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Anthem Offers CPT 90837 Documentation Guidelines

Posted By Karen J. Hardin, Tuesday, November 7, 2017
Updated: Tuesday, November 7, 2017

Several OPA members who are also panel providers for Anthem Blue Cross Blue Shield have reached out to me regarding letters they have recently received. The letter is similar to communications received from other insurance companies in the past, addressing the providers use of CPT Code 90837. Psychologists who receive the letter are informed that their use of CPT Code 90837 (60-minute psychotherapy session) is “higher than the expected billing distribution as determined by the average billing behavior of other physicians within your specialty and peer group.” The letter goes on to state, “Our goal is to help providers ensure that the documentation and reporting guidelines are followed and that their documentation supports the level of care billed for each service.”

Letter recipients have reached out to me expressing concern and confusion regarding the purpose of the letter.  Most feel confused about the meaning of the above statements. In an effort to help, I reached out to Anthem and asked for more information. In their response, Anthem clarified: “our letter is strictly educational in nature and its purpose is to ensure that your documentation supports the codes that are being billed.” Their response continues by outlining the documentation they would expect to see to support the CPT 90837 service billed:

  • Date of service
  • Length of session (start/end time), therapy time with patient and/or family
  • Therapeutic maneuvers utilized
  • Diagnosis -for each visit- related to treatment and therapy for the visit 
  • Progress or lack of progress to the goals
  • Updates to treatment plan if necessary
  • Provide signature (Electronic or written)

Also to note, these services are NOT included in the “time” for the session:

  • Time spent arranging services/appointments
  • Time spent in communication with other healthcare providers
  • Time spent documenting or providing reports

The intent of the letter, then, is to remind recipients to follow documentation guidelines for CPT Code 90837. No information was given on whether record audits should be expected at some point in the future. However, it seems clear that following these guidelines should help Anthem providers pass audits with no issue. I would also like to note that these record keeping guidelines are very similar to current standard accepted practices for the insurance industry and to recommendations I have given in the past.  

I hope you find this helpful.  Please feel free to stay in touch should you have other issues or concerns.

Jim Broyles, PhD
OPA Director of Professional Affairs

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Adjustments of Previously Paid Claims

Posted By Jim Broyles, PhD, OPA Director of Professional Affairs, Thursday, October 12, 2017

I was recently contact by an OPA member who was encountering a difficult situation with an insurance company.  He received notice from the company in question stating a prior reimbursement they made was invalid, and they were therefore asking for the payment to be returned.  The initial payment had been made more than two years prior to the date the determination notice had been sent.  The psychologist contacted me about the legitimacy of this determination and request.  Like so many of us, he vaguely recalled there are limits to such “take back” requests, but he was unsure of the specifics.  (Apparently the insurance company making this determination was somewhat lacking in understanding, also). 

I reminded him of Ohio law on this topic, which I am copying below.  Insurance companies may look back and make a new determination about previously paid claims, but they are limited to a two-year period.  In other words, a request for return of paid claims is limited to the two-year period immediately preceding the notice requesting the return of funds.  The following is taken from the Ohio Department of Insurance website:

Adjustments of Previously Paid Claims

Claim payments that are made on or after July 24, 2002, are deemed final two years after the payment is made. After that date, the amount of the payment is not subject to adjustment, except in the case of fraud by the provider. 
 
A third-party payer may recover the amount of any part of a payment that the third-party payer determines to be an over-payment if the recovery process is initiated not later than two years after the payment was made to the provider. 
Upon determination of an over-payment a third-party payer shall send a notice to the provider that contains the following:

  1. The full name of the beneficiary who received the health care services for which over-payment was made;
  2. The date or dates the services were provided;
  3. The amount of the over-payment;
  4. The claim number or other pertinent numbers;
  5. A detailed explanation of basis for the third-party payer's determination of over-payment;
  6. The method in which payment was made, including, for tracking purposes, the date of payment and, if applicable, the check number;
  7. That the provider may appeal the third-party payer's determination of over-payment, if the provider responds to the notice within thirty (30) days;
  8. The method by which recovery of the over-payment would be made, if recovery proceeds under division (B) of this section.

