Are all services provided by individual psychologists/psychiatrists triggers for performance reviews?
A. Mental health services provided to long-term care facilities, including those provided to patients living in independent apartments attached to nursing homes appear to be under the most scrutiny. Q. Are all Medicare carriers conducting the same methods of scrutiny of individual mental health professionals= billing practices? A. From my informal survey of regional practices, it appears that different carriers can do different things. The government website on fraud and abuse in Medicare implies that each carrier has the responsibility to have a plan to combat questionable billing practices, but there appears to be room for creativity. Q. What can individual mental health providers do to ensure their ability to provide services to Medicare beneficiaries and get paid appropriately? A. Obviously clinicians must provide services following clinical necessity which admittedly are not always clear cut. I recommend the termination of formal therapy when you determine that treatment is no lon
