Psychiatric Association

A District Branch of the American Psychiatric Association march 2013

#OMG! @NCPsychiatry Rebrands, Revamps Webpage, Joins Social Media

we also hope that members will find that the “front-end” user experience is easier to navigate, control, and tailor to individual preferences. The new In This Issue platform also allows for increased communication between members NCPA’s Advocacy Efforts Focus on Access to Care and committees via bulletin board PAGE 3 groups, creates E-lists to easily hold NAMI - NC Offers Valuable Patient email conversations, and a establishes a Services social community with Facebook-style PAGE 4 The North Carolina Psychiatric profiles, walls, photo galleries, etc. Annual Meeting Speakers Association makes first major change Announced! to its website since its debut in 2000. Keep Your Information PAGE 15 Current At its November meeting, Executive One exciting feature of the updated Council voted to approve the transition website is the enhanced Find-A-Doctor into a new membership database and tool. The search is primarily used by website redesign; they also approved the public and office staff to locate a rebranding project (see Executive members who are accepting new Director Robin Huffman’s column on patients. The NCPA office receives calls page 7 for more details). Since then, from patients seeking a doctor every NCPA office staff members have day, so this search feature was a big Follow NCPA Online! been busy migrating the previous part of updating the website. membership database to a new The NC Psychiatric Association system powered by the association The old Find-A-Doctor search feature is now on Facebook and Twitter. management software, MemberClicks. typically provided limited results If you’re online, be sure to Like because of the search criteria and the Us at www.facebook.com/ This new system provides an functionality of the site search. For NCPsychiatricAssociation or updated platform for organizing and example, patients would enter in too @NCPsychiatry on Twitter. managing member information, online many criteria, become confused by event registration, website content some search fields or just be intimidated We will be sharing educational management and more. The goal is by the search page’s length. Staff often resources, news, updates for to create a system that offers more fielded calls from patients seeking a members and more. If you have a functionality and is still easy to use – doctor close to home, but the old system smart phone, scan these QR codes basically a more up-to-date system didn’t allow for mapping or searching to follow us immediately! that lets NCPA do more for you, our based on distance. The new Find-A- members. Doctor search allows people to search by zip code, with the optional selection While the new software makes daily of physician gender—the two most operations more efficient in the office, commonly requested search requested Twitter Facebook Continued on page 14... NORTH CAROLINA Psychiatric Association | march 2013 NORTH CAROLINA Psychiatric Association | march 2013 Governor McCrory Announces Aldona Wos, M.D., as Secretary of How NCPA Advocates for You Health and Human Services Debra A. Bolick, M.D., D.F.A.P.A., President

