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February 1, 2018
Arizona Psychologist MonthlyIn this issue . . .
President's Message: Gratitude,Leadership, and the FutureThank you, Cindy Olvey!Save the Date: 2018 Convention FeaturesLegislative Update: Politics andPsychology DayCE Committee UpdateArizona Board of Psychologist Examiners:Information and Meeting SummaryUpcoming Meetings, Workshops, andEvents
Featured AzPA Member Article: Opting Outof Medicare, by Aynne Henry, Ph.D.Sidebar: Why Arizona Psychologists OptInto the Medicare SystemLink to classified adsJoin colleagues having funMembers in the News: Michelle Melton,Psy.D. Journal ArticleOdds 'n EndsJoin a committeeComments, Suggestions, Complaints
Gratitude, Leadership, and the Future Gary Perrin, Ph.D., AzPA President
As the incoming AzPA President for 2018, I thank you for the honor of serving in this role. As a longtimemember of AzPA who has been involved in numerous activities of AzPA for many years, it is interestingto look at AzPA within its historical context.
AzPA initially was created in 1950 by a handful of psychologists who believed that our collective effortswere stronger than what we could do individually. Now, sixty-eight years later, many of our colleaguescontinue to hold the same belief. They join AzPA and other professional organizations, serve in variousleadership roles, contribute immense amounts of time and money, and may receive a “thank you” fortheir efforts. Of course, the most valuable benefits are the feelings of gratitude they experience forstrengthening their profession and the various communities in which they live.
Over our sixty-eight year history, we have gone from having no staff members to having one staffmember to having three staff members. Over the past fourteen months we have moved from closingour office and laying off our staff members to contracting with KCA to provide a wide variety ofadministrative duties for us. Numerous KCA staff members have assisted in this transition that hasresulted in stronger administrative and financial positions for AzPA.
At KCA, Debbie Webber serves as our Executive Director and Jessica Painter coordinates ourmembership, CE events and other activities. They, and other KCA staff members, have made manycontributions to enhancing our stability and positioning us to move forward. On Friday, January 19, we held our annual leadership retreat at the home of Pat Johnson (thanks, Pat!).During this all-day meeting of 24 of our leaders, we discussed the current state of AzPA and ourpriorities for going into our future. Many of those present talked about the importance of enhancing ourmembership ranks and, particularly, developing a more diverse membership and leadership. Diversity
in this context includes attracting more early career psychologists, more people of color, more peopleresiding outside of Maricopa County, and more psychologists of various sexual orientations. The strength of AzPA is dependent upon you, our members. We need more of you to enter theleadership pipeline, to run as candidates for all leadership positions (and particularly for President), toserve on committees and as committee chairs, and to voice your visions for AzPA. Seek out any personin a leadership role and ask how you can become more involved. We need a co-chair and committeemembers to help Arti Sarma with our membership committee, and we need people to help with CEevents, finance, legislative actions, diversity, disaster response, strategic planning, and updating ourcorporate documents. If you have interest in any of these activities, let us know. Lastly, I cannot express enough the gratitude we should all have for the work Mark Rohde has doneduring his years as President and President-Elect. He is a central reason AzPA is in a better placetoday. Also, many thanks to Leo Caraballo for stepping up to the role of our current President-Elect. Butour gratitude also goes out to all of the Governing Council members, committee chairs and members,financial supporters, convention and CE speakers and attendees that make AzPA work.
Thank you!
Sincere Thanks to Dr. Cindy Olvey
Dr. Cindy Olvey was honored at the recent AzPA LeadershipRetreat for her exemplary service to our professionalcommunity. Dr. Olvey recently retired from her position asExecutive Director of the Arizona Board of PsychologistExaminers.
Gary Perrin, AzPA President, and Cindy Olvey.Photo by Arti Radhika Sarma
Save The DateAzPA 2018 Convention
Professional Excellence: Taking it to the Next Level
Featuring Keynote Speaker
DONALD MEICHENBAUM
September 27 - 29, 2018Hilton El Conquistador, Tucson
If you are interested in sponsoring this event please contact Jennifer Dvoskin,[email protected] or Jessica Painter, [email protected].
Pre-Conference Supervision Workshop
We are honored to have Carol Falender, Ph.D., as a presenter for the pre-convention workshop onsupervision on Thursday and the convention on Friday.
Dr. Falender teaches at Pepperdine and UCLA, and she has a private practice working with childrenand families. Dr. Falender is the chair of the APA Board of Educational Affairs Supervision Task Force.She is an international speaker on the transtheoretical model of competency-based supervision. Thatis a developmental model that cuts across theoretical orientations to develop skills in ethics andclinical service delivery.
