Advice on Contract’s With Managed Care Programs

OPEN MINDS The Behavioral Health & Social Service Industry Analyst Industry News William H. Ayres, M.D., Past President of the Northern California Psychiatric Society, has offered some advice to therapists when contracting with managed care programs. He advises that when reviewing the managed care contract, providers should determine: The rate that will be paid for each CPT code. Which CPT codes are not reimbursable. Which diagnoses (DSM-III-R or ICD-9-CM) are not reimbursable. If there is a ‘withhold’ (a percentage of the reimbursement rate that is held back in a risk-sharing arrangement) and the amount . . .