DETROIT – A recent billing change announced by Blue Cross Blue Shield of Michigan will affect access to mental health care across the state, according to psychiatric offices. The insurance provider says the change is in line with up-to-date guidance.
Local 4 is following the announcement after first covering how a change in “incident-to” billing could specifically impact social workers who provide outpatient mental health counseling in Michigan.
After publishing the first story, several viewers reached out, saying this would also impact nurse practitioners who work in psychiatric offices.
“With incident-to billing, clinics are going to be forced to transfer care from nurse practitioners to psychiatrists,” Emily Williams, the chief operating officer at Serenity Bay Health said.
“With the policy that will be starting in March, when the nurse practitioner sees those patients, reimbursement will only be at 80%,” Williams said.
Experts say “incident-to” billing has been the standard for private practices in Michigan for years.
In this case, it allows psychiatrists to sign off on nurse practitioners helping with patient care, meaning the work done by a nurse practitioner is billed under their supervisor.
“There are many more nurse practitioners than there are psychiatrists,” Williams said. “So, the access to care will be decreased.”
Because of the move, Williams says staff like hers will have to make changes. She says studies say psychiatry is already a severely understaffed specialty.
“Our office has 2 psychiatrists and we have 8 nurse practitioners,” she said. “Our psychiatrists mostly see the new patients. They provide them with diagnoses and they set up the treatment plan. In order to continue to see new patients and provide care, they have to pass those patients on to nurse practitioners who can follow up with them on a monthly basis, or more frequently.”
Williams also says there could be a trickle down impact when individuals who can’t get into an office end up in the emergency room for help. She worries the reality will also stretch current psychiatrists too thin.
Local 4 reached out to BCBSM.
“In service to our members, Blue Cross Blue Shield of Michigan reviews our payment policies on a regular basis to ensure they reflect the most up-to-date guidance and data,” they say. “This change requires providers to file claims under their own National Provider Identifier. This ensures that providers such as nurse practitioners and physician assistants bill for their services directly, rather than billing through the supervising physician. This will allow them to participate more directly in Blue Cross’ incentive and value-based programs that are at the forefront of our patient-centered care efforts. It also ensures services are delivered by appropriately qualified providers and aligns our policy between Blue Cross and Blue Care Network commercial health plans.”
Local 4 asked Williams what she’d say to the insurance company.
“Right now, it can take up to two months to see a psychiatrist,” she said. “Make these policy changes and see how much longer that becomes.”