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Members of the Southern California Psychiatric Society are being audited by Medicare for overbilling.
Members of the Southern California Psychiatric Society (SCPS) are facing numerous barriers in obtaining Medicare reimbursement for psychotherapy.
So said William Arroyo, M.D., SCPS president-elect, at the Board of Trustees meeting in Washington, D.C., in September.
The Health Care Financing Administration (HCFA) has conveyed through a local Medicare insurance carrier, Transamerica Occidental, that psychiatrists in the Los Angeles area are responsible for a large increase in billing for psychotherapy recently.
Transamerica claims psychiatrists are overbilling for psychotherapy visits in comparison with psychiatrists in other areas of the country, said Arroyo. "Moreover, Transamerica has not been willing to support their claims with data."
Arroyo referred to Samuel Miles, M.D., SCPS treasurer and a member of its Medicare Task Force, who told Psychiatric News, "Transamerica is conducting a special audit of psychiatrists and requiring progress notes for each session beyond the 20 covered visits to determine if the service is medically necessary."
Miles added that Transamerica is reimbursing for the standard 20 psychotherapy visits for each episode of a Medicare patient’s illness rather than for each provider seen. As a result, "some psychiatrists have been denied Medicare payment after just the second visit without being asked for additional information," said Miles.
Because the appeals process is so time consuming, some psychiatrists do not believe it is worth the effort and are forgoing reimbursement, observed Miles.
SCPS officers met with Transamerica representatives in May to discuss the problems and asked for documentation to support HCFA’s claim.
The figures provided by Transamerica at the meeting revealed that psychologists and social workers were also responsible for increased billing.
SCPS officers have not been able to obtain a copy of the Transamerica document despite repeated requests, said Miles.