Please note number seven above which allows for an appeal of the re-determination.  I urged the psychologist who reached out to me to appeal the adjustment determination, including a copy of the above information.

I hope you find this reminder helpful.  Please feel free to let me know whether you have encountered similar difficulties and about any problems you had responding to such requests.  

Jim Broyles, PhD
OPA Director of Professional Affairs

 

 

 

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Insurance Core Issues: Ohio's Prompt Payment Law

Posted By Jim Broyles, PhD, OPA Director of Professional Affairs, Wednesday, August 23, 2017

I have received a number of questions and requests in the past two months regarding difficult insurance issues encountered by OPA members.  The problems involved range from delayed reimbursement to challenges with prior authorizations. Since many of these difficulties stem from a few basic core issues, I thought it might be helpful, now and in the next few weeks, to remind everyone of a few important consumer and provider protection laws which give needed support for nearly every practicing psychologist who must interact with health insurance companies.  

The first of these is Ohio’s Prompt Payment Law, which establishes strict time frames for the processing and payment of claims by insurance companies.  Specifically, the law states:

  1. A third-party payer has fifteen (15) days from receipt to notify a provider when a materially deficient claim is received. Examples of materially deficient claims include claims with an incorrect patient name or benefit contracts number, a patient that cannot be identified, a claim without as or treatment code or a claim without a provider's identifying number. The fifteen (15) day time period and the time spent correcting the deficiencies do not count toward the calculation of time in which a claim must be processed.
  2. A third-party payer has thirty (30) days to process a claim if no supporting documentation is needed.
  3. A third-party payer has forty-five (45) days to process a claim if the third-party payer requests additional supporting documentation. However, third-party payers must request supporting documentation within thirty (30) days of the initial receipt of the claim. The time period of forty-five (45) days is suspended until the third-party payer receives the last piece of information requested in the initial thirty (30) day period.
    • The time period is not suspended if a third-party payer requests additional supporting documentation after receiving initially requested information.
    • A request for additional supporting documentation that is made outside the thirty (30) day time period and that is based on information received in the initial request regarding a previously unknown pre-existing condition may suspend the forty-five (45) day processing time.
  4. A third-party payer may refuse to process a claim submitted by a provider if the provider submits the claim later than forty-five (45) days after receiving notice from a different third-party payer or a state or federal program that that payer or program is not responsible for the cost of the health care services, or if the provider does not submit the notice of denial from the different third-party payer or program with the claim.
  5. A third-party payer that has a timely filing requirement must process an untimely claim if all the following apply:
    • The claim was initially submitted to a different third-party payer or state or federal program;
    • The provider submits the claim to the second payer within forty-five (45) days of receiving notice that the first payer denied the claim; and
    • The provider submits the notice of denial along with the claim
  6. When a claim is submitted later than one year after the last date of service for which reimbursement is sought, a third-party payer shall pay or deny the claim not later than ninety (90) days after receipt of the claim or, alternatively, pursuant to the requirements of sections 3901.381 to 3901.388 of the Revised Code.

Many reimbursement issues encountered by psychologists may be eligible for a complaint under this law.  For example, an insurance company may review a claim to determine whether it was medically necessary.  However, they may not withhold payment, beyond the time frames stipulated, while making this determination.  The timelines above still apply.  

If you need to file a Prompt Pay Law complaint or any other complaint with the Ohio Department of Insurance (ODI), the best way is to establish an ODI Provider Gateway Account.  Once established, filing complaints with ODI becomes streamlined.  Instructions for establishing this account with ODI may be found here:
https://legacy.insurance.ohio.gov/ODILogon/Legacy/content/Documents/PC/ProviderGatewayAccount.pdf

I encourage all psychologists who interact with insurance companies to establish this account with ODI.  Providers may also use a printed form:
http://www.insurance.ohio.gov/forms/documents/INS0505.pdf

It may be helpful to share this information with office managers.  They may contact me directly for questions and support, providing they work for an OPA member.  In the next few weeks, I will be providing information on more laws associated with these core issues of difficulty affecting many of us.  In many cases, the solution may involve interacting with ODI, so following the above suggestion will facilitate my recommendations in the future. (Please note: ODI does not govern Medicaid or Medicare plans.  Please contact me directly for help with these).

