MAAPPN Welcomes New Committee!
Insurance Committee Launch: At the MAAPPN Member meeting on Wednesday, January 22, 2025, Gretchen Berkowitch announced the formation of the MAAPPN Insurance Committee . The Committee is complosed of members who will work on establishng working relationships with insurance companies based on a liaison model used by MAAPPN since the 1990’s.
Third Party Payer Issues: In recent years, payers have largly “gone dark” in refusing to appoint liasons to meet with MAAPPN and expressing a lack of interest in helping Psych APRN providers navigate questions and concerns as these come up. Additionally, payers have shown persistent ignorance as to laws such as the STEP Bill signed by Gov Baker on Nov 1, 2022 that states prior auth decisions need to be completed in 1 to 3 days. Further, payers regularly engage in antibusiness practices by refusing to reimburse APRNS for orders if not co-signed by physicians, slow walking payment, rate reimbursement errors, audits with no feedback, clawbacks dating back over 12 months, and lack of transparency in publishing medical necessity criteria as well as rates for various providers. These practices prevent patient access to appropriate care, isolate providers, count on provider inattention, reduce fair reimbursements as well as prevent appropriate rate negotiations. These are expensive and burdensome for Psychiatric APRNs.
Committee Limitations: While the duties of the Insurance Committee have yet to be detemined, one thing that the Committee WILL NOT be able to do is engage in rates negotiations. This activity solidly remains as the duty of the provider. All rate negotiations must be conducted individully by APRNs.
Take Away Advice: Gabrielle Abelard, offered a slide deck on billing How to’s in todays climate. Abelard, an expert on billing, coding and third party payer processes, advises Psych APRNs to keep copies of their rate agreements so that when reimbursement errors occur they can confront the errors with data.
Gretchen can be reached on the listserve or at gretchenb.aprn@hushmail.com
Topic: MAAPPN Insurance Meeting
Time: Jan 29, 2025 10:00 AM Eastern Time (US and Canada)
Join Zoom Meeting: https://us02web.zoom.us/j/82211806691?pwd=m9aHSOeQaVEt3HuHakEoZ74aFaugQa.1