Prior Authorization Update: Patient Stories Needed
Do you have patients whose care has been delayed because of prior authorization decisions from
insurance plans? A bill before the Pennsylvania House of Representatives aims to improve response times by increasing transparency and standardization of the prior authorization process.
We need your help in supporting House Bill 1293. The PaACC, the Pennsylvania Medical Society, and our coalition partners are looking for patients to share their story and continue building support for HB 1293. Here are ways you can help:
APA addresses member concerns about Maintenance of Certification (MOC): resources available
The APA membership department recently contacted all district branch executives to address member concerns about Maintenance of Certification (MOC). They informed us that members have been asking, "What are you doing to represent my interests on MOC?" and "The APA isn't doing enough to counter increasing MOC requirements." To help educate members, they
created a webpage to highlight the APA's role in MOC, their accomplishments providing the opportunity for feedback.
In addition to MOC advocacy, the APA is constantly updating resources to help members meet MOC requirements, including:
- A webpage dedicated to meeting MOC requirements
- A Psychiatrist's Guide to MOC which is available online and was also sent in January as a mailer to ECPs and general members within 2 years of needing to recertify. Those exempt from continuous MOC were excluded from the mailing.
ECPs also receive a free online subscription to FOCUS: The Journal for Lifelong Learning in Psychiatry, which meets many of the requirements of MOC. They just need to call 888-357-7924 each year to subscribe.
Our Society is taking an active role in address member concerns with the current MOC process. For more information on what we have done so far and next steps, contact Deb Shoemaker, our executive director at 1.800.422.2900 or via email at email@example.com.
Find a Psychiatrist
APA's Find a Psychiatrist is a resource open to the public that helps patients locate psychiatrists by geographic and practice area. To be included in this database, log in to your APA account to access the opt-in form.
Find a Member
Find APA members, district branches, Assembly representatives, components, administrative staff, and more. APA's Find a Member database is a designated service to and for personal, non-commercial and informational use by its members only.
Advocacy & APA Political Action Committee
Stay current on the APA's advocacy initiatives encompassing legislative, regulatory and political affairs.
Discover APA's Learning Center, access books and journals, and meet certification requirements.
*NEW through the Learning Center: FREE Integrated Care Training
October 2017 Course of the Month-Neurocognitive Implications of Heavy Marijuana Use in Adolescence
October Course of the Month - Neurocognitive Implications of Heavy Marijuana Use in Adolescence
Access the link here
Additional Resources for Psychiatrists
Practice Management and Professional Interests
Leadership and Awards Opportunities
Research and DSM Information
Resources for psychiatry residents.
Resources for medical students interested in a career as a psychiatrist.
More from APA
Mental Health Parity resources from the APA:
The Consumer Portal:
Consumer Guide to Disclosure Rights
Warning Signs - Plan or Policy Non Quantitative Treatment Limitations (NQTLs) that Require Additional Analysis to Determine Mental Health Parity Compliance (pdf)
What can Psychiatrists do to Help Enforce Parity (pdf)
The Stepping Up Initiative resulted from a partnership of The American Psychiatric Association Foundation, the Council of State Government Justice Center, and National Association of Counties.
White House Task Force Releases Report
White House Task Force on Parity releases report with recommendations to federal legislators to ensure enforcement.
White Hous e Report (pdf)
Fact Sheet (pdf)
Mental Health & Substance Use Final Report (pdf)
DSM 5 Coding Updates
On October 1st, ICD issue updates to ICD-10. APA's Office of Healthcare Systems and financing provides updated DSM V codes.
DSM 5 Coding Updates 2016 (pdf)
The Following Message is Sent on Behalf of Dr. Saul Levin, APA CEO and Medical Director
On October 14, 2016, the Centers for Medicare and Medicaid Services issued the Final Rule setting policies for new Medicare payment reforms and quality reporting under the Medicare Access and CHIP Reauthorization Act (MACRA). This new rule will change the way our members practice into the future. In our response to the proposed rule, we raised several concerns regarding its impact on psychiatric practice and some of our advocacy efforts have paid off.
1) A large number of psychiatrist will be exempt.
Now, psychiatrists who have no more than 100 Medicare patients or no more than $30,000 in annual Medicare billings will be exempt from quality reporting requirements in 2017. As a result of these changes, CMS projects that 49% of psychiatrists who see Medicare patients will be exempt under the “low volume threshold;” another 8% will be exempt because they just enrolled in Medicare that year; and close to 1% will be exempt because they qualify for the incentive for “advanced” alternative payment models. However, these psychiatrist can still choose to participate in the MIPS program – and potentially qualify for a bonus – if they wish to do so.
2) Flexible reporting period in 2017.
Psychiatrists who choose to participate in the MIPS program can ease into reporting in 2017 due to relaxed “Pick Your Pace” reporting for that year.
3) Decreasing the requirements to meet “full reporting” in order to earn a bonus for 2017.
Many of the different categories reporting on practice improvement activities and quality measurement reporting have been reduced by one third.
4) Psychiatrists will not be penalized for seeing sicker, economically disadvantaged patients for the first year.
Unfortunately, as currently measured for the Value-Based Payment Modifier, negative adjustments have tended to go to those physicians who care for the most vulnerable populations. The new cost performance category measures Medicare spending for all of a psychiatrist’s Medicare patients. Contribution to the final score will gradually increase to 30% by 2021.
5) Psychiatrists can earn a bonus for some participation in alternative payment models (APMs).
Psychiatrists who have at least 25% of their Medicare covered services or 20% of their Medicare patients in certain “advanced” APMs are exempt from MIPS reporting in 2017 and can earn a 5% bonus in 2019.
Member education and guidance is coming! We will soon provide you with a MACRA Toolkit for Psychiatrists, as well as a series of webinars to educate psychiatrists on these new programs and requirements. More information will be available at www.psychiatry.org/MACRA and on the attached flier that I ask you to share with your colleagues.
Thinking of joining? We encourage you to learn about all that the APA and PaPS can do for you and your career. Contact the PaPS administrative office to request our Member Outreach Brochure. We can be reached at firstname.lastname@example.org or (800) 422 - 2900.
Need to renew your current membership? Renew online!