Please let me know if you have comments or questions.

Jim Broyles, PhD
OPA Director of Professional Affairs

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OPA Insurance Committee Survey: CPT Codes and Session Length

Posted By Jim Broyles, PhD, OPA Director of Professional Affairs, Wednesday, June 28, 2017

Many psychologists who work in private practice have become well familiar with the many difficulties which continually develop as they interact with insurance companies. Policy and procedures imposed by these entities constantly evolve, creating an ever-moving target so difficult for many psychologists to follow. The most recent difficulty encountered by most of our members involves our use of the psychotherapy CPT (Current Procedural Terminology) codes. For those who are less familiar, these are codes which describe, through their definition, the type of psychotherapy provided (individual, family, etc.)  Individual psychotherapy codes are further specified by session time (30, 45, or 60 minutes). Most psychologists who are experienced at psychotherapy emphasize that a variety of factors, including patient need, diagnosis being treated, and clinical judgement, are considered when choosing the most appropriate procedure.

Recently, a number of insurance companies have begun to restrict or limit the use of certain codes. For example, some require preauthorization for the 60-minute code, while others have sent warning letters to clinicians who “overuse” this longer session time. Together with OPA’s insurance committee, I have been monitoring this circumstance and have felt considerable concern about the reasoning behind the emergence of these newer policies. Specifically, many of the insurance companies have justified these restrictions by reasoning that most clinicians do not use longer session times routinely. This idea stands in direct contradiction to information gathered informally by OPA’s Insurance Committee and me. Through conversation and email, many of you have reported you consider the 60-minute psychotherapy session crucial to your treatment approach with clients. Others have stated they would use the 60-minute session much more often, but are unable to due to insurance company restrictions.

In response to these confusing and contradicting circumstances, OPA’s Insurance committee has developed their own survey. The purpose of the survey is to gather accurate, objective information about psychotherapy CPT codes commonly used by psychologists and others. The survey takes only a minute or two to complete, and the results will be used to help advocate for our members on this issue. It would be enormously beneficial to our efforts if you will take that minute to participate in our survey now:

https://www.surveymonkey.com/r/XKLMWQ9

It would also be quite helpful if you would pass along the link to the survey to other mental providers in your practice or community. I will be happy to report survey results as well as other efforts related to this issue as they develop. 

On a related note, many psychologists who are Medicaid providers have been experiencing confusion regarding the implementation of Medicaid Behavioral Health Redesign. The proposed redesign changes were initially scheduled to be implemented July 1 of this year. Due to a number of concerns expressed about readiness by community mental health providers, the implementation of the redesign has been postponed.  Ohio Department of Medicaid will continue the existing mental health and substance use disorder service codes, billing logic, rates and policies until a future date for Behavioral Health Redesign implementation is determined. However, qualified Ohio hospitals who offer outpatient community behavioral health services may begin implementing the new behavioral health code set and policies beginning August 1, 2017. Please let me know if you would like further details. The Ohio Department of Medicaid will also continue staffing its Rapid Response telephone lines (1-800-686-1516, Option 9) in order to respond to questions from providers.