Governor Pat McCrory announced Secretary Wos has both New The North Carolina Psychiatric working to reduce administrative with the new Governor, Speaker in December that Ambassador York and North Carolina medical Association is committed to and regulatory burdens, such as of the N.C. House, and other key Aldona Wos, M.D. would serve licenses; she practiced medicine in advancing the practice of psychiatry prior approval of medications for legislators. Letters of welcome and as the Secretary of Health and for many years before and promoting the highest quality stable patients that keep you from introduction were mailed to all the Human Services. Dr. Wos was born moving to Greensboro. She has care for residents with mental delivering patient care. NCPA newly and re-elected legislators illness, including substance use in , . She earned been a member of the American also supports the inclusion of and to appointed leaders, including disorders—two key provisions in her medical degree at the Warsaw Medical Association, and American our mission. As part of this effort, psychiatry in integrated care and Commissioner of Insurance Wayne Medical Academy, and completed College of Physicians, the Greater we strive to serve as a resource to medical homes. We are committed Goodwin, Secretary of DHHS her internship and residency in Greensboro Society of Medicine and policy leaders in the state. Our to helping small- and medium- Dr. Aldona Wos, and her recent internal medicine and a fellowship the North Carolina Medical Society. legislative efforts vary slightly sized psychiatric practices remain appointment, Carol Steckel, in Pulmonary Medicine in New from year to year, so I wanted to financially viable and available to Director of Medicaid. Meetings York. Her experiences include time From 2004-2006, Secretary Wos take this opportunity to share with treat patients. are being scheduled to formally as a physician in private practice, served as an United States you the 2013 legislative and public meet these leaders and to share our corporate medicine, attending Ambassador to Estonia as an policy priorities approved by your Legislators are concerned about the public policy priorities. physician duties, clinical care, appointment of President George Executive Council. rates of prescription drug abuse teaching and consulting for both W. Bush. and overdose in the state. NCPA Most recently, we have provided The NCPA advocates for improved is helping to develop sensible Secretary Aldona Wos, M.D. hospitals and private industry. a response to the Request for access to medical care by supporting solutions to these problems. We Information (RFI) on Medicaid expansion of insurance coverage have signed on as supporters from the North Carolina DHHS. for the uninsured. One of our of Senate Bill 20, which seeks to An NCPA task force convened most pressing issues is stabilizing provide limited immunity for and prepared an insightful our public mental health system. bystanders who call for emergency comprehensive paper addressing It is crucial that strong medical help in overdose situations and our concerns and recommendations. NCPA also is a member of The leadership and accountability are increase access to the opioid Coalition, an advocacy group that brought back into every level of antagonist Naloxone. advocates for services and supports the delivery system—including for mental health, developmental Executive Editor managing Editor associate Editors DHHS, DMA and the agencies Gun safety and violence, with a disabilities and addictive disease. Jim Michalets, M.D. Robin B. Huffman, Executive Director Kristin Milam, Communications Coordinator that provide care. NCPA has focus on those with mental illness, The Coalition has pooled its Katy Dorman, Membership Coordinator been vocal regarding expansion have received national attention resources to hold several outreach of the Medicaid waiver, which following the recent shooting days for both North Carolina The NCPA News is a publication of the NC Psychiatric Association, 4917 Waters Edge Drive, Suite 250, Raleigh, NC 27606. moves all psychiatric services to tragedies. The organization General Assembly leadership and To update your mailing address or if you have questions or comments about NCPA News, contact Kristin Milam, 919-459-0752 or [email protected] capitated managed care run by supports gun safety initiatives that general members. multiple LME/MCOs across the do not perpetuate stigma about NCPA Executive Council Committees While our Executive Director and Constitutional Committees state. We are concerned that the mental illness. Our Psychiatry President Debra A. Bolick, M.D., D.F.A.P.A. lobbyist have been hard at work Budget President-Elect Ranota T. Hall, M.D., D.F.A.P.A. Harold Carmel, M.D., D.L.F.A.P.A. rapid move to waivers has created and Law Committee continues carrying our concerns forward, Vice President Burt P. Johnson, M.D., D.L.F.A.P.A. Constitution and Bylaws Charles R. Vance, M.D., Ph.D., D.F.A.P.A. situations that hurt psychiatrists— to research the issue, and Robin Secretary Ethics Diana Antonacci, M.D., D.F.A.P.A. there are opportunities for you to Arthur E. Kelley, M.D., L.M. such as nonpayment for services, Huffman has met with law Treasurer Harold Carmel, M.D., D.L.F.A.P.A. Fellowship Elizabeth Pekarek, M.D., D.F.A.P.A. become involved. In April NCPA Assembly Representative Debra A. Bolick, M.D., D.F.A.P.A. Membership Arthur Kelley, M.D., L.M. duplicative contracting processes enforcement officials to discuss our members have the opportunity to Assembly Representative Nominating Ranota T. Hall, M.D., D.F.A.P.A. Stephen E. Buie, M.D., D.F.A.P.A. and administrative burdens. perspective. personally present our issues to the Immediate Past President John H. Gilmore, M.D. standing Committees Further, high administrative costs Past President B. Steven Bentsen, M.D., D.F.A.P.A. Access to Care Task Force Drew E. Bridges M.D., D.F.A.P.A. legislators during two advocacy to run multiple managed care Finally, NCPA wants to stay Councilor at Large Samina A. Aziz, M.D., F.A.P.A. Addiction Psychiatry Tom Penders, M.D., D.L.F.A.P.A. days. We hold “White Coat Community and Public Psychiatry Burt P. Johnson, M.D., D.L.F.A.P.A. involved in the development Councilor at Large Donald T. Buckner, M.D., D.F.A.P.A. organizations reduces the amount Wednesdays” in conjunction with Councilor at Large Daniel L. Johnston, M.D. Cultural Diversity John Shin, M.D. of money available for patient care. of telemedicine in a way that Councilor at Large Venkata “Amba” Jonnalagadda, M.D. Disaster Allan Chrisman, M.D., D.L.F.A.P.A and John Wallace, M.D. strengthens the workforce of our the North Carolina Medical Society. NCCCAP Representative Allan Chrisman, M.D., D.L.F.A.P.A. Legislative Keith McCoy, M.D. This year, White Coat Wednesdays Practice Management As more psychiatrists opt for state. NC Psychoanalytic SocietyRepresentative Rex J. Moody, M.D., D.F.A.P.A. Randy Grigg, M.D., D.L.F.A.P.A. are April 3 and April 17. The events NC Medical Society Representatives B. Steven Bentsen, M.D., D.F.A.P.A. 2013 Program Chris Aiken, M.D. employment, NCPA is keeping an John G. Wagnitz, M.D., D.L.F.A.P.A. Psychiatry and Law Peter N. Barboriak, M.D. eye on the abuses of the “Corporate Members of NCPA have been provide opportunities for meeting Forsyth County Chapter President Technology Chris B. Aiken, M.D., D.F.A.P.A. Gary Peterson, M.D., D.L.F.A.P.A. Practice of Medicine” statute. actively involved in promoting local legislators in Raleigh as a MIT Representative Robin L. Casey, M.D. (UNC-CH) NCPA Representative Palmetto/GBA/Medicare Carey Cottle, M.D, D.F.A.P.A. representative of the NCPA. MIT Representative Nora M. Dennis, M.D. (Duke) NCPA Representative State Employees & Teachers’ Comprehensive We want to ensure that medical these priorities. Several members MIT Representative Richard Gestring, M.D. (ECU) Health Plan Jackson Naftel, M.D., D.F.A.P.A. decision making is in the hands of attended an opening day legislative MIT Representative Ryan G. McQueen, M.D. (WFU) NCPA Representative Department Waiver Advisory Committee physicians. Your organization is Jackson Naftel, M.D. D.F.A.P.A. reception and were able to meet

