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New Medicare Billing Rules: What MFTs, MHCs, and IOP Providers Need to Know

Client Alert

Starting January 1, 2024, Medicare began covering services provided to Medicare beneficiaries by marriage and family therapists, mental health counselors, and Intensive Outpatient Program (IOP) services. With this change, Medicare has become the primary payer for these services. 

To allow providers time to enroll in Medicare, the Ohio Department of Medicaid (ODM) and MyCare Ohio plans have continued to pay claims for these services for Medicaid enrollees with dual Medicare and Medicaid eligibility through June 30, 2024. Once providers are enrolled with Medicare, claims must be submitted to Medicare before the provider seeks cost-sharing reimbursement from Medicaid.

In compliance with these updates, ODM recently announced updates to its Medicare and Third-Party Liability Bypass List, effective July 1, 2024. The Bypass List, organized by procedure code, indicates which provider types may bypass Medicare and bill Medicaid directly. The list has been updated to reflect the small set of provider types now eligible to bypass Medicare.

Please contact BMD Healthcare Member Daphne Kackloudis at dlkackloudis@bmdllc.com or Attorney Jordan Burdick at jaburdick@bmdllc.com with any questions.


I Went to Bed and the Rules Changed: the Corporate Transparency Act is Back on Hold

The United States Court of Appeals for the Fifth Circuit ordered on December 26, 2024 that in an effort to “preserve the constitutional status quo” while it considered the Federal Government’s appeal, it vacated the prior order for a stay of the nationwide injunction pending appeal entered on December 23, 2024, and reinstated the preliminary injunction enjoining enforcement of the CTA and its corresponding Reporting Rule.

Telemedicine Flexibilities Extended to March 31, 2025

The American Relief Act of 2025 extends key telehealth flexibilities through March 31, 2025, originally enacted during the COVID-19 Public Health Emergency (PHE). These flexibilities remove geographic and originating site restrictions for Medicare patients, expand the list of qualified practitioners, and allow for audio-only services and telehealth mental health care without in-person requirements. Although this extension is temporary, it provides continued access to essential healthcare services. Congress will need to pass permanent legislation to solidify these changes beyond March 2025.

Corporate Transparency Act Is Back in Effect: Are You Ready?

On December 23, 2024, the Fifth Circuit Court of Appeals reinstated the filing requirements under the Corporate Transparency Act (CTA), overturning a prior injunction. Businesses now have updated deadlines to file initial beneficial ownership information reports with the Financial Crimes Enforcement Network (FinCEN), based on their registration date. Affected companies must comply with these new deadlines, which vary depending on when the company was created or registered.

Checklist of Legal Considerations for a Med Spa

Checklist of key legal considerations for a med spa providing a broad overview of certain state and federal legal requirements.

Understanding Ohio House Bill 660: A Game-Changer for Student-Athletes

Ohio House Bill 660 is set to reshape Name, Image, and Likeness (NIL) agreements for student-athletes by allowing direct compensation from universities and providing greater financial opportunities while preserving amateur status. The bill simplifies the regulatory framework, introduces safeguards, and creates challenges and ethical considerations for stakeholders.