Jim Broyles, PhD, OPA Director of Professional Affairs

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APAPO Survey on the valuation of CPT codes

Posted By Jim Broyles, PhD, OPA Director of Professional Affairs, Wednesday, May 24, 2017

You may be receiving a very important survey soon from the American Psychological Association Practice Organization. The surveys will be emailed to APAPO members, and will be gathering vital information regarding the valuation of Current Procedural Terminology (CPT) codes commonly used by psychologists, which directly affects reimbursement rates set by all insurance companies. The survey is developed by the American Medical Association /Specialty Society Relative Value Scale Update Committee (RUC). Click here to view an article from a recent APAPO Practice Update which explains the survey. It is very important for you, if you are a member of APAPO, to be on the lookout for the survey and to set aside the 2 hours it may take to complete it. If you have questions feel free to contact me.

On a related note, I received many positive comments about my last communication with OPA members regarding the letters from Change Healthcare. This group contacted psychologists regarding their billing practices and use of certain CPT codes. In that communication, I outlined concerns expressed by APAPO and OPA to Change, as well as gave specific recommendations on how to respond to their requests. During our recent OPA Convention and through email, many of you pointed out how helpful this information was. I feel compelled in response to point out to everyone that the guidance from that communication would have been impossible if not for the considerable efforts of APAPO’s office of Legal and Regulatory Affairs, specifically attorneys Alan Nessman and Connie Galietti. Both expended considerable time and effort communicating with the organizations in question, drawing on their considerable legal experience and expertise, to produce the guidance you received. This is only a small example of the ongoing advocacy and support Ohio psychologists receive from APAPO. Many psychologists today remain unaware of the vital support they receive from APAPO, and how our more local advocacy efforts are dependent on their help. I urge all Ohio psychologists to be mindful of this when making a decision on whether to become a member of this organization.

Tags:  apapo  cpt codes  survey 

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Can Psychologists Continue to Bill Medical Mutual 90837?

Posted By Jim Broyles, PhD, OPA Director of Professional Affairs, Sunday, April 23, 2017

In March of this year, many psychologists in Ohio received letters from Change Healthcare, acting on behalf of insurance company Medical Mutual concerning the frequency of their use of CPT® code 90837 (psychotherapy, 53+ minutes with patient and/or family member) billed to Medical Mutual. These letters were addressed to psychologists allegedly using 90837 at a high rate compared to other Medical Mutual psychologists. Change Healthcare defines “high rate” as anyone using 90837s 70% of the time compared to 90834s or 90832s. Although these letters stated that they were for informational purposes only, some members read them as implying the possibility of onerous audits (and the possibility of refunds) unless the utilization of 90837 codes by the psychologists began to decrease. 

In the past, the Legal and Regulatory Affairs staff of the American Psychological Association’s Practice Organization (APAPO) has reached out to Change Healthcare to seek clarification of their intent in sending these letters in other states. During those discussions APAPO raised many issues about the letter. For example, APAPO staff noted that outpatient mental health practice lends itself more to the use of the longer 90837 code, while codes representing shorter time periods are more likely to occur in nursing homes or integrated care facilities. As a result, those psychologists who were allegedly high users of 90837 might not necessarily have been high users if they were compared to other psychologists in a typical outpatient practice. Furthermore, APAPO staff noted that the nature of these letters could give a chilling effect and dissuade psychologists from using the procedure codes most appropriate for their patients. 

Change Healthcare clarified for OPA and APAPO that the intent of these letters was truly to be educational (although we believe that this educational project was unnecessarily anxiety producing). Change Healthcare does not presume that a higher use of 90837 involves inappropriate billing. We learned that here will be no routine audit of those who use 90837 at a higher rate than other psychologists. Nor will Change Healthcare initiate any unusual efforts toward seeking refunds from psychologists who use the 90837 codes more frequently than others. 

Can Psychologists Continue to Bill Medical Mutual 90837?
Psychologists should continue to use their clinical judgment to determine the health care needs of their patients, including the length of a psychotherapy session. At this time, we are not aware of Change Healthcare limiting the use of 90837. We recommend that psychologists billing 90837 with Medical Mutual continue to use its billing guidelines as described in the next section. According to official guidance for CPT codes, 90834 (psychotherapy, 45 minutes with patient and/or family member) is to be used for sessions lasting 38-52 minutes. Code 90837 is to be used for sessions that are 53 minutes or more in duration. In addition, 

  • Psychotherapy times are for face-to-face services with the patient and/or family member.
  • The patient must be present for all or some of the service.
  • In reporting, choose the code closest to the actual time (i.e., 53 or more minutes for 90837).
  • Document start and end times.

