Experts: prepare now for the onslaught of Medicare Part D.

Publication: Getting Paid in Behavioral Healthcare

Publication Date: 01-OCT-05

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COPYRIGHT 2005 Manisses Communications Group, Inc.

First there was the Health Insurance Portability and Accountability Act (HIPAA), the federal privacy law that had health care organizations scrambling to implement systems that were both compliant and financially viable.

Now, with little fanfare but much potential complication, comes the implementation of Medicare Part D, the new drug benefit provision that takes effect on Jan. 1, 2006. And while it may not have received the same advance buildup that accompanied HIPAA, Medicare Part D does introduce a whole host of issues that behavioral health organizations must address to hold disruption to their clients, operations, and revenues to a minimum.

The new act will affect an estimated 42 million people who are Medicare beneficiaries. Many of these people, especially those who are eligible for both Medicare and Medicaid (the 6.5 million so-called "dually eligible"), have complex mental health needs that they rely on the community behavioral health system to meet.

Moreover, these clients will probably ask providers to help them with enrollment questions, and the populations most likely to be affected by the change are also some of the most fragile. So some organizations may feel a financial impact before the plan even takes effect.

"I think there's going to be a high demand for appointments once consumers get this information, so you may have a mismatch between supply and demand for provider appointments," notes Susan Parker, CPA, MT, executive vice president and co-founder of Parker Dennison & Associates, a healthcare consulting firm. "Pay attention to the time it takes to help consumers with this and whether it's billable," she adds.

The answer to that question depends on the state and the reimbursement source. For dually-eligible clients, Medicaid often pays for case management services, whereas for Medicare-only clients, such consultation will probably not be billable, Parker advises.

Another potential problem is that staff won't fully bill for the time they spend on helping clients with the transition, perhaps because they are unaware that they should. Additionally, productivity rates may drop when staff members assist clients for whom the time won't be reimbursed.

"It's really scary once you start...

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