Her workshops will be highly relevant for any psychologist doing practicum, internship, or residencysupervision. In addition, faculty members who teach practicum or supervision probably already use hertextbooks for their graduate courses. Her most recent book is Falender and Safranske (2016)Supervision Essentials for the Practice of Competency-based Supervision.
Dr. Falender's workshops at the convention are being sponsored through a training grant from the APABoard of Educational Affairs awarded to the Arizona Psychology Training Consortium and AzPA. We aregrateful to the APA for bringing one of the leading experts in the country to our annual convention. Youjust have to be there!
Legislative Committee Update
Politics & Psychology Day
Nearly 30 people from across the state met in alarge conference room at the Association ofGeneral Contractors across from the capitolbuildings on Tuesday, January 30th. We spentthe morning listening, discussing and learningabout legislative issues and politicalactivism. Thanks to Cindy Olvey, Alex Ingram andAli Faraz for their excellent presentations.The new Executive Director of the AZ Board ofPsychologist Examiners, Ms. Jenna Jones, wasintroduced and spoke about her work with ourcurrent legislators to address HB2237, whichwould allow an alternative national certification toAPA, Psychological Clinical Science AccreditationSystem (PCSAS), to enjoy the same automaticacceptance for licensure. The board and AZPAare opposing this bill because PCSASaccreditation requirements do not assurecompliance with established minimumstandards for licensure in AZ. Ms. Jones alsoreported that SB1246, which would haveabolished the Board of Behavioral HealthExaminers, is dead and will not be heard incommittees this session. The afternoon wasspent meeting with individual legislators.
Summary submitted byPhil Barry, Ph.D.
Continuing Education CommitteeJudith Rand, Ph.D., Chair of the Continuing Education Committee for AzPA
As the new year picks up steam, I am reminded how important time,energy, and commitment of each of our members, as well ascollaboration amongst our members, are to the health of our stateassociation. It amazes me how the idea of one individual can spark aconversation, ignite a committee or a group to brainstorm a plan, andexplode into a fantastic result much along the lines of the “gestalt!” That’show ideas come together for CE events.
The CE Committee is planning events that will focus on ethics, domesticviolence/child abuse, obsessive-compulsive disorder, teen datingviolence, research on sex trafficking, and much more. If you have anational or regional speaker that you would like us to consider, please letme know. We are creatively planning ways to host big name events! Staytuned.
Best, Judith
ABPE Update
Board Composition
The Arizona Board of Psychologist Examiners (ABPE) consists of ten members: five licensedpsychologists, two licensed behavior analysts and three public members. Board members areappointed by the Governor for five year terms, subject to confirmation by the Arizona StateSenate. Officer rotation occurs on January 1st of each year. Current Board and staff members are asfollows:
Board Officers
Chair - Janice K. Brundage, Ph.D., Psychologist MemberVice-Chair - Tamara Shreeve, MPA, Public MemberSecretary - Lynn L. Flowers, Ph.D., Psychologist Member
Other Board Members
Bob Bohanske, Ph.D., FNAP, Psychologist MemberBryan Davey, Ph.D., BCBA-D, Behavior Analyst MemberDiana Davis-Wilson, DBH, BCBA, Behavior Analyst MemberJoseph C. Donaldson, Public MemberRamona N. Mellott, Ph.D., Psychologist MemberFrederick S. Wechsler, Ph.D., Psy.D., ABPP (Clinical), Psychologist Member
Staff Members
Executive Director - Jenna JonesDeputy Director - Heather BroaddusInterim Licensing Specialist - Krishna Poe The most recent in-person Board meeting was held December 8, 2017. In addition to discussion anddecisions regarding applications for licensure and for approval to sit for the EPPP, the Boardconsidered individual cases brought before it. Highlights are as follows:
Complaints
· Complaint by the mother of a minor against a psychologist who performed a psychosexualevaluation on the child as a condition of a plea agreement on a criminal charge involving an Internetsex crime. The mother alleges that “the psychosexual report for her son is inaccurate and has had direconsequences, including unnecessary sex offender treatment.” Specific concerns include themodification of psychological tests, which may impact the validity of findings; use of DSM-IVterminology and diagnoses; making recommendations prior to conclusion of the evaluation; andduration of the clinical interview. The Board passed a motion moving the complaint to informal hearing. · A licensee requested a move to medical inactive status until February 2018. The licensee statedthat although medical clearance was granted, a voluntarily 90-days of inactive status was desired. TheBoard approved the request and thanked the licensee for proactive due diligence.
