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

Client Alert
July 9, 2024

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.

MedicareMedicaidOhio Department of MedicaidHealth LawDaphne KackloudisJordan Burdick
Client Alert

CLIENT ALERT: Will Ohio Recognize a Biddle Claim in a Post-HIPAA World?

October 17, 2019OHIO SUPREME COURT WILL HEAR CASE INVOLVING CLASS ACTION FOR ALLEGED HIPAA VIOLATIONS: Will Ohio Recognize a Biddle Claim in a Post-HIPAA World?Client Alert

CLIENT ALERT: Proposed New Rules to both the Stark Law and the Anti-Kickback Statute

October 14, 2019On October 9, 2019, as part of the “Regulatory Sprint to Coordinate Care,” the Centers for Medicare and Medicaid Services (“CMS”), along with the US Department of Health and Human Services, Office of Inspector General (“OIG”), proposed new rules to both the physician self-referral law (“Stark Law”) and the Anti-Kickback Statute (“AKS”). Rule changes are aimed at fostering innovative arrangements for coordinating care consistent with a shift to a value-based system. Both proposed rules are expected to be published to the Federal Register on October 17, 2019. Public comments are due 75 days after publication.Client Alert

CLIENT ALERT: New Overtime Rule Raises Minimum Salary Requirements and Other Changes to the Fair Labor Standards Act

September 24, 2019Today, the U.S. Department of Labor (DOL) issued its Final Rule updating the regulations under the Fair Labor Standard Act: Effective January 1, 2020, employees who make less than $35,568 are now eligible for overtime pay under a final rule issued by the U.S. Department of Labor (“DOL”). The DOL expects 1.3 million workers to become newly eligible for overtime by updating the thresholds. The new rule will raise the salary threshold to $684 per week ($35,568 annualized) from $455 per week. This means that even if your employee qualifies under one of the overtime exemptions, if the employee is not earning at least $684/week, the employee will be eligible for overtime and minimum wage requirements.Client Alert

CLIENT ALERT: BWC issuing $1.5 billion in premium refunds to Ohio employers

July 9, 2019The Ohio Bureau of Workers’ Compensation (BWC) has now reported that the Board of Directors approved a proposal to send $1.5 billion of the agency’s revenues to Ohio employers covered by the BWC system.Client Alert

CLIENT ALERT: Medicare Providers having multiple locations should verify and revalidate their address information to avoid claim denials

June 4, 2019MLN Matters SE19007 “Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations” notifies providers that Medicare is now requiring the exact match of all addresses for practice locations that are listed on provider claim submissions to Medicare.
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