Counselors and MFTs:

Are You Ready for Medicare?

As you may have heard, Counselors and Marriage and Family Therapists will become eligible to provide services to Medicare clients as of January 1, 2024. But even if you choose NOT to become a Medicare provider, you may have to take some action in the coming months. Read on...

Since I'm no Medicare enrollment expert, I'm interviewing Medicare expert and veteran mental health biller Susan Frager, of YourBillingBuddy.com. Frager has decades of experience working with Medicare, and consults with therapists nationwide to help them navigate the Medicare enrollment and billing maze. Here she answers our most frequently asked questions:

"Can therapists and counselors just start providing services to Medicare folks as of January 1st, 2024?" "Unfortunately, no," says Frager. "you will need to be enrolled as a Medicare provider to be paid by Medicare."

"When will enrollment be opening for MFTs and counselors?"  "It will likely be opening in the 2nd or 3rd week in November," says Frager. "However, the earliest you could see a Medicare client would still be January 1, 2024."

"How does enrollment work?" Frager explains that when you submit your application, you will be assigned a Medicare analyst, who will review your application and pronounce it "clean" or deficient. You have 30 days to fix any deficiencies. If you don't fix problems in 30 days, you'll have to start all over again. 

"If I'm interested in becoming a Medicare provider, what should I be doing now?"  Here's Frager's advice:

• "Many clinicians register for their National Provider Identifier (NPI) and Employer Identification Number (EIN) and never update these official addresses," says Frager. "If these addresses don't match your Medicare enrollment address, this can delay your Medicare application." So, her advice? "Choose an address you want to use, and go back to be sure that's the one listed at NPPES (the website for the National Provider Identification). You might want to do the same for the address you have listed for your EIN -- "everything has to match." (Note: If you don't have an EIN, click here to get one, so you can use it in place of your Social Security Number on claims and superbills).

"While it is unlikely, remember that Medicare could visit your location to make sure it’s a legit business," Frager says. "They are required to do this to prevent fraud." Therefore, the use of a USPS or UPS address as your service location could lead to your disenrollment if Medicare researches your address. However, according to Noridian, one of the Medicare Administrators, as of 10/3/23, "current processing standards dictate that on-site reviews should not be ordered for locations that are identified to be solely used for telehealth." But, says Frager "If you are telehealth only, or your physical office isn’t clearly marked with your name/business information, I'd advise you to call Provider Enrollment after submitting your application and discuss any concerns about a potential site visit.” 

• "If you have incorporated or have a LLC, you must have an EIN and a Type 2 NPI for that entity to enroll in Medicare," says Frager. "If you don't have a Type 2 NPI, get one now."
• "If you are using an EIN, dig out IRS Form CP 575 now. This is the form the IRS sent you when they assigned you an EIN," says Frager. "If you can't find it, ask the IRS for a copy." You'll need this for enrollment.

"But keep in mind," Frager warns, "that changing your address or NPI type or moving from a SSN to EIN can mess up your private insurance claims. You may need to alert insurance plans and CAQH of these changes and your new official office location," and submit a W-9 form if you get an EIN. 

"What if I'm an MFT or counselor but I'm NOT interested in joining Medicare?" "Medicare isn't like private insurance," says Frager. "After January 1, 2024, counselors and MFTs will need to officially opt-out if you want to be able to see Medicare clients as self-pay clients in your practice. Once you opt-out, your Medicare clients will need to complete a Medicare Private Contract" -- click here to read more about these steps.

"What about us LCSWs and psychologists?"  "You need to either enroll to be a Medicare provider or officially opt-out and use a Private Contract if you want to see Medicare clients in your practice," says Frager. "You don't need to wait until January 1st." Again, click here to read more about these steps.

"How can I make the decision whether to become involved in Medicare, if I don't know anything about Medicare?" To help clinicians, Frager is offering several "non-threatening, informal" small-group workshops to help clinicians make this decision. "I'll be sharing my experience as a biller working with Medicare, and answering questions about enrollment, auditing, reimbursement rates, coverage, and addressing myths and horror stories," she says. She will also be facilitating several online workshops where she'll actually walk therapists through the Medicare enrollment process; at the end of the session, you would be ready to submit your enrollment. Find out more about her upcoming workshops -- click here

"Any other helpful resources?" This is complex stuff! So Frager helped me put together a graphic to help me better understand our choices involving Medicare. Check out my informative graphic that will have surprising answers to your questions. I call it, "When Can A Therapist or Client Be Reimbursed By Medicare?" You can download this handout now: click here

" I have more questions about working with Medicare!" Great! But PLEASE don't contact me, unless it has to do with Medicare documentation or audits! Schedule your consultation with Susan Frager at www.YourBillingBuddy.com or contact her at [email protected]

UPCOMING LIVE WEBINARS

"Couples Therapy Blunders: Common Mistakes when Billing, Documenting, and Handling Ethical Dilemmas”

Saturday, October 21, 2023

9:30 am- 12:10 pm PDT | 10:30 am-1:10 pm MDT |

11:30-2:10 pm CDT | 12:30-3:10 pm EDT

Can't make it live? All registrants get the recording!

Sponsored by the Zur Institute

This training will focus on the practical challenges of couples work. When can you bill insurance? Who is your client? What common mistakes do couples therapists make, and how can you avoid them? We will cover the issues you deal with daily, challenge myths you may have about couples work, clarify areas of confusion, and invite you to rethink your policies. For more info or to register, click here

"Audits and Records Requests:

What EVERY Therapist Should Know"

Saturday November 4, 2023

11am-1pm PDT | 12- 2pm MDT | 1-3pm CDT | 2-4pm EDT

Can’t make it live? All registrants get the recording!

In this webinar, we take a closer look at the reasons your notes might be requested by a health plan, how to respond if they are requested, and how to prevent any loss of income. For information or to register, click here

"What Out-of-Network Therapists Should Know About Billing" FREE!!

Tuesday, November 14, 2023

12-1pm PDT | 1- 2pm MDT | 2-3pm CDT | 3-4pm EDT

Can’t make it live? All registrants get the recording!

Free training sponsored by SimplePractice. Open to all!

Do you think because you aren’t in-network with insurance plans that you don’t need to know about insurance stuff? Think again! Your lack of knowledge about how insurance works can cost you and your clients money. For more info or to register, click here