Insurance Resources
NYSPA's Insurance Committee's Avenues for Seerking Help with Insurance Issues guide
NYSPA provides insurance resources as part of our commitment to allow members access to the most up-to-date information possible to support their practices. We hope this section will prove to be an invaluable tool and daily resource.
The information is regularly, addressing the most frequently asked and discussed topics on NYSPA’s listserve, and calls received at Central Office. Use the following link to access the weekly topics highlighted in the NYSPA Friday Flash newsletter in the 'Just Ask Me" section. We invite members to share their knowledge and experience with colleagues by sending suggestions and new information to This email address is being protected from spambots. You need JavaScript enabled to view it. .
This site also allows members to learn more about NYSPA's Insurance Committee and how they are helping shape the future and protect your interests as a psychologist.
Please note: you must be logged in as a member to view member-only links. If you are not a current member, please join us!
CPT codes for Psychologists, Psychiatrists, and LCSWs
CPT codes for Psychologists, Psychiatrists, and LCSWs compiled by Health Assets Management, Inc.
Physician Quality Reporting System (PQRS)
Quick Reference Guide for PQRS measures, procedure codes, and G-codes - APA Practice Central has put together an easy reference chart of G-codes for you to use once an eligible patient and measure have been identified.
Health Insurance Claim Form: This is a sample claim form for PQRS reporting.it includes the proper placement of the G codes.
Reporting Options 2013: This paper describes the PQRS reporting system for Medicare. It is the result of many folks working to produce a user friendly document with accurate information. Included are the measures open to psychologists. There is also a sample claim form with examples of G code placement.
More Articles...
- Medicare Enrollment Forms
- 2011 Medicare Fee Schedules Posted on NGS Website
- Reprocessing Claims Affected by the Affordable Care Act and 2010 Medicare Physician Fee Schedule Changes
- New ACO Rules Outline Gains And Risks For Doctors, Hospitals
- Medicare Payments Reduced for 2011
- NGS Medicare Link
- How To Opt Out of Medicare
- Sample CMS-1500 Form for Medicare (NGS) Claims
- Governor Cuomo Announces Department of Financial Services Investigation into Out-of-Network Medical Costs Affecting New Yorkers Across the State
- New York State Department Of Health Standard Clauses For Managed Care Provider/IPA Contracts
- NYS Workers Compensation - Workers' Compensation Board Mandates Electronic Claims Filing Process (eClaims)
- Recently Issued or Revised Worker's Compensation Board Forms
- New York Medical Treatment Guidelines
Subcategories
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CPT Codes/Health and Behavior Codes
CPT (Current Procedural Terminology) codes are numbers assigned to every task and service a clinician may provide a patient including medical, surgical and diagnostic services. These codes are then used by insurers to determine amount of reimbursement that a practitioner will receive for services rendered.
On January 1, 2013 new psychotherapy CPT Code have replaced codes that most psychologists have heavily utilized in the past. Please familiarize yourself with what the old code was and what the new code is that replaces it. Click here to view the code changes. Please stay tuned to how managed care companies will be executing these new codes.
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Fair Health
This independent, not for profit organization was formed in 2009 with the mission to ensure fairness, accountability and transparency in out of network reimbursement to clinicians.
- Health Care Reform
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HIPAA
This resource provides you with documents and articles related to HIPAA. The acronym stands for Health Insurance Portability and Accountability Act. This Act provides regulations for use/ disclosure of an individual’s health information. The Rule defines how covered entities use individually identifiable health information, how it can be disseminated and what steps must be taken to protect the consumer.
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Insurance Committee Minutes
Minutes of NYSPA's Insurance Committee.
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Just Ask Me Insurance Solutions
Deanna Stephenson has published "Just Ask Me" articles in the Friday Flash, NYSPA's electronic newsletter. The source of these articles are from NYSPA member questions that are forwarded to Central Office. An archive of articles separated by topic can be accessed from the menu to the left or in the Insurance Resources / Subcategories section. **you must be logged in as a member to access these files.**
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Medicare
Medicare remains a large player for the business of psychology. Many of their policies and procedures set the standard for all other billing and administrative practices in the insurance world. It is imperative whether you are a provider with Medicare or you “opted out” to understand all the nuances with this entity. The following information will inform you on how to use a CMS- 1500 billing form, how to ‘opt out of Medicare”, Medicare reimbursement as how to access Medicare Local Coverage Determinations and enrollment forms.
- Medicaid
- New York Health Care
- New York Regulations
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Parity
The interim rule was put in place but a final rule has not been set to date. Please note that where ever state rules are weaker the federal rule will apply and visa versa. New York does have strong parity rules named after 13 year old Timothy O’Claire (Timothy’s Law).
An Employer’s Guide to the Mental Health Parity and Addiction Equity Act
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Worker's Compensation
Information regarding Worker's Compensation.
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Avenues for Seeking Help with Insurance Issues guide
This guide, developed by NYSPA's Insurance Committee in April 2013, will help you most efficiently work through any insurance issues.