Medicare is a federal health insurance program for people aged 65 and older, as well as people with certain disabilities. It provides coverage for a wide range of medical services, including doctor visits, hospital stays, and prescription drugs.
Counselors who work with Medicare beneficiaries need to be familiar with the program in order to provide accurate and helpful information to their clients. This blog will provide an overview of Medicare, including its benefits, eligibility requirements, and costs.
Medicare Benefits
Medicare Part A covers inpatient hospital stays, skilled nursing facility stays, hospice care, and home health care. Medicare Part B covers doctor visits, outpatient services, and preventive care. Medicare Part D covers prescription drugs.
Medicare Part B is what applies to most mental health providers in private practice settings.
Medicare Eligibility Requirements
To be eligible for Medicare, you must be a U.S. citizen or permanent resident who is 65 years of age or older, or who has a certain disability. You must also meet certain residency requirements. It is a common misconception that Medicare is only for seniors.
Medicare Costs
Medicare Part A is premium-free for most people. Medicare Part B has a monthly premium of $148.50 in 2023. Medicare Part D premiums vary depending on the plan you choose.
Medicare & Counselors
Counselors can play an important role in helping Medicare beneficiaries understand their coverage options and make informed decisions about their health care. They can also help beneficiaries navigate the complex Medicare system and resolve any problems they may encounter.
If you are a counselor who works with Medicare beneficiaries, there are a number of resources available to help you learn more about the program. The Centers for Medicare & Medicaid Services (CMS) is the gold standard, their website has a wealth of information about Medicare, including eligibility requirements, benefits, and costs. CMS also offers a number of educational resources for counselors, including webinars and online courses.
In addition to CMS, there are a number of other organizations that offer Medicare counseling services. These organizations can provide counselors with information and support as they help their clients navigate the Medicare system.
Mastering Insurance also has a course on Medicare and Medicare Credentialing inside the Admin Academy program. We also provide credentialing services for those who are interested in becoming a Medicare Provider.
What you need to know about Medicare:
- Medicare does not cover all counseling services. Only services that are considered to be medically necessary are covered.
- LPCs and LMHCs must be enrolled in Medicare in order to bill for services. The enrollment process can be complex, so it is important to start the process early.
- Medicare requires that LPCs and LMHCs use specific codes when billing for services. These codes are called Current Procedural Terminology (CPT) codes.
- Medicare pays for counseling services on a fee-for-service basis. The amount that Medicare pays for a service is based on the CPT code and the patient’s level of care.
- Medicare requires that LPCs and LMHCs submit claims for services within 12 months of the date of service. Claims that are submitted after the 12-month deadline may be denied.
Here are some additional tips for Mental Health Professionals who are billing for Medicare services:
- Make sure that you are familiar with the Medicare coverage requirements for counseling services. You can find this information on the Centers for Medicare & Medicaid Services (CMS) website.
- Be sure to use the correct CPT codes when billing for services. You can find a list of CPT codes on the American Medical Association (AMA) website.
- Submit claims for services within 12 months of the date of service. This will help to ensure that your claims are processed promptly.
- Keep good records of all of your billing activities. This will help to resolve any billing problems that may arise.
Medicare and LMHCs, LPCs and LMFTs
According to the American Counseling Association, licensed professional counselors (LPCs), licensed mental health counselors (LMHCs), and marriage and family therapists (MFTs) will be able to bill Medicare Part B for mental health services beginning on January 1, 2024. This is a result of the Mental Health Access Improvement Act, which was passed by Congress in December 2022.
The Mental Health Access Improvement Act is a significant step forward for mental health care in the United States. It will allow more people to access the mental health services they need, and it will help to reduce the stigma associated with mental illness.
If you are an LPC, LMHC or MFT, you can start preparing to bill Medicare now. You will need to enroll in Medicare and obtain a National Provider Identifier (NPI). You will also need to be familiar with the Medicare billing process.Mastering Insurance is happy to assist you with this process.
Conclusion
Medicare is a complex program, but it can provide valuable coverage for people aged 65 and older, as well as people with certain disabilities. Counselors who work with Medicare beneficiaries can play an important role in helping their clients understand their coverage options and make informed decisions about their health care.