page 2 page 3 NORTH CAROLINA Psychiatric Association | march 2013 NORTH CAROLINA Psychiatric Association | march 2013 NAMI North Carolina Serves as a Resource for Patients, Psychiatrists For NCPA member Mary Mandell, mental illnesses that are brain NAMI North Carolina has 36 local students who have mental illness at four North Carolina psychiatry have lost their lives to mental illness M.D. NAMI North Carolina is disorders in adults and children, affiliate chapters that consist of the local community college. residency programs to join NAMI- and to help raise funds, combat not just a community outreach including schizophrenia, major family members and individuals NC. In fact, Wake Forest University stigma and promote awareness. organization working to educate depression, bipolar disorder, living with mental illness, friends NAMI also offers programs for has 100 percent participation NAMIWalks is a community-wide the public about mental illness; obsessive compulsive disorder, and professionals. According to family members and friends of among residents, according to Dr. event and NAMI welcomes and it is a compliment to the care panic disorder, attention deficit Dr. Mandell many of the programs individuals with mental illness Mandell. encourages participation from local she provides her patients. “I disorder, autism and pervasive offered by NAMI such as the Family-to-Family businesses, communities of faith, have seen several patients developmental disorder and can provide Education Program. This is a free, Being involved in NAMI doesn’t providers and partners as well as develop confidence and a sense other brain disorders. additional 12-session course on mental illness have to be a lot of work – it can the general community. Bring your of belonging and purpose while NAMI is an support to that seeks to help family members be as simple as sharing NAMI’s family and friends to the celebration participating in NAMI activities,” NCPA has long organization which the family and friends understand the illness, brochures with patients or letting being held on the Dorothea Dix she explained. Dr. Mandell partnered with NAMI and patients provide insights into how to help them know about support groups campus on May 4. serves on the NAMI NC Board of North Carolina in can help psychiatrists she treats. their loved one, as well as strategies available through NAMI. Further, Directors and is a member of the advocacy efforts at help their patients These free for the family to overcome the being a NAMI member allows “I think a lot of psychiatrists have Moore County local chapter in a state level. And in and families... programs difficulties of living with severe psychiatrists to keep up with NAMI a general idea of what NAMI Pinehurst. September, NAMI-NC’s and resources mental illness. (For a full listing of activities, resources, publications is,” said Dr. Mandell. “I want my executive director, Deby have made a NAMI North Carolina Programs, and conferences. colleagues to know that NAMI is NAMI, or the National Alliance on Dihoff, and two NAMI-NC difference in see gray box.) an organization which can help Mental Illness, is a 210,000-member board members (Dr. Mandell and several of her One such activity is NAMIWalks. psychiatrists help their patients strong organization that spans Amy Singleton, M.D., also an patients’ lives. One such patient In addition to targeting patients NAMIWalks brings together and families. I encourage all mental 1,200 affiliate chapters across the NCPA member) met with NCPA’s with Asperger’s Disorder has and family members, NAMI thousands of individuals and health care providers to learn more United States. The nonprofit’s Executive Council to discuss become an instrumental component North Carolina has been seeking supporters to celebrate mental about what NAMI has to offer.” movement focuses on those collaboration. in developing programs to support out psychiatry residents at all illness recovery, to honor those who

