medicare and Medicaid Services (CMS) have announced changes in 2010 to Medicare’s payments for the practice expense portion of numerous services including those commonly billed by psychologists. Although the exact amount varies for each service, we expect Medicare payments for psychological services to be reduced on average by 7% based on the practice expense changes.

We recognize that this reduction is a considerable loss for psychologists. We are providing information below to help members understand why CMS is making this change in how it will pay for Medicare services next year. Psychologists should also know that they are not the only Medicare providers facing these changes; many other specialties including cardiology, nuclear medicine, oncology, radiology, social work, and urology will also see significant reductions in practice expense in 2010.

What the practice expense values represent

The practice expense values are one part of the Medicare reimbursement formula and represent the costs attributed to providing a service. The practice expenses values have two components: direct and indirect. Direct expenses are those associated with a specific service; for example, booklets or plates that are used during testing. Indirect expenses are incurred regardless of the service being provided such as administrative staff salaries, utilities, computers, and rent. Indirect expenses are based on data that considers the typical costs per year and the numbers of hours per year that a practice operates.

Why the practice expense values are changing in 2010

In 2005 CMS revised its methodology for calculating practice expense values, an action that stemmed in part from requirements under the Balanced Budget Refinement Act of 1999 and was designed to make practice expense values more specific to the service provided. The impacts from that change have been phased-in over the past three years with the transition scheduled to conclude with the 2010 fee schedule. Under the new methodology, practice expense payments for psychological services were reduced by about 2% each year from 2006 through 2009.

Amid concerns that CMS was using outdated information a multi-specialty survey was launched in 2007 - 2008 to obtain current data about the indirect costs of providing services. The survey was a joint effort among the American Medical Association, APA, and fifty other physician and non-physician organizations. None of the organizations had a role in the survey’s design or administration. Independent research firms collected and analyzed the survey data which was then sent to CMS for use in the calculation of practice expense values.

Prior to the multi-specialty survey, there was no baseline indirect practice expense data for a number of specialties including psychology. Since 1998 psychologists’ overhead expenses per-hour had been cross-walked to those reported by psychiatrists. The recent survey provides more specific indirect cost data for each specialty, including psychology. CMS will now make payment determinations based on the survey data that more accurately reflects the indirect costs associated with practice expense. For psychology, the survey data indicates that indirect practice expenses are lower than what had been previously assumed under the cross-walk to psychiatry.

APAPO utilized the services of its actuary to review the practice expense data obtained in the survey. After confirming the validity of the data our actuary noted some possibilities why the survey results indicated that psychologists had low indirect practice expenses. Psychologists tend to have small practices with few administrative and clinical staff. Also, in response to the economic downturn over the past few years psychologists have likely improved their productivity and/or reduced spending for items such as technology (e.g., computers, software) and office supplies.

How the practice expense changes differ among services

Not all psychological services will see the same rate of change in their practice expense values because of the way the values are calculated. The practice expense value for a code is based on multiple factors used to calculate both the direct and indirect costs of the service. Factors included in the formula used by CMS are:

Direct Costs
• Supplies, equipment, clinical staff time/cost;
• The utilization rate for each service plus the sites-of-service (in-office or in a facility);
• The current pool of practice expense values allocated to direct costs for all services in the fee schedule;
• The conversion factor; and
• A budget neutrality factor.

Indirect Costs
• Survey data of rent, utilities, administrative staff and numbers of hours per year that the practice is open;
• The current pool of practice expense values allocated to indirect costs for all services in the fee schedule;
• The conversion factor; and
• A budget neutrality adjustment.

The direct and indirect costs are calculated separately and then blended into the final practice expense value. In most cases, the practice expense values account for approximately 30% of the total payment for psychological services. Neuropsychological testing, however, is unique because of the supplies and equipment that are used to provide these assessments. Due to the costs for supplies and equipment the practice expense values for neuropsychological testing services account for a larger percentage of the total fee than they do for psychotherapy or psychological testing. As a result, reductions in the practice expense values for neuropsychological testing, including changes in indirect costs such as rent, utilities, and administrative staff, have a greater impact on the final payment than do practice expense reductions for other psychological services.

Service for psychological and neuropsychological testing by a computer will have their practice expense values raised. These changes are due in part to the new data about the direct practice expense costs for these services that APA provided to CMS in late 2007.

The chart below projects payment changes for the most commonly billed psychological services.