Following this guidance should put psychologists in a good position if Change Healthcare later decides to review their records and/or practices. 

Finally, OPA members can contact me if their experiences with Highmark appear contrary to the guidelines described above.

Please note: Legal issues are complex and highly fact specific and require legal expertise that cannot be provided by any single article. In addition, laws change over time and vary by jurisdiction. The information in this article does not constitute legal advice and should not be used as a substitute for obtaining personal legal advice and consultation prior to making decisions regarding individual circumstances.

Current Procedural Terminology (CPT®) copyright 2015 American Medical Association. All rights reserved.

Tags:  Change Healtcare  cpt code 90837  Insurance audits 

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Insurance Audits: How to be Prepared!

Posted By Jim Broyles, PhD, OPA Director of Professional Affairs, Wednesday, April 12, 2017

I have spent considerable time in the last couple of years providing OPA members help and support with insurance issues. Often, concerns from psychologists arise when an insurance company questions individual psychologist’s billing or record keeping practices. When these questions are raised, psychologists often feel confused about whether, what kind, or how much information an insurance company may need, what they are entitled to, and how to provide this. This past month has been no exception to this ongoing need for clarification. Many who follow the listserv or read my emails know that Medical Mutual recently contacted several Ohio psychologists through an auditing company, Change HealthCare, to raise questions regarding billing codes used by psychologists. My experience with these issues continually leads me back to some basic suggestions for most of us who provide clinical services: a little bit of preparatory work can go a long way toward being ready for audits or other kinds of scrutiny from insurance companies. With this in mind, I would like to make the following suggestions:

  1. Make sure the initial consent document used in your practice includes language designed to provide consent for releasing patient information in response to a broad array of insurance company requests.

    For example:
    You should also be aware that your contract with your health insurance company requires that I provide it with information relevant to the services that I provide to you. I am required to provide a clinical diagnosis. Sometimes I am required to provide additional clinical information such as treatment plans or summaries, or copies of your entire clinical record.... By signing this Agreement, you agree that I can provide requested information to your carrier.

    This allows for the release of basic clinical information which may be required by the insurance company.

  2. HIPAA allows for psychotherapy notes to be kept separate from the rest of a client’s clinical record, and offers a greater level of protection for these notes.  I suggest psychologists maintain this separate record. This allows for less sensitive, more basic clinical information to be easily released in response to an insurance company audit while offering greater protection for client privacy.

  3. Most insurance companies require that we follow basic record keeping guidelines set primarily by Medicare. When billing time based CPT codes, the more general clinical record should include documentation which supports the procedure (separate from the psychotherapy note) for each session billed including:
  • Session start and stop time
  • Modality
  • Diagnosis
  • Symptoms
  • Functional Status
  • Focused Mental Status Exam
  • Treatment plan goal addressed, prognosis, and progress
  • Name, signature, and credentials of the person performing the service

Following these suggestions will help many psychologists to readily respond to most audits conducted by insurance companies for the variety of reasons that I am familiar. More detailed guidelines on record keeping will be provided during my workshop at OPA’s upcoming convention (Thursday, April 27 at 9:00 a.m.). I hope to see you there! 

Jim Broyles, PhD
OPA Director of Professional Affairs

Tags:  insurance  Insurance audits 

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Insurance Audits: OPA can help!

Posted By Jim Broyles, PhD, OPA Director of Professional Affairs, Monday, March 27, 2017

On March 1, I assumed my role as your new Director of Professional Affairs.  As many of you likely know, I follow in the footsteps of Dr. Bobbie Celeste, a very tough act to follow to say the least.  Many of you may be less aware, however, that some OPA staff duties and responsibilities have been reorganized, and that one of my main duties in this role will be to help our members troubleshoot the many insurance issues which continually crop up for us as psychologists. Fortunately, my experience as the owner of a busy private practice and my time spent as chair of OPA’s Insurance Committee have helped prepare me for this job.  It is becoming increasingly clear to me that, not only is this role new for me, but I have the opportunity to shape the DPA role for the association.  