NAMI Patient and Family Programs

Family-to-Family Education knowledge, insight, and coping community presentations by Parents and Teachers as Allies: trained in the NAMI Support initiative promoting the idea of Program: This is a free 12 session strategies for living with their trained consumers who can A two-hour mental health Model or offers its own support wellness in both mind and body. course that is open to family illness. They will also develop a show first-hand what it is like education program for school group process, these groups Wellness is an ongoing process members who have a close crisis plan. to live with mental illness, as professionals. It focuses on are designed to reach both of learning how to make choices relative with a mental illness. well as convey a treatment and helping school professionals consumers and their families to that support a more successful, The course includes ways to NAMI Basics: This is a free 6 recovery message. and families within the school fill a need that complements the healthy life. Wellness is about understand and help the person week course for parents or community better understand NAMI Education Programs. the individual; you can decide with the illness, and helps the direct caregivers of children and Young Families Program: Offers the early warning signs of what parts of your life you family overcome the difficulties adolescents (18 or younger) support groups and phone mental illnesses in children NAMI Connection: A recovery would like to change and you can of coping with this family crisis. who are showing symptoms of support from family members and adolescents. Also includes support group program for adults determine your own success. or who are diagnosed with a of children and adolescents who the lived experience of mental living with mental illness that Peer-to-Peer Education Program: mental illness. have a mental illness. It also illness and how schools can best is expanding in communities Visit www.naminc.org for more Consists of ten two-hour classes, offers educational workshops communicate with families. throughout the country. These information. free of charge, taught by a In Our Own Voice: Educates and presentations by trained groups provide a place that team of two who are personally the general public and changes volunteers that help parents Support Groups: NAMI affiliates offers respect, understanding, experienced at living well with attitudes and stereotypes about and child-serving agency know that effective support encouragement and hope. mental illness. The course uses who has mental illness and how professionals better understand groups are a key facet of NAMI’s lecture and interactive exercises those persons look and act. the nature and treatment of grassroots organization. Whether NAMI Hearts and Minds: An to help participants gain This is accomplished through mental illness in children. the affiliate has individuals online, interactive, educational

page 4 page 5 NORTH CAROLINA Psychiatric Association | march 2013 Changes to NCPA’s Logo, Website and More Robin B. Huffman, Executive Director

