Articles:  The insurance war on psychodiagnostic testing &
 Psychologists adjust to the world with coronavirus 
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The insurance war on psychodiagnostic testing

By Jerrold Pollak, Ph.D.
April 18, 2020 - 

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A woman in her early 70s was recently referred to me for testing by a neurology practice. Their question was does she have a cognitive change referable to cerebral vascular disease. They also needed a baseline prior to a follow-up with a vascular surgeon to reassess the need for a possible carotid endarterectomy or stenting.

Given the circumstances, this referral was considered time-sensitive.

The patient was covered under Medicare, which normally allows unfettered access to testing with a physician referral. However, on the day preceding the testing appointment it was discovered that this particular Medicare plan required pre-authorization involving completion of a lengthy form reviewing history, symptomatology and a detailed list of proposed tests with time allotments and procedure codes for each test.

The appointment had to be canceled pending completion of the form and an insurance company review.

There are powerful disincentives for psychologists to offer testing services on more than a limited/part-time basis. These include pre-authorization, low reimbursement and payment delays, the costs of a state-of-the-art armamentarium of testing equipment/supplies and revenue loss from late cancellation and no shows when several hours are put aside for each appointment.

The upshot is that most psychologists do not test. The relatively small group who do often do not take insurance. In many communities, there are no providers of this service and waits of at least several months have become commonplace across the country.

This is an especially vexing state of affairs as testing is arguably the most

empirically supported mental health intervention to facilitate accurate

diagnosis and treatment planning. It has a solid track record for providing

a comprehensive assessment of a patient’s neuropsychiatric

difficulties and needs.

Unfortunately, our medical colleagues in pediatrics, neurology and psychiatry – the most frequent sources of referral for testing among the medical specialties – have done little to advocate for more reasonable insurance company practices despite extolling the virtues of this service and expressing regret that it is not more available.

The advent of the 2019 testing code revision (a truly impressive achievement) may help to improve this sorry state of affairs. But it could have unintended negative consequences – an increase in claims as well as the amount billed resulting in more restricted criteria for medical necessity and an uptick in mandatory pre-authorization.

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Jerrold Pollak, Ph.D., ABPP, ABN, specializes in clinical and neuropsychology. He coordinates the program in medical and forensic neuropsychology at the Seacoast Mental Health Center in Portsmouth, N.H., and is affiliated with Exeter Hospital in Exeter, N.H. His email is: jmpoll49@comcast.net.

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Psychologists adjust to the world with coronavirus

By Kathy Lynn Gray, Associate Editor
April 18, 2020 

As the coronavirus sweeps across the country, clinical psychologists are struggling with a very practical question: Should they continue to see patients face to face?

Many, such as one neuropsychologist in Rock Hill, N.Y., are choosing to conduct all of their therapy online for the next few weeks rather than seeing patients in an office setting.

And at the Telebehavioral Health Institute in California, “the phones have been ringing off the hook,” said Marlene M. Maheu, Ph.D., executive director.

“We’ve seen a dramatic uptick; it’s unbelievable,” she said. The 26-year-old institute (telehealth.org) offers clinical, legal, ethical and competency-based professional training, staffing, and consultation to advance the responsible use of technology in healthcare.

Maheu said in addition to individual psychologists, she had several groups and agencies calling her about training staff, such as college counseling offices and national behavioral organizations.

She’s also seen a rush of people who previously purchased training signing back in to finish their certifications.

“Their employers are asking for this,” she said. Maheu also has had several organizations ask her to set up web-based presentations about teletherapy.

The American Psychological Association (APA) suggested in early March that psychologists explore telepsychology options because of the outbreak, which was officially designated a global pandemic on March 11 by the World Health Organization (WHO).

“In this fast-moving environment, APA staff is working to provide appropriate and timely guidance to psychologists and the general public on a wide range of issues related to coronavirus,” Jared Skillings, Ph.D., APA’s chief of professional practice, said via email.

The association has posted a lengthy notice, “How to protect your patients and your practice,” on its website, urging psychologists to consider their flexibility and how the pandemic might impact their business.

The notice encourages psychologists to find out if teletherapy sessions will

be reimbursed by insurance, develop a way to stay in touch with patients during

the outbreak, write a notice explaining how your office will function and talk

with patients about their comfort

level with teletherapy.

The notice also encourages psychologists to promote hygiene in their offices, have hand sanitizer available, practice self-care and quell fears by offering credible information to patients and others in the community.

Maheu said this is the perfect time for psychologists to use telepsychology.

She said most psychologists can use their own computers and can pay monthly for a platform that will support the practice.

She said top-of-the-line training costs about $1,500.

“The cost has gone down over the years and if you add that to the pandemic, it just makes sense,” she said. “People have said it was going to take a catastrophe for people to realize telehealth is viable, and now we have this.”

Maheu said teletherapy reduces barriers for people to get the care and its expansion will be something good for everyone.

As a result of the coronavirus, Congress passed legislation in early March expanding when Medicare will pay for telehealth services. That legislation, the Coronavirus Preparedness and Response Supplemental Appropriations Act, will allow more – but not all — patients to engage in teletherapy with clinical psychologists and have it covered by Medicare, according to the act. 

Others offer training in teletherapy, including the Zur Institute.

“The research is clear that telemental health is cost-effective, serves as an effective approach to delivering care and allows for well-matched therapeutic relationships where they were unavailable before,” the institute said on its website. “With the coronavirus causing major concerns and even panic in some sections, there was never a more appropriate and relevant time than now to get educated/trained and offer existing and new clients telemental health services.”

WHO issued suggestions on March 6 on mental-health considerations during the pandemic. These include avoiding constant access to news about the virus, opting instead to seek information once or twice a day; finding ways to promote positive stories about the virus, such as stories about those who have recovered; managing stress; seeking support from colleagues, and getting adequate rest.

Psychologists also are being called on to quell the fears of their patients, the general public and those quarantined because of the virus. 

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