Pending Legal Matters
· The Board authority to accept anonymous complaints had previously been challenged, with itsauthority being upheld at the Superior Court level. A Subsequent appeal is pending in the Court ofAppeals.
· The Board discussed a challenge regarding the application of Board statutes associated withcourt services, noting that the challenge is currently in discovery within the Superior Court.
Legislative/Licensure Issue Regarding PCSAS
The Board discussed proposed legislation that would permit psychology licensure for individualsgraduating from programs accredited under the Psychological Clinical Science Accreditation System(PCSAS).
A representative of PCSAS from Arizona State University addressed the Board, requesting eithersupport or a neutral position as PCSAS moved through the legislative process.
The representative described PCSAS as a scientist-practitioner model requiring an internship inclinical settings. It was noted that APPIC does not currently recognize PCSAS programs and the Boardnoted concerns of beginning to license general psychologists as opposed to current standard oflicensing health psychologists.
The Board noted that PC-SAS lacks a current description of what constitutes an evidenced-basedinternship. The Board registered no decision regarding future PC-SAS legislation.
Potential Changes in Behavior Analyst Certification Requirements
The Board discussed newly-released standards for supervision. It was noted that BCBA releasedseveral immediate clarifications based on frequently asked questions on applications. Additionalchanges to the way Bachelor’s hours are counted towards licensure were noted, and providers mustnow be in practice for at least 1 year before providing supervision.
Teleconference meeting held December 22, 2017
The Agenda posted for this meeting on the ABOPE website indicates that the Board discussedproposed legislation that would repeal several regulatory/licensing Boards, including the Board ofBehavioral Health Examiners.
The next in-person Board meeting is scheduled for Friday, March 2, 2018. Please confirm date, time,and location by referring to the Board's website.
Thank you to Diana Milner, Ph.D., and Alex Levitan, Psy.D., for contributing to this summary.
NAPS NewsNAPS has several continuing education events planned for the winter and spring in Flagstaff.
On February 16th, there will be a workshop on re-thinking the treatment of mild to moderate mooddisorders.
Dr. Gary Perrin, the president of AzPA will be presenting on what to do if you are ever the subject of aBoard complaint on March 30th.
Then on April 13th, there will be a workshop on healing fractured couples.
Our continuing education meetings are held in room 201 of the Eastburn Education Building on theNAU campus in Flagstaff.
The cost of an annual membership in the Northern Arizona Psychological Society is still only $25. Joinus for continuing education and use it as an excuse for a weekend getaway to Flagstaff.
Upcoming Meetings, Workshops, and EventsDiversity and LGBTQ Committees The Diversity and LGBTQ Committees would like to announce that they will be holding monthlyConsultation Calls to discuss relevant issues. The teleconferences will be held the 3rd Wednesday ofthe month, with odd months of the year focusing on LGBTQ consultation needs and even months onbroad diversity consultation needs.
The Diversity Committee met recently, Saturday, January 27, 2018, at The McKinley Club, 800 N. 1stAve. Phoenix, AZ. This was an informal workshop with the theme of Be(coming) a Citizen PsychologistThrough a Multicultural Lens. Meetings are held monthly from 10 a.m. to 12 p.m. Please contact Dr.
Michelle Melton at [email protected] for further information.
Effective, Ethical and Efficient Private Practice Marketing
On March 1, Thursday evening, Larry Waldman, PhD, ABPP, Co-Chair of the AZPA Early CareerPsychologists (ECP) Committee, will present “Effective, Ethical and Efficient Private PracticeMarketing,” for the Scottsdale Psychological Society (SPS). It will be held at the home of Dr. AimeeGoldstein, SPS President, in Paradise Valley. All are invited. Emphasis will be given to ECP’s. Topicscovered will include: APA Principles of Marketing; What is Marketing; Effective and Efficient Marketing;and Non-traditional Sources of Income.
Contact: [email protected] for more information.
Granite Mountain Psychological Society
GMPS would like to pass along the following invitation for an event hosted by the West YavapaiGuidance Clinic Foundation. “Coffee with the Doctor” will begin with teaching by Gayle Gregory, MD.,followed by group discussion/Q&A, and ending with a brief tour.
Dr. Gregory is a psychiatrist at the nonprofit West Yavapai Guidance Clinic, specializing in the care ofchildren and adolescents. She earned both her Bachelor of Science in Psychology and her Doctorateof Medicine from the University of Illinois. Dr. Gregory is board certified by the American Board ofPsychiatry/Neurology and completed an additional fellowship in Child/Adolescent Psychiatry atUniversity of California, Irvine.