I like tradition. I like the familiar. I of medicine and the mental health also think our new look will help like print newsletters and the look world. NCPA’s Executive Council NCPA stand out. But even with a of crisp black ink on a printed approved this new logo at our facelift, the work of NCPA for the page. February meeting, just in time for psychiatrists in the state and for this issue of our newsletter and the the patients you treat is the work But this isn’t about me. It is about introduction of our new website. YOU help us do every day. By your you, and how we can maximize the We are proud of it and hope you willingness to serve on committees resources of the North Carolina will be too. We think this logo and Executive Council. By your Psychiatric Association to better represents that psychiatry is part of help in developing relationships meet your needs and provide an evolving health care world that with your local elected officials useful services to your psychiatric is moving toward integrated care, at the county and state levels. By practice and to you. medical homes, and team-based your emails and phone calls to the medicine. NCPA office to let us know what At last fall’s NCPA Annual Meeting is happening in your community we surveyed members and There is more in this issue that and in your practice, so that uncovered a long list of issues of gives the nuts and bolts and things we can better assist you in our importance to members. In trying you need to know about our new conversations at the state level. to develop resources to provide website and database. There will information about those issues be some changes. (I know, change So rest assured, although we have a (CPT coding changes, integrated is hard!) You will receive shortly new look, we are continuing in the care, federal health care reform, a letter with your new login and strong NCPA tradition of serving state public health reform), we password information for the our members. stuffed our website full. So full that website. You will be able it is hard for any of us to find all to change the password to this helpful information! make it one that is easier for you to use and remember. So we redesigned our website, and As with our current website, while we were at it, we did a pretty there is information just for major makeover of NCPA’s “public our members that can only face.” We hope you like it! Better be accessed using your yet, we hope you LOVE IT! password. We will have useful public information, This month, I celebrated my 13th but these members’ only year with the North Carolina resources are benefits of Psychiatric Association. When your membership. I came, I didn’t touch our logo, and only implemented a minor One of the biggest changes tweaking of our newsletter and will be new “online Visit us online. If you’re on Facebook, letterhead. I thought things looked communities” for communication visit our page and “Like” us —and tell good and honored the tradition among NCPA committees and your friends and family to like us too! that I had inherited. But, with the members; we are also reviving our changing times, comes a need to committee listservs as a way for The new www.ncpsychiatry.org is refresh our look. you to be active and stay engaged much more user-friendly and member with committee work from your resources are just a couple of clicks Here’s what we are doing: The most own desks. You’ll even see Twitter away. Check it out today! obvious is—with this newsletter— and Facebook icons. Imagine that! the introduction of a new NCPA logo. One that graphically captures All in all, we think our new website NCPA’s unique position of being will make information of use to an important part of both the house members easier to find. And we

page 7 NORTH CAROLINA Psychiatric Association | march 2013 NORTH CAROLINA Psychiatric Association | march 2013 CPT Coding Update Venkata “Amba” Jonnalagadda, M.D.

