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Medicare

Medicare Contracting Reform (or section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) was implemented in 2011.  In this reform, it was determined that 23 Medicare Administrative Contractors (MACs) will administer Medicare regionally.   National Coverage Determinations (NCDs) “describe the circumstances for which Medicare will cover specific services, procedures, or technologies on a national basis.  MACs are required to follow NCDs.  If an NCD does not specifically exclude/limit an indication or circumstance, or if the item or service is not mentioned at all in an NCD or in a Medicare manual, it is up to the Medicare contractor to make the coverage decision.”   If there is no  national coverage policy, MACs create Local Coverage Determinations (LCDS), which explicate which items are, and are not covered under Medicare by that MAC.  This variability has made it difficult to identify which services are covered locally.

 

The Society of Clinical Geropsychology (12/II) and PLTC share a combined Public Policy Committee, as policy issues impact members of both organizations similarly.  This committee has developed a database of MACs and LCDs by state, complete with websites, contact information, and information related specifically to psychology codes.  Drs. Mary Lewis and Margie Norris worked tirelessly on this database to make it available for GeroCentral users.

Click here to download Find Your MACs and Psych LCDs

 

Fee reductions due to Sequestration:
If you read your Remittance Notices carefully, this will help you understand the fee reduction due to the sequestration:

 MM8378 – New Claim Adjustment Reason Code (CARC) to Identify a Reduction in Payment Due to Sequestration

 

Additional Resources

Karlin, B. E., & Humphreys, K. (2007). Improving Medicare coverage of psychological services for older Americans. American Psychologist, 62 , 637-649.

 

For more information, see the Billing page of the Clinical Toolbox.

For recommendations about Medicare documentation, see the Documentation page of the Clinical Toolbox.