Reimbursement Issues in Private Practice; Episode 267

ANNOUNCEMENT: If you're a caregiver based in New York State or still have family in New York, join me on Thursday June 18th for my webinar, Caregiving: A Public Health Issue. 8pm est; $15 per person.Sign up here: https://www.eventbrite.com/e/1991026454723?aff=oddtdtcreatorOn this episode of The Social Work Rants Podcast, I discussed the changes to reimbursement rates for providers using CPT codes 90834 and 90837 on the Alma platform, effective July 15th. The changes involve adjusting the rates for session durations, with code 90837 (53 minutes and up) being reimbursed at the same rate as code 90834 (37-52 minute sessions). Basiliso also mentioned the impact of inflation on these changes, citing a recent 4.2% inflation rate.Inflation and Mental Health ConcernsI discuss the impact of inflation on various aspects of life, including healthcare costs and gas prices, noting that while President Biden reduced the national inflation rate, many expenses continue to rise. I expressed concerns about technology platforms like Headway that visually scan patients during mental health sessions, citing ethical issues around patient privacy and surveillance. I also mentioned challenges with audits and payment reimbursements for agencies.I highlight the work of Justin Gillespie from Blue Cross Blue Shield of Michigan, who is working on legislation to address reimbursement rates at both state and national levels.Payer Regulation Impact on NonprofitsI discussed recent payer regulation changes affecting Medicaid and HMO services, including increased denial rates and higher audit frequencies leading to potential nonprofit closures. They highlighted budget issues in New York City affecting nonprofit organizations' ability to pay staff and bills. Basiliso noted that the full impact of the HR1 legislation may not be fully realized until after the November general election.Medicaid Recertification Changes UpdateI also warned about upcoming changes to Medicaid recertifications and a new work requirement effective in July, which will require individuals to show proof of working up to 80 hours to maintain their benefits. These changes will significantly impact vulnerable populations and make social workers' jobs more challenging. The discussion was presented as educational content to help professionals understand the evolving landscape affecting their work.