MassHealth no longer paying crossover fee

MassHealth no longer paying crossover fee
(December 2009 Issue)

By Ami Albernaz

Some psychologists in Massachusetts who submit Medicare crossover claims to MassHealth were surprised to find that MassHealth is no longer paying for services outside of testing. In keeping to a ruling that's been on the books since 2001 - but only, it appears, reinforced since spring - MassHealth is no longer paying the crossover fee for non-testing services, including therapy.

A regulation printed in a Massachusetts Division of Medical Assistance provider manual from 2003 states "The Division does not pay a psychologist for diagnostic (other than by testing) or treatment services." Yet psychologists were paid for these anyway, until the implementation of an updated claims processing system - the Medicaid Management Information System - earlier this year. Those affected by the change say they were given no warning, and that finding answers to why the reimbursements stopped has been time-consuming and frustrating.

"I hadn't seen anything informing us of the change," says Peter Kinney, Ed.D., a psychologist with an outpatient practice in Mansfield. Kinney says he is missing around $2,000, some of which was held up by a glitch in the claims processing system last year. Once the glitch was fixed, some of the held-up claims were denied in accordance with the "new" payment system.

Some psychologists who provide therapy in nursing homes have been heavily affected, as residents who have exhausted their assets in paying for the homes rely on MassHealth to pick up the portion of the costs that Medicare does not.

Donna Levine, owner of Healthcare Billing Specialists in Sharon, Mass., bills for one provider who has missed out more than $30,000 in payments since the spring. Another is owed more than $5,000. Both do a considerable amount of work in nursing homes.

"We're talking a lot, lot of money," Levine says. "It's a huge issue."

In an email to the New England Psychologist, Health and Human Services spokesperson Jennifer Kritz explained that "psychologists are independently credentialed with MassHealth and are solely to provide psychological testing services," which seems to reflect the law. Claims for other services such as individual, family and group counseling are denied because MassHealth does not cover them, she added.

Yet with the MassHealth portion of non-testing services paid for so long - " They've been reimbursed for 10, 15 years," Levine says - many were at a loss to understand why, seemingly all of a sudden, they aren't. Levine says that as her staff began checking into unpaid claims, the confusion seemed to be mirrored at MassHealth.

Members of Levine's staff were told that claims were in suspension and being manually reviewed. One staff member reported calling several times and being "given different information each time about when we might see a resolution." Eventually, the claim was denied because it did not pertain to testing.

"Hours and hours of staff time are being spent," says Levine. "It's been very frustrating."

Elena Eisman, Ed.D., executive director of the Massachusetts Psychological Association, has been talking with MassHealth officials, and says they are "trying a different number of strategies." Yet the tight economy and shrunken budgets have complicated the issue.

"When you're talking about making policy changes that will increase expenditures, it's difficult," Eisman says.

Eisman adds she isn't sure how many psychologists have been affected, though the impact is considerable. She has heard psychologists say they can no longer afford to work in nursing homes.

Kinney says he will not stop seeing any of his current patients. "The amount that MassHealth is responsible for amounts to about $25 per session, so I'm not going to turn them away," he says. He adds he hasn't yet decided whether to take on new patients requiring crossover claims. In the meantime, he has spoken with a state senator in hopes of resolving the issue.

Eisman is advocating a strength-in-numbers approach to try to resolve the issue. "I would urge everyone involved to come onboard with MPA to work together on this," she says.