At this event, Dr. Gregory will share her views and experience regarding the importance of guidingchildren to use less screen time and focus on more positive, interactive, human experiences.
This event will be held Saturday, January 27, 2018 from 9:00 am to 10:30 a.m. at WYGC’s PrescottOutpatient Clinic for Kids, 505 S. Cortez St., Prescott, AZ.
This event is "Adults Only" and "By Invitation Only." To RSVP, contact: [email protected] or 445-5211, ext. 3634.
Featured AzPA Member Article
What to Do About Medicare?Your Choices Are Either
Intentionally Follow Medicare RulesOr Follow a Specific Process
to Opt OutBy
Aynne Henry, Ph.D.
What is the Medicare mandate?
Psychologists are included with the group of professionals who are required to participate withMedicare and follow specific Medicare rules when they treat Medicare eligible beneficiaries. They arealso allowed to formally opt out of Medicare participation. Mandated professionals who have not optedout are required by statute to: 1) transmit patients’ charges to Medicare for any medically necessarycovered service; and 2) agree to accept no more than the Medicare-specified allowable fee. It is aviolation of federal law to charge any clients with Medicare coverage for any billable service unless thepsychologist follows the two rules above.
If a practitioner elects to opt out of providing services to Medicare patients, they agree that they will notprovide services to any Medicare patients for any covered service. If a practitioner is a mandatedprofessional covered under Medicare and does not officially opt out, they could be automatically optedin. Medicare rarely, but could possibly, apply fines and levy bank accounts when there is evidence thata professional or an organization willfully and wantonly neglects to follow Medicare rules. Themandated requirement can potentially leave practitioners vulnerable if they are not aware of the rules.
This article will review these conditions and address the specific regulations involved in opting out ofMedicare participation.
Who is impacted by this mandate?
The Medicare rules affect different medical professionals in different ways. An opportunity to opt in oropt out is available to psychologists as well as other licensees that Medicare considers physicians.These include individuals with M.D. degrees, Osteopaths, Podiatrists, Optometrists, Licensed SocialWorkers, and Dentists who perform certain types of surgery. In addition, certain physician extendersare mandated to follow the same Medicare rules as their associated physicians. These physicianextenders include: Nurse Practitioners, Physician Assistants, Clinical Nurse Specialists, NurseAnesthetists, Registered Dieticians, and Licensed Midwives.
Some providers are not allowed to opt out of Medicare participation. These include Speech andHearing Therapists, Physical Therapists, Occupational Therapists and Chiropractors. Treatmentsprovided by Naturopaths, Homeopaths, Acupuncturists, Licensed Counselors, and Marriage andFamily Therapists are not covered by Medicare rules. How does Medicare’s federal mandate impact psychologists?
It is important to remember that practitioners often have clients who are Medicare beneficiaries, butwho are not seniors. For example, a 30 year-old may be disabled and collecting Social SecurityDisability. After two years of receiving SSDI benefits (or after an appeals process that began two yearsearlier and was favorably concluded), a client could be automatically covered by Medicare. It isimperative that practitioners have office forms that specifically ask about Medicare status in order toprevent confusion and ensure a compliant practice. Clearly, not all Medicare patients are seniorcitizens.
Intentionally Opting In
The process of becoming a Medicare participating provider is beyond the scope of this article.Colleagues who typically contract with third-party insurance panels often report that being a Medicareprovider is a very acceptable option. Even with fears of fee reductions (which will eventually impactmost third party insurance reimbursements whose fees are tied to Medicare), Medicarereimbursement is still higher than the rates allowed by many HMOs and some third-party payers.
Additionally, when psychologists participate in standard Medicare there are very few restrictivelimitations for treatment (Medicare approved treatment must be medically necessary): there are nohours on the phone obtaining case worker pre-approval nor are there visit limits with a reasonabletreatment schedule. If Medicare covers the service, the secondary insurance plan is mandated to coverit also. That may not be the case in Medicare Advantage Plans (MAP), for which separate applicationsand reimbursement rates may apply.
Some psychologists have reported that, after not seeing Medicare clients for many years, they learnthey are no longer considered providers in the Medicare system and must reapply. There are manysimilarities in the frustrations involved in interacting with private insurance companies (a multitude ofform resubmissions) and opting in or out of Medicare.
