Health Law alert by Lamb McErlane PC attorneys Vasilios J. Kalogredis, Esq. and Sonal Parekh, Esq.

On November 2, 2023, CMS finalized several rules which will have extensive implications for U.S. healthcare providers. For the first time, marriage and family therapists (“MFTs”) and mental health counselors (“MHCs”) may enroll as Medicare providers and start billing for their services starting January 1, 2024.

The Calendar Year 2024 Medicare Physician Fee Schedule (“PFS”) final rule prioritizes behavioral health care, supporting family caregivers, and promoting value-based care with an overarching goal of advancing health equity by expanding access to care and services for underserved populations. CMS’s Behavioral Health Strategy aims to support a person’s emotional and mental well-being through their behavioral health care. In line with the Strategy, the rule allows (i) MFTs, (ii) MHCs, and (iii) eligible addiction, alcohol, or drug counselors who meet qualification requirements for MHCs, to enroll as a Medicare provider and bill for their services starting January 1, 2024.

Enrolling in Medicare:

MFTs and MHCs should apply to enroll in Medicare as soon as possible in order to submit claims and get paid for covered items and services. CMS issues step by step instructions on how to “Become a Medicare Provider or Supplier”.

MFTs and MHCs can enroll electronically using PECOS (you must create an account if you do not have one) or on paper form CMS-855I. Providers can find their Medicare Administrative Contractor’s website here and contact information here.

Need more information? Visit CMS’s FAQs or the Medicare Enrollment for Providers & Suppliers webpage.

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Vasilios J. (Bill) Kalogredis, Esq. has been advising physicians, dentists, and other healthcare professionals and their businesses as to contractual, regulatory and transactional matters for over 45 years. He is Chairman of Lamb McErlane PC’s Health Law Department. Bill can be reached by email at bkalogredis@lambmcerlane.com or by phone at 610-701-4402.

Sonal Parekh, Esq., is an associate at Lamb McErlane PC who focuses on healthcare transactional matters and a broad range of healthcare regulatory-related issues on behalf of healthcare systems, physicians, dentists, and other healthcare providers, and is a pharmacist by education and training. Sonal can be reached by email at sparekh@lambmcerlane.com or by phone at 610-701-4416.

*This alert is for educational purposes only and is not intended to be legal advice. Should you require legal advice on this topic or have any questions or concerns, please contact Vasilios J. (Bill) Kalogredis, Esq. or Sonal Parekh, Esq.

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