What Do Therapists Need To Do About Medicare? Opting in or out for 2024: An interview with Joy Alafia, CAE

Curt and Katie interview Joy Alafia, Executive Director of California Association of Marriage and Family Therapists, on the journey for MFTs and Counselors to become eligible to be Medicare providers. We look at the high-level tasks that every therapist needs to take. We also talk about the decision-making process for whether you should opt in or opt out, providing some basic guidance and resources on the steps you need to take now.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode, we talk about MFTs and Counselors becoming Medicare Providers

Curt and Katie have spent hours in advocacy efforts for MFTs and Counselors to become Medicare providers through their past involvement in the California Association of Marriage and Family Therapists (CAMFT). And it’s finally gone through! We asked Joy Alafia to come join us to discuss this journey as well as what therapists need to do now that we’re eligible to be Medicare providers. We answer the following questions and have a step by step guide in our show notes at mtsgpodcast.com:

What was the process for MFTs and Counselors to be included in Medicare?

Now that Marriage and Family Therapists and Counselors are eligible to bill Medicare, what do we need to do?

What do therapists need to do if they would like to Opt In to provide Medicare services?

What do therapists need to do if they would like to Opt Out of billing Medicare?

What should therapists consider when deciding whether to take Medicare?

·      Clinical specialty – if you work with folks 65 and older or with disabled folks, you will want to strongly consider taking Medicare as these clients are typically eligible and would like to use their insurance

·      Access – if you have the ability (i.e., space in your caseload) to see Medicare patients, there is a huge need for providers who accept this insurance

·      Credibility – there is increased credibility as a provider when you are able to take Medicare

·      Rates – check out what the rates are for the areas where you see clients. To do so, look for your locality on the Physician Fee Schedule and multiply the rates by 75% if you are a masters level provider. If the rates are sufficient, you will consistently get clients and will consistently get paid. If the rates are not sufficient for your business, you will want to consider opting out and remaining private pay for these clients.

·      Documentation requirements – the documentation requirements are similar for most insurance plans, especially Medicaid. If you’re able to keep clean, efficient documentation, this should not be a deterrent for taking Medicare

·      Billing complexity – you will want to make sure to take trainings available (see below) to understand how you will need to bill this insurance plan and/or hire a biller who does

·      Consistency and recession-proofing your practice – Medicare is known to pay consistently and provide a lot of clients for your practice. As the population ages, this will be a larger and larger portion of the folks seeking mental health services. You may want to consider taking Medicare.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together LOTS of resources mentioned in this episode and put together some handy-dandy links.

California Association of Marriage and Family Therapists (CAMFT)

California Association of Marriage and Family Therapists (CAMFT)

CAMFT’s Medicare Corner (for CAMFT members)

CAMFT’s Medicare Webinars

A TON of other Resources can be found on our website at mtsgpodcast.com.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

Our Linktree: https://linktr.ee/therapyreimagined

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/