Officially Opting Out
This article will focus on the steps to opt out of participation in Medicare. “A valid opt-out affidavit signedon or after June 15, 2015 automatically renews every two years. And, if an affidavit has not been signedand received by Medicare on or before June 15, 2015, a new affidavit must be submitted to initiate theopt-out period.
The decision to opt out of Medicare participation is not permanent. New practitioners who recentlyopted out can cancel their opt-out status within the first 90 days. Any practitioner who chooses todiscontinue his or her opt-out status may notify Medicare in writing 30 days prior to the end of the lasttwo year opt out period. Psychologists who have never participated in Medicare and do not plan to start within the next fewyears, may want to formally opt out to ensure that their intent is clear and they are not unintentionallyseeing Medicare patients. Psychologists who prefer not to limit their ability to treat Medicare patients inthe future may choose to apply for Medicare participation but not treat Medicare patients until they arepersonally confident about billing procedures.
It is important to note that if practitioners have made no Medicare decisions and have not signed opt-out forms indicating their choice, they could be opted in by default. For example, if a client (or arepresentative of a client’s estate) sends Medicare a billing statement and the practitioner has notformally opted out (and has no Private Contract), they may end up being automatically opted in byMedicare. Practitioners could be required to send the patient’s claim form, accept the Medicare feeschedule, and refund any excess fees that have been previously collected.
Why is having a NPI number important?
A practitioner who is planning to embrace becoming a Medicare provider will require a NationalProvider Identifier number (NPI). Enrolling in Medicare authorizes practitioners to bill and be paid forservices provided to Medicare beneficiaries. Providers must obtain a NPI number prior to enrolling inthe Medicare program. Practitioners who do not have an NPI number may also consider applying for aNPI number even if they are planning to opt out.
Connecting opt-out status to your NPI number avoids confusion for patients when searching forMedicare providers. Also, a NPI number is valuable to professionals who operate in the medical arenaby designating them as a verifiable adjunct provider. A NPI helps to validate the credentials of thepractitioner. Psychologists may apply for an NPI at https://nppes.cms.hhs.gov/ or by calling the NationalPlan and Provider Enumeration System (NPPES) at 1-800-465-3203. There is no fee.
What is the process of opting out?
New psychologists and those who have never participated in Medicare can follow the instructionsbelow to opt out. If practitioners have participated in the Western region before and intend to opt out ofMedicare participation, they can send a cover letter and a Medicare Opt-Out Affidavit form to NoridianHealthcare Solutions, our regional Medicare carrier. (See specific timing below).
The Medicare Opt-Out Affidavit form is required and includes the provider’s full name, address,telephone number, Tax ID or SSN, Date of Birth and NPI. The form can be found on the AzPA websiteand at: https://med.noridianmedicare.com/web/jeb/enrollment/opt-out. Any previously-signed Medicareparticipation agreements will terminate on the effective date of the affidavit.
Signature on this affidavit indicates that the psychologist will not submit a claim to Medicare for anyeligible service on any eligible beneficiary during the opt-out period, nor knowingly allow any other entityto do so, except when there is an emergency medical condition (Centers for Medicare & MedicaidServices [CMS] Internet-Only Manual [IOM] Pub lication 100-02 Medicare Benefit Policy Manual, Chapter15, Section 40.28.).
What is the timing of the process?
The cover letter that accompanies a new opt-out request should reference the effective date of the opt-out plan. If a practitioner has been a Medicare Provider in the past and has missed the renewaldeadline, their opt-out letter and affidavit must be received by Noridian at least 30 days before the firstday of the next calendar quarter, showing an effective date of the first day in that quarter (i.e., 1/1, 4/1,7/1, or 10/1).
An individual who has never been approved to bill Medicare may opt out at any time. However, Medicarerequires that their opt-out material must be submitted at least 10 days before their first eligiblebeneficiary is to be treated with opt-out status. Realistically, practitioners may not want to plan onseeing Medicare patients until they receive a response acknowledging their approved opt-outapplication – this could require up to sixty days.
Many practitioners have experienced the “We have not received those documents” phenomena. It isrecommended that one sends documents in a manner that requires a signed record of receipt, suchas USPS certified mail or signature-required delivery through FedEx or UPS. Documents can still bemisplaced, but at least the sender will have a record.
It has been indicated that part of the problem is that that the Medicare office does not have adesignated opt-out department and enrollment staff has limited knowledge about the opt-out process.Some frustrated Medicare correspondents have found it beneficial to send documents to the streetaddress for the Medicare facility in Fargo. A personal signature of the recipient can be valuable.