The updated codes in the are continuing to contact insurers Please note: If you are billing an E/M Psychiatrists may also choose to • Prognosis; as they become available. If there Psychiatry section of the AMA’s on behalf of our members. We also code along with a psychotherapy bill an initial evaluation with the • Risks and benefits of are questions, please contact us. We Current Procedural Terminology continue to field questions related add-on code, you cannot choose the appropriate E/M code (99201- management (treatment) are here to help. became mandatory for billing and to the changes; below are the top E/M code on the basis of counseling 99205) in place of 90792. options; documentation for all insurers inquiries about billing. and coordination of care. Also, if If you have questions or concerns, effective January 1, 2013. While the you use a “timed” add-on code, 99201 vs. 99211: The new outpatient • Instructions for management please contact NCPA’s office, 919- anticipation building up to these Psychotherapy Codes you cannot use a “timed” E/M code visit code (99201-99205) is used (treatment) and/or follow-up; 859-3370. The APA can also help. changes, which are applied to all as part of the service. when this is the first time you’ve • Importance of compliance Email questions and/or problems There are three timed ever treated the patient or it has services, caused some preliminary psychotherapy codes that are with chosen management to [email protected] or call the HSF anxiety, overall providers continue Evaluation and ManagementNew (E/M)Patient Patient Evaluation Examples been more than three years since (treatment) options; Practice Management HelpLine, to be used in all settings when seeing the patient. to adjust to the changes. By now, psychotherapy is theOffice, only Established The documentation Patient requirements • Risk factor reduction; 800-343-4671. practices have beenwww.psychiatry.org through at least service provided (90832 – 30 for the 90792 are very similar to Counseling and • Patient and family education one or two reimbursement cycles. minutes;CPT® five 90834-digit codes, – descriptions, 45 minutes; and other the data onlydocumentation are copyright 2012 forby the no-longer- American Medical Coordination of Care Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values or related listings are and 90837included in – CPT®. 60 CPT® minutes). is a registered In trademarkavailable of the 90801. American The Medical only Association difference (AMA). Counseling and coordination of Counseling and coordination of NCPA has heard from several addition there are three timed add- is the need to list any medical work care definition encompasses the care are not the same as performing members who have had difficulties IMPORTANT on psychotherapy codes when when billing the 90792. A 90792 following: psychotherapy. with reimbursements. If you are psychotherapy is provided along covers deciding and prescribing The sample progress notes below meet criteria for the specified E/M code, but do not necessarily meet criteria for the multiple other purposes (e.g., clinical, legal) having problems, please contact with an E/M service (90833 – 30 medications in the session, which • Diagnostic results, impressions, We are learning together to of documentation. For illustration, the documentation meets requirements specified by the codes for the exact levels of each of the 3 key components. In practice, Robin Huffman at 919-859-3370 or minutes; 90836 – 45 minutes; and can be one component of the and/or recommended navigate these changes, and will criteria for these codes may be met by documenting only 2 of 3 of the key components at or above the level required by the code. [email protected]. We 90838 – 60 minutes). medical service. diagnostic studies; continue to provide more updates SERVICES SHOULD ALWAYS BE MEDICALLY NECESSARY.

99213 Office visit for a 9-year-old male, established patient, with ADHD. Mild Office visit for a 27-year-old female, established patient, with stable Updated Resources are Available symptoms and minimal medication side effects. depression and anxiety. Intermittent moderate stress. CC 9-year-old male seen for follow up visit for ADHD. Visit attended by patient and 27-year-old female seen for follow up visit for depression and anxiety. Visit mother; history obtained from both. attended by patient. Expanded Problem NCPA has compiled resources for our members, including

HISTORY documentation templates, FAQs, E/M sample patients, and more. HPI Grades are good (associated signs and symptoms) but patient appears distracted Difficulty at work but coping has been good. Minimal (severity) situational sadness Focused (quality) in class (context). Lunch appetite poor but eating well at other meals. (quality) and anxiety when stressed (context). Visit www.ncpsychiatry.org/member-resources and check out the HPI scoring: 3 elements = Brief HPI scoring: 3 elements = Brief “CPT Coding Changes” section.

N/A N/A :

HISTORY PFSH

ROS Psychiatric: denies depression, anxiety, sleep problems Psychiatric: no sadness, anxiety, irritability Updated Information about the new codes and other resources ROS scoring: 1 system = Problem-pertinent ROS scoring: 1 system = Problem-pertinent for providers are also available to APA members online at Const Appearance: appropriate dress, comes to office easily Appearance: appropriate dress, appears stated age Exp. http://www.psychiatry.org/cptcodingchanges. Focused EXAM MS N/A N/A

Problem Problem Psych Speech: normal rate and tone; Thought content: no SI/HI or psychotic symptoms; Speech: normal rate and tone; Thought content: no SI/HI or psychotic symptoms; E/M Patient Examples from the APA (Left) Associations: intact; Orientation: x 3; Mood and affect: euthymic and full and Associations: intact; Orientation: x 3; Mood and affect: euthymic and full and : EXAM

appropriate appropriate; Judgment and insight: good Examination scoring: 6 elements = Expanded problem-focused Examination scoring: 7 elements = Expanded problem-focused The sample progress notes at left meet criteria for the specified E/M code, but do not necessarily meet criteria for the multiple Problem 1: ADHD Problem 1: Depression