Projected 2010 fees* for the most commonly billed services

CPT Code Descriptor 2009 Average Fee 2010 Average Fee % Change 2010 v. 2009
90801 Psych. diag. intvw. $152.92 $151.48 - 0.94
90806** 45-50 min. outpt. psychtx $ 89.08 $ 82.59 - 7.28
90818 45-50 mins. inpt. psychtx $ 85.84 $ 80.07 - 6.72
96101 Psych testing by psych $ 84.40 $ 77.90 - 7.69
96102 Psych testing by tech $ 51.21 $ 54.82 7.04
96103 Psych testing by comp/ $ 46.17 $ 59.51 28.89
96118 Neuropsych testing by psych $108.20 $ 89.81 -17.00
96119 Neuropsych testing by tech $ 74.30 $ 63.48 -14.56
96120 Neuropsych testing by comp. $ 68.52 $ 84.40 23.16
96150 Health/Beh. assmt. $ 22.72 $ 20.56 - 9.52
96152 Health/Beh. interv. $ 20.92 $19.12 - 8.62
* 2010 fees are based on the 2009 conversion factor and do not reflect the projected SGR cut.
** The 5% restoration for psychotherapy services is not included in these calculations.

As mentioned above, other specialties will also see significant reductions in practice expense. Cardiology and radiology, for example, will each have their practice expense values cut by 10% while radiation oncology will lose 17% and nuclear medicine 12%.

Additional information

There are still other activities that may yet impact payment next year. APAPO is actively lobbying Congress to extend the restoration providing an extra 5% for psychotherapy services for an additional two years to 2012. Final payment amounts for 2010 will not be known until Congress decides if and how to address the SGR cut currently projected by CMS to reduce all payments by 21.5%. In addition, parity in Medicare will be phased-in starting in 2010 when Medicare’s payment rises to 55% and the beneficiary’s portion drops to 45%. Full parity, with 80% paid directly by Medicare, will take effect in 2014.

Psychologists with any questions about Medicare reimbursement may contact the Government Relations Office by telephone at 202-336-5889 or by email at pracgov@apa.org. CMS lists its complete payment formula and issues affecting the practice expense methodology in the July 13, 2009 Federal Register, Vol. 74, No. 132, on pages 33526-33552.
_________________
Ernest J. Bordini, Ph.D.
Editor/Administrator
http://www.NeuropsychologyCentral.COM

Executive Director
Clinical Psychology Associates of North Central Florida
http://www.cpancf.com
2121 NW 40th Terr. Suite B
Gainesville, FL 32605
(352) 336-2888

[drejb]

Date: November 2, 2009



To: SPTA and Division Federal Advocacy Coordinators

APAGS Coordinators



From: Marilyn Richmond, J.D., Assistant Executive Director for Government Relations

American Psychological Association Practice Organization


Cc: Katherine Nordal, Ph.D., Executive Director for Professional Practice

SPTA Executive Directors

SPTA Directors of Professional Affairs

CAPP



Re: Update on Impact of Medicare Payment Changes in 2010







As we reported last week, the Centers for Medicare and Medicaid Services (CMS) have announced changes in 2010 to Medicare’s payments for the practice expense portion of numerous services including those commonly billed by psychologists. As you may recall from our July 15 Information Alert, CMS’s proposed rule would have resulted in an expected reduction in Medicare payments for psychological services by an average of 7%. The final rule, published by CMS last Friday, would phase in the reduction over four years, resulting in a lesser immediate impact of an average of 2% for services in 2010.



The chart below projects payment changes for the most commonly billed psychological services.



Average 2010 fees* for the Most Commonly Billed Services



CPT Code
Descriptor
2009 Average Fee
2010 Average Fee
% Change 2010 v. 2009

90801
Psych. diag. intvw.
$152.92
$153.64
0.47%

90806**
45-50 min. outpt. psychtx
$ 89.08
$88.00
-1.21%

90818
45-50 mins. inpt. psychtx
$ 85.84
$86.56
0.84%

96101
Psych testing by psych
$ 84.40
$82.95
-1.71%

96102
Psych testing by tech
$ 51.21
$53.02
3.53%

96103
Psych testing by comp.
$ 46.17
$49.77
7.80%

96118
Neuropsych testing by psych
$108.20
$100.63
-7.00%

96119
Neuropsych testing by tech
$ 74.30
$67.81
-8.74%

96120
Neuropsych testing by comp.
$ 68.52
$72.85
6.33%

96150
Health/Beh. assmt.
$ 22.72
$22.36
-1.58%

96152
Health/Beh. interv.
$ 20.92
$20.56
-1.73%


* 2010 fees are based on the 2009 conversion factor and do not reflect the projected SGR cut.

** The 5% restoration for psychotherapy services is not included in these calculations.



For additional information on why CMS is making the change, please see the Information Alert from last Friday, October 30.



Psychologists with any questions about Medicare reimbursement may contact the Government Relations Office by telephone at 202-336-5889 or by email at pracgov@apa.org. CMS lists its complete payment formula and issues affecting the practice expense methodology in the July 13, 2009 Federal Register, Vol. 74, No. 132, on pages 33526-33552.
_________________
Ernest J. Bordini, Ph.D.
Editor/Administrator
http://www.NeuropsychologyCentral.COM

Executive Director
Clinical Psychology Associates of North Central Florida
http://www.cpancf.com
2121 NW 40th Terr. Suite B
Gainesville, FL 32605
(352) 336-2888

[bobbie]

Would you mind to updates your service fee.
_________________
hydraulic fracturing equipment