Street Address for Fargo N.D. Noridian Health Care SolutionsAttention: Provider Enrollment Part B (Opt Out)900 42nd Street SouthFargo, North Dakota, 58103-2119 P.O. Box Address for Fargo N.D. Noridian Health Care SolutionsAttention: Provider Enrollment Part B (Opt Out)P.O. 6704Fargo, North Dakota 58108-6704 The phone number: 877-908-8431
*Note: Sometimes vague and contradictory answers are provided to questions about opting out. If asecond call results in a disparate response, call back and ask for a supervisor for clarification.
The fax number: 701-277-7868.
*Note: Do not send Opt-Out Affidavits by fax. Original signatures are required. There will be noresponse even if the fax receipt is confirmed.
Does opt-out status need to be renewed?
The most recent change in Medicare policy is that Medicare no longer requires professionals toofficially opt out every two years on a specific date. For many, worrying about missing the two-yeardeadline was a regular nail-biting affair. If you missed an opt-out date prior to June 16, 2015, you willneed to reapply with a letter and an affidavit. If a psychologist opted out after June 16, 2015, she or hewill never have to opt again—the opt-out contract is automatically renewed. If your last opt-out date wasafter June 16, 2015 and you sent in your affidavit, you will be automatically renewed each yearthereafter. If you did not know that your opt-out application was now being auto-renewed and youcontinue to send an affidavit every two years, you will not be penalized, but it is unnecessary.
If you did not opt out before June 16, 2015 and you do not remember if you opted out afterwards, then tobe safe, you should reapply following the timing mentioned above with an affidavit. All opt-outpractitioners are still required to have their patients sign a “Private Contract” every two years.
How can you adopt Medicare requirements most effectively in your practice?
Practitioners can manage their opt-out status by implementing several cautionary processes.
First, it is important that practitioners or their staff discuss a patient’s Medicare status prior to makingan initial appointment. Clients who are close to Medicare participation would need to understandimpending changes to financial arrangements. Optimally, a client’s Medicare status would be clarifiedbefore scheduling an appointment with a practitioner who has opted out of Medicare. Clients aregrateful to have an understanding of a Medicare participation agreements and Private Contracts. Thechoice to start with an opted-out practitioner may require thought and consideration.
If clients are eligible for Medicare benefits, they must be given a Medicare Private Contract. Opted-outpractitioners are required to provide services to Medicare beneficiaries only through a Private Contract.Private Contracts must meet the criteria of the CMS IOM Publication 100-02, Medicare Benefit PolicyManual, Chapter 15, Section 40.8 for services that, but for their provision under a Private Contract,would have been actual Medicare-covered services.
Practitioners may use the sample Private Contract available on the Noridian website, write their own, orare welcome to use one written by this author and available on the AzPA website.
On the AzPA Private Contract, there is a space for the client to initial each subsection and sign toconfirm he or she has read the document in its entirety. The Noridian sample contract may beaccessed at: https://med.noridianmedicare.com/web/jeb/enrollment/opt-out#private_contract. As of thispublication, the form did not reflect the new information regarding auto-renewal.
Even though Medicare no longer requires providers to officially opt out every two years, a signature on aPrivate Contract is still required every two years. The purpose of the Private Contract is to insure that aclient fully understands the opt-out arrangements and that it is signed every two years. Practitionersmust ask patients to sign the Private Contract at their first appointment and ensure that, if they returnafter a two year period, they re-sign the Private Contract. This author typically asks Medicarebeneficiaries to sign forms each January covering a two-year period. Signage on an annual scheduleavoids tracking a multitude of different contract expiration dates and potentially missing any contractdeadline.
A valid Private Contract must:
1. Be in writing with print large enough to be easily read by beneficiaries.2. Clearly indicate the reason the provider is not participating (e.g., opting out versus having had
contracting privileges removed for some infraction).3. State the effective date and the expiration date of the contract. To be compliant with Medicare
guidelines, the contract must be renewed every two years. There could be a significantproblem, if there is a lapse in compliant contract dates.
4. Be signed by the beneficiary (or a valid representative of the beneficiary), as well as, the treatingpsychologist (not an office representative). The original must be on file and a copy provided tothe client.
5. Be retained with original signatures for the duration of the two-year opt-out period.6. State that services must not be contracted during an emergency or crisis. It is important to
screen for Medicare enrollees and explain opt out rules prior to scheduling appointments. (Opt-out providers can treat clients in an emergency by billing Medicare and agreeing to accept thecurrent prevailing rate of reimbursement).
