1) Effective January 1, 2021 there is a new fee schedule. You can find it on Navinet. While the reimbursement for each code has changed (and in most cases dropped), the daily cap has not. Reimbursement for evaluations has dropped significantly. We encourage you to reach out to your provider representative and share your disappointment and then encourage them to eliminate the daily cap and allow us to bill up to 4-5 units for each visit. They need to hear from you!
2) Highmark is getting into the Medicare Advantage business. By now you may have received a contract in the mail. We want to point out that you should be cautious before signing. They do not offer a fee schedule in the contract and make reference to a Highmark Medicare allowance. This is not clear and we’ve asked them on several occasions to provide more detail. In addition, we’ve asked if there is an underlying authorization process – again we are awaiting a response. We encourage you to reach out to your provider representative to get more detail before signing this contract. Accepting a low paying contract negates our years of pushing for better reimbursement.