Medicare Policy Update December 2023

(See the end of the email for the bullet-point summary.)

Hello TAMFT Members and friends!

We hope 2023 is coming to a productive and positive conclusion for you all! As many of you have heard, LMFTs will be eligible to bill Medicare as of January 1, 2024, provided they have properly enrolled. While each clinician must decide how this change will affect their practice, the TAMFT Board believes this to be great news for the profession overall. As with any legal change, however, there are bound to be some surprises and this change is no different. 

First and foremost, clinicians who decide not to enroll to be a Medicare provider CANNOT simply practice as usual. EVEN IF YOU DO NOT PLAN TO ENROLL AS A MEDICARE PROVIDER, YOU MUST OPT OUT OF MEDICARE. Clinicians cannot ignore this change.

According to The Social Security Act (Section 1848(g)(4)), a service provider must either opt out of filing claims for Medicare beneficiaries OR become a Medicare provider. The consequences of failing to do either are serious. If a clinician privately contracts with a Medicare beneficiary who then submits a superbill, Medicare may penalize clinicians who do not opt out. This could result in a penalty of as much as $2000 per violation. Therefore, clinicians could be in violation and not even know it.

To avoid such violations, providers who do not wish to enroll with Medicare MUST opt out. However, some insurance contracts may require eligible clinicians to be enrolled in Medicare. Choosing to opt out could be a violation of the contract, and the insurance company could drop the clinician for non-compliance. 

LMFTs need to decide whether they are going to enroll to become a Medicare or not. This is a personal choice that has many factors. Please do your due diligence when making this decision, including consulting existing insurance agreements. If a clinician wants to learn more about enrolling in Medicare and integrating it into their practice, AAMFT has put together some informative resources HERE, including a series of webinars, with information that LMFTs should know.

If a clinician wants to opt out, however, the clinician must complete and submit an opt-out affidavit for their state. (The opt-out affidavit for Texas LMFTs can be found HERE.) The affidavit should be sent to the address at the top of the form, mail or fax only. The clinician will then be opted out of the Medicare program for a mandated two years. The opt-out is automatically renewed every two years. 

The need for an opt-out came as a surprise to the board in recent days, but this should be done before the beginning of 2024 to avoid inadvertent penalties.