7. Be explained and signed by the beneficiary or legal representative before services arefurnished.
8. Be made available to CMS (Medicare) on request.9. Be renewed for each two-year opt-out period in order to be valid.
10. Be properly signed by all Medicare-eligible clients for their two-year opt-out period.
By signing the Private Contract, the beneficiary or his/her legal representative:
1. Accepts full responsibility for payment of charges for all services furnished.2. Understands that Medigap plans do not cover services that are not covered by Medicare.3. Agrees not to submit claims to Medicare, nor any Medigap plans.4. Understands that Medicare limits do not apply to what the provider may charge for services.5. Understands that the beneficiary has the right to obtain Medicare-covered services though other
psychologists who will accept Medicare payment rates and have not chosen to optout. Practitioners are urged to provide contact information for other psychologists who contractwith Medicare, if the beneficiary chooses to use these benefits. (See AzPA Medicare Providerslist – a member benefit)
6. Acknowledges that Medicare payments will not be made for any service furnished by the opted-out provider even if services are generally covered by Medicare and would be paid to anotherprovider who was contracted with Medicare.
What about secondary coverage?
A Medigap plan is generally known as the patients’ secondary insurance. To clarify the many questionsabout billing patients’ secondary insurance plans, Diane M. Pedulla, J.D., Director of Regulatory Affairsat the American Psychological Association, wrote:
“No b ills should be submitted to a patient’s Medigap policy. Since the patient is seeing the opt-outprovider under a Private Contract there is no claim to Medicare and hence no cost for the service canbe passed on to the Medigap policy. If, however, the patient has some other type of supplementalinsurance (e.g., coverage under a spouse’s employee health plan), then the patient should check withthe insurer regarding whether services obtained under a Private Contract with an opt-out provider areeligib le for any type of reimbursement under the policy.”
Practitioners might not want to rely on clients to obtain information to assess the potential for adjunctbilling. Many patients tell their providers that they want to bill their plan and ask for superbills.Professional billing companies attempt to bill Medigap insurers and some are paid. Ethicalpractitioners should verify secondary billing prior to providing a superbill. In this author’s practice, withover 18 years as a practitioner who opted out, only one client qualified for tertiary billing.
In summary, to treat Medicare-eligible patients, practitioners must either fully participate and plan to billMedicare or opt out (initially with an affidavit) and always with a signed Private Contract. The informationin this article should not be a substitute for legal advice. If you have any questions about Medicare visit https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf
Dr. Aynne Henry has kept AzPA members up to date on Medicare opt-out policies since 2005. She hasserved as President of Maricopa Psychological Association (1990), Arizona Psychological Association(1995), and Scottsdale Psychological Society (2016). Dr. Henry is a frequent lecturer on the topic ofevaluating and effectively treating clients with resistant mood disorders; she works closely withphysicians, and other professionals to develop individualized treatment programs. Dr. Henry providespsychotherapy for individuals, families, and couples and uses methods such as Interpersonal SocialRhythm Therapy, Sex Therapy, Emotionally Focused Family Therapy, (EFT), and Eye MovementDesensitization Therapy (EMDR). She is certified in Feeling State Addiction Protocol (FSAP) an EMDRprogram for behavioral excesses and substance abuse. She is in independent practice in Phoenix.
AzPA Colleagues Respond: Why I TakeMedicare Insurance
A recent informal listserve query asking for comments by AzPA members who accept Medicare inpayment for services revealed the following:
I take Medicare because I believe that everyone who wants it deserves to receive good therapy.The paperwork required is time consuming for patients and for me. But it’s wrong for those whoare on Medicare, whether due to age or to disability, to be unable to find a psychologist. I owe itto them!
I often find myself wondering why some psychologists do not want to become Medicareproviders.
I take Medicare because, with the typical supplemental insurance that most Medicare patientscarry, the compensation is higher than other insurance payments. In addition, most of myMedicare patients are best suited for the type of therapy I provide. I continue to be surprised thatmore therapists do not take Medicare.
I do neuropsychological evaluations. Only about 50-60% involve adults over 65, and many ofthem have Medicare. My understanding is that we don't need preauthorization forneuropsychological evaluations with Medicare and that the process is much morestraightforward than with commercial insurance plans. BUT, the real answer to your question inmy case is that I work at a site that takes Medicare and I don't have to deal withbilling/insurance. My answer might be different if I were in private practice. I'd be curious to hearwhat others say!
Living in a rural area, I believe that Medicare (and AHCCCS, for the truly adventurous) both paymore than any other private insurance. Also, there is no real private pay market here. VA Choicealso pays what Medicare allows, and allows you to serve veterans, in rural areas.