I am coming to realize very quickly that I must maintain two high priorities as your DPA: 1) to monitor, learn about, and provide support for the everchanging challenges which emerge for psychologists as you interact with the world of insurance companies; and 2) communicate often and clearly my best understanding of how to navigate these rough waters.  My intention is to do this through emails such as this, as well as through my blog on the OPA website and our social media.  If insurance issues affect you, look for these communications and feel free to contact me and give feedback.


As those of you who follow the OPA’s general listserv know, my efforts to help with these insurance issues have been required in the last two weeks.  Many psychologists who are Medical Mutual providers have received letters from Change Healthcare, a company who has contracted with the insurance carrier to provide auditing for them.  The form letter received by our members essentially expressed concern that some psychologists are overbilling psychotherapy code 90837.  Those of us who have worked with insurance issues for some time recognize these letters as the latest example of a larger effort on behalf of the entire insurance industry to discourage the use of a commonly used psychotherapy session time (CPT 90837—60 minutes) and encourage the use of a shorter one (CPT 90834—45 minutes).  As so many of our many members have observed, these efforts have been ongoing absent any clearly articulated research or clinical effectiveness based rational.  


Fortunately, at the state and national level, we have experience working with this issue.  In 2016, another insurance carrier, Anthem Blue Cross Blue Shield, made similar efforts through an auditing company with whom they contracted, EquiClaim.  A number of letters similar to those sent out by Change Healthcare were received by our members from EquiClaim in early 2016. Following this, OPA reached out to APA’s office of Legal and Regulatory Affairs.  Their staff attorneys were able to intervene with Anthem, and the results were positive.  These results were summarized in an article published on APA’s website in March, 2016:


Practice Organization members have reported receiving letters about the frequency of their use of CPT® code 90837 (psychotherapy, 60 minutes with patient and/or family member). These letters, sent by EquiClaim on behalf of Anthem Blue Cross Blue Shield, were addressed to psychologists allegedly using 90837 more than average for Anthem psychologists.


The letters indicate they are for informational purposes; however additional language states EquiClaim’s monitoring of the psychologist’s 90837 billing practices may lead to a request for “medical records of members with the intention of identifying any improper coding and recovering associated overpayments.” Members expressed concern that continued use of 90837 might result in an audit and refund demands.


Practice Legal and Regulatory Affairs staff has developed a good relationship with leaders at Anthem. Using a collaborative approach (which proved successful with the Santé Analytics and Inovalon audits), we contacted Anthem to clarify the meaning and intent of the EquiClaim letters. Anthem promptly provided a statement (PDF, 102KB) assuring us that this is an educational process without financial consequences. 


In response to our concerns about these letters, Anthem has made changes internally to ensure further reviews of these types of communications occur in advance of distribution.

 

As I write, these same APA staff attorneys are reaching out Medical Mutual representatives in an effort identify similar solutions.  I will be happy to keep you updated on their results.  (I remind myself that this is the reason I pay my APAPO dues!)

I look forward to continuing these regular communications with you.  Feel free to share your thoughts!

Jim Broyles, Ph.D.
OPA Director of Professional Affairs

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Medical Mutual Audit

Posted By Karen J. Hardin, Friday, March 24, 2017
Updated: Friday, March 24, 2017
I am taking some time this morning to review my efforts in advocating for us on this issue.  I have received or have become aware of a couple of other points of information I will be forwarding to APA to support them in their effort to assist us.  As I review the posts here on this thread, I become appreciative of this passionate, robust conversation.  It strikes me that, during moments like this, so many are moved to speak their truth about what we do as psychologists, and how we are often hampered in our efforts by entities and organizations who have little understanding of our work.  At the same time, I want to encourage all of you to be willing to do more.