Comment: Relatively stable; mild symptoms Comment: Stable MED other purposes (e.g., clinical, legal) of documentation. For Plan: Renew stimulant script and increase dose; Plan: Renew SSRI script at the same dose;

Low illustration, the documentation meets requirements specified by

Return visit in 2 months Return visit in 3 months ICAL MAKING ISION

the codes for the exact levels of each of the 3 key components. Problem 2: Anxiety Complexity

DEC Comment: Stable In practice, criteria for these codes may be met by documenting DEC Plan: Same dose of SSRI only 2 of 3 of the key components at or above the level required : MAKING ISION

Problem scoring: 1 established problem, stable (1); total of 1 = Minimal Problem scoring: 2 established problems, stable (1 for each = 2); total of 2 = Limited ICAL Prob by the code. For other examples, visit www.psych.org/practice/

Data Data scoring: Obtain history from someone other than patient (2); total of 2 = Limited Data scoring: None = Minimal managing-a-practice/cpt-changes-2013 MED Risk Risk scoring: Chronic illness with mild exacerbation, progression, or side effects; and Risk scoring: Two stable chronic illnesses; and Prescription drug management = Moderate Prescription drug management = Moderate

SERVICES SHOULD ALWAYS BE MEDICALLY NECESSARY.

page 8 page 9 NORTH CAROLINA Psychiatric Association | march 2013 NORTH CAROLINA Psychiatric Association | march 2013 HHS Releases Final HIPAA Privacy and Security DSM-5 Now Available for Preorder Rule for March 26 2013 Effective Date Mental health diagnostic manual set for May 22 publication American Psychiatric Association HHS recently released a Final Rule Longevity of the HIPAA Redefining “Breach” and on the HIPAA Privacy and Security Privacy Rule’s Protections Breach Notifications Rule; the effective date for the final The APA is holding a special DSM- The print version of the book, as While the APA advocated for the HHS redefines “breach” and decides rule is March 26, 2013. The APA 5 Train-the-Trainers session at well as a suite of complementary HIPAA Privacy Rule’s permanent against devising a “bright line” is pleased with the Final Rule’s the APA Annual Meeting in San publications (see aqua box), protection of decedents’ health rule for breach notification, arguing inclusion of several additional Francisco and has offered this may be ordered online or by information, HHS has modified a bright line standard would be privacy protections for patients, opportunity for two representatives calling 1-800-368-5777. Visit the definition of “protected health costly and unduly burdensome to including permitting patients to from each district branch to attend www.psychiatry.org/dsm5 for more information” so that the HIPAA implement. To ensure the breach ask for a copy of their electronic the in-depth training. Taking the information. Privacy Rule does not protect the provision is applied uniformly and medical record, enabling patients training for North Carolina are individually identifiable health objectively by CEs and business who pay with cash to instruct Syed Saeed, M.D., D.F.A.P.A. and information of persons who have associates, HHS has removed the Available in May their health care providers to not Mehul Mankad, M.D., F.A.P.A. The been deceased for more than 50 harm standard and modified the make information about their NCPA is planning several DSM- Diagnostic and Statistical Manual of years beyond their deaths. HHS risk assessment to focus more • treatment available to insurers, and 5 trainings across the state over Mental Disorders, Fifth Edition (DSM- emphasizes that this 50-year period objectively on the risk that the requiring health care providers the summer. Watch your inbox for 5) – Guidebook used by clinicians and of protection for decedent health protected health information has who are HIPAA covered entities more information about attending researchers to diagnose and classify information does not supersede or been compromised. Therefore, (CEs) to include within their these in-depth workshops. mental disorders. $199 (hardcover); interfere with state or other laws the Final Rule does not require $149 (paperback) Notice of Privacy Practices (NPPs) that provide greater protection breach notification if a CE or The most recent revision of a statement of the right of patients Additionally, to help people • Desk Reference to the Diagnostic of decedents’ individually business associate, as applicable, Diagnostic and Statistical Manual to be notified following a breach of understand the context for many of Criteria from DSM-5 – Concise identifiable health information or demonstrates through a risk of Mental Disorders (DSM-5) is their protected health information. the changes, the APA has published reference provides quick access to the