I take it because I don't see it as a burden. I have a billing service, they send it in and later (OK,later than other insurance companies) I get money. And they automatically bill the secondary.
I have been a Medicare provider for well over 20 years. They are reliable, pay reasonably well,and don’t cause any problems (like questioning your diagnosis, rejecting claims, etc). Theyhave been a breeze to work with. The only drawback is applying and renewing (which is veryinfrequent). Their systems for that are cumbersome and they’re not always on the ball, but whatinsurance company isn’t frustrating?
I primarily see people over 65 on Medicare, and only a few on disability Medicare. This is myage group now and I love to work with my age cohort. I myself am on regular Medicare +supplement and I love it from a consumer/patient perspective as well (and I’ve unfortunatelyhad a lot of opportunity to test it out).
I am a Medicare provider. At this time, Medicare reimbursements are actually better than mostof the insurances.
I take a few Medicare clients because I have seen the clients before they reached the age ofmedicare and I don't want to jeopardize care.
I do assessments and although I am dropping all other insurances for 2018, Medicare is one ofthe few I'm keeping. I'm doing so for a couple of reasons:
I want Medicare patients to have access to having evaluations done when needed (afterstroke or TBI, possible dementia) without the financial burden in retirement;
It pays pretty well without too much hassle (most of the time);
I don't see many Medicare patients, maybe 1-2 per month at the most.
I live in a rural community. In many cases, Medicare referrals pays better than most insurances,There is no cash-pay market here.
Several reasons:
I am of Medicare age myself and I like talking to my cohort;
I was first listed in the 90s when I was a student and never thought to change it until thislist brought it up;
Most of my clients are not Medicare;
I have not had a bad experience with Medicare . I used the list of Medicare providers justthe other day to find a provider closer to home for a new client. Some Medicare folks areon disability and some of them have BIG issues.
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Join Colleagues at Leisure
A way for members to share interests - invite colleagues to meetfor leisure activities--a painting class, movie, or concert; dinner ortravel. To post an invitation, contact [email protected]
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Happy Birthday, Dr. Jefff McWhirter!
James Jeffries McWhirter, Ph.D., ABPP (Jeff) celebrated his80th birthday in style, with friends and colleagues, at CaseyMoore's in Tempe, Saturday, January 27th.
From organizer, D. Scott Herrmann, Ph.D., ABPP: It was abig success. For anyone who missed it, we will do it again in20 years when Jeff turns 100!
If you're a scuba diver, consider joining your colleagues thissummer for a week in paradise. A group of us are considering thePhilippines, St. Croix, or Tobago. If interested, contact Mark Rohde,at 602-980-1875 or [email protected]. If you're not yet adiver, lets fix that!
Members in the NewsMichelle Melton, Psy.D., Diversity Representative and Co-Chair of the Social Diversity Committee is veryexcited to announce publication of an article entitled Ally, Activist, Advocate: Addressing RoleComplexities for the Multiculturally Competent Psychologist. The article is now available onlinethrough psychnet at: (Melton, M. L. (2018, January 11). Ally, Activist, Advocate: Addressing RoleComplexities for the Multiculturally Competent Psychologist. Professional Psychology: Research andPractice. Advance online publication. http://dx.doi.org/10.1037/pro0000175).
Membership Wants You!
The Membership Committee is looking for enthusiastic AzPA members who would like to join our veryactive committee in planning events and working on initiatives to continually improve the memberexperience. The Membership Committee serves AzPA by recruiting potential members and helpingcurrent members benefit from the association. The committee plans several events throughout theyear and is always looking for creative ideas for the next initiative. We hope that you can help uscontinue to make AzPA the professional home of psychology in Arizona. Please contact Dr. Arti Sarmaat [email protected] to learn more.
Join a Committee or Task Force
If you would like to join a committee or participate in a task force, we can use your talents. Let us knowof your interest. Contact [email protected]
The Arizona Psychologist Monthly
The online Arizona Psychologist Monthly newsletter is intended to provide support and information toour members. Contributions, suggestions, and, of course, actual hands-on assistance, is alwayswelcome.
If there is anything you would like to see in our monthly updates or if you would like to join theCommunication and Publications committee, please contact Sandra Klar at:[email protected].
Please Tell Us What Irritates You
Need help with access to training, better resources, AzPA websiteshould be more user-friendly, hate the politics on the listserve,inappropriate referrals from the AzPA office, looking for easy ways toget involved . . . You name it, we want to hear it!
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