Dr. Lewis makes some excellent points about the value of psychologists, and the unique skills which set us apart as from other mental health professionals.  Did you know that OPA has a Marketing Task Force?  This small group has been meeting and working regularly for some time. Its job has been to develop marketing strategies to shape public perception of our unique strengths and skills as psychologists.  As an association, our thinking is that if we can help the more general public understand the unique strengths and skills psychologists possess compared to other mental health professionals, it becomes more difficult for insurance companies to identify us as equivalent to other kinds of professionals on their panels.  The Marketing Task Force meets once week via conference call and could use more members to help accomplish its purpose.

Did you know that OPA has an Insurance Committee?  This committee's purpose is to tackle these very thorny difficulties which arise when insurance companies, whose actions so clearly affect all our lives, develop a new policy or procedure which reflects so little understanding of best practice within our profession and ultimately hampers our effectiveness.  It is the committee's job to develop and implement strategies to respond to the problems and barriers created by these companies like the one under discussion here.  This group meets once per month via conference call and would also benefit from more members who are energized to take some action.

My point here is that I am aware we are all very busy and often do not think about taking an action to tackle a problem until it touches our lives in a very obvious and painful way.  However, from the larger perspective of our association, efforts to tackle these problems have been ongoing for some time.  Change only becomes possible when we come together, and in OPA the work of coming together for collective action occurs in our committees.  If anyone reading this post is interested in joining these ongoing efforts, please contact me.

Jim Broyles, Ph.D.
OPA Director of Professional Affairs

Tags:  Insurance  Insurance Committee  Medical Mutual Audit 

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Affordable Care Act Replacement Legislation - Act Now!

Posted By Jim Broyles, PhD, OPA Director of Professional Affairs, Thursday, March 9, 2017
I recently had the privilege of attending APA’s Practice Leadership Conference as OPA’s new Director of Professional Affairs. As many of you may know, an important feature of the conference is the attendee’s advocacy efforts on behalf of professional psychology at the national level. State leaders participate in a series of meetings with their respective state’s senators and representatives to advocate for key issues which affect our profession. The impending changes in the Affordable Care Act currently being considered by Congress were obviously at the top of our list of crucial issues to discuss. Most of our direct interaction was with Legislative Assistants from each Member’s office, and on the eve of our scheduled appointments, the ACA replacement legislation was formally introduced to Congress. As you may imagine, a disquieting attitude gripped Capitol Hill this past Tuesday as our discussions moved forward. Among the most productive moments for some members of our Ohio delegation was the meeting in Senator Sherrod Brown’s office. The Senator’s assistant with whom we met shared our concern about the changes which were quickly evolving and the potential for negative impact on so many if careful deliberation were not applied by key decision makers. She was appreciative of our core request as psychologists: do not repeal the ACA without simultaneously enacting replacement legislation which preserves reliable coverage for mental health and substance use disorder treatment at parity with coverage for other services. 

The assistant in Senator Brown’s office reminded us that all Ohio psychologists and citizens can do their part to support changes in the ACA which includes the above mentioned benefits. To accomplish this purpose, she stated it would very helpful if everyone could take the time to do the following: 
  1. Contact your representative (Click here to find your representative.)
  2. Express your concern, particularly if you worried about individuals who may be negatively impacted if important benefits are cut.
  3. Most importantly: tell a story about someone you know who has been helped by the benefits extended by the ACA or who may be seriously harmed if these benefits are lost. The Senator’s assistant urged us to not underestimate the power of these stories.
I think we are at the crossroads of an important time in the evolution of our future healthcare system. We also live in a time when so many of us feel helpless when it comes to having an effect on forces which shape our professional lives. Right now before us is an opportunity to take a small action which could make a large impact. 
 

Jim Broyles, PhD
OPA Director of Professional Affairs


Tags:  ACA  Affordable Care Act Replacement  mental health parity 

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