professional responsibilities assessment that there is a low now available for preorder from a series of articles highlighting the information essential to making a of mental health or other health probability that the protected health American Psychiatric Publishing. changes from DSM-5 to DSM- diagnosis. $69 (paperback) care providers. information has been compromised, DSM-5, which received final 5. This series will continue up • The Pocket Guide to the DSM- Additionally, rather than demonstrate that there approval by APA Board of to publication of the book. The 5 Diagnostic Exam – Clinician’s Blatt Medical Billing Service Inc. HHS would is no significant risk of harm to the Trustees on December 1, 2012, is series began with an overview companion for using DSM-5 in permit CEs individual the guidebook used by clinicians that focused on the development diagnostic interviews. $65 (paperback) Full range of to disclose and researchers to diagnose and process for DSM-5, followed by an Available in August We have over 20 years services including: a decedent’s Culpability for HIPAA classify mental disorders. It is the overview of changes in the diagnosis of experience in  Verify Insurance information to Violations first major revision of diagnostic of neurodevelopmental disorders. • DSM-5 Self-Exam Questions –  Authorization family members HHS broadens the list of persons criteria to be published since The APA also created a DSM-5 Designed to test the reader’s Medical Billing tracking and others who who may be liable for HIPAA 1994. Preorders for the book will web page featuring news updates, knowledge of the new diagnostic  Electronic Claims Services for Mental were involved be fulfilled beginning on the criteria. $65 (paperback)  Post insurance/ Privacy Rule violations to include fact sheets, videos, highlights of Health Providers. patient payments in the care or subcontractors employed by a CE’s manual’s publication date of May changes, and order information. • DSM-5 Guidebook – User-friendly, supplementary guide for psychiatrists,  Patient payment for care business associates. A four-tier 22. Visit www.psychiatry.org/dsm5 for This enables us to psychologists, and other mental statements of the decedent financial penalty structure is set for more information. understand your needs  health practitioners. $70 (paperback) Timely insurance/ prior to death,” breaches deemed serious enough to “This new manual represents the patient follow ups and put processes in unless disclosure warrant a federal-imposed penalty. current science and best practices Available in September  Monthly tracking The manual’s comprehensive counters the of our field providing standard place that will work reports Fines range from $100 to $50,000 per revision process, the first complete prior expressed criteria by which mental disorders • Study Guide to DSM-5 – Companion best for your business.  And more …. violation, with a $1.5 million cap on revision since 1994, has spanned preference of are diagnosed,” said James H. volume for students, residents, and violations of an identical provision over a decade and included clinicians. $70 (paperback) the deceased occurring within a calendar year. Scully, MD, medical director and contributions from more than 1,500 DSM-5 Clinical Cases – Presents Blatt Medical Billing Free internet access individual as chief executive officer of APA. • experts in psychiatry, psychology, patient cases that exemplify the Service Inc. is committed to to our practice known to the CE. Find out more at www.psych.org. “Since the last revision, a wealth social work, psychiatric nursing, mental disorders in DSM-5. $129 management of new research and knowledge excellence and long term, pediatrics, neurology, and other (hardcover); $89 (paperback) software included. has become available. Our hope is personalized relationships. related fields from 39 countries. that by more accurately defining • DSM-5 Handbook of Differential The book’s publication coincides disorders, diagnosis and clinical Diagnosis – Designed for both with APA’s annual meeting in San clinicians and students learning To find out how we can help you, please call us care will be improved and new Francisco on May 18 to 22. psychiatric diagnosis. $87 (paperback) at 919-274-2640 or blattmedicalbilling.com. research will be facilitated to improve our understanding.”

page 10 page 11 NORTH CAROLINA Psychiatric Association | march 2013 Federal and State News Briefs Let Your Voice be Heard; Contact the APA and NCPA with Concerns

We suspect many psychiatrists health and/or substance use Please call or email the are hesitant to “bother” the NCPA services for a patient who has a NCPA office to let us know office with questions or problems plan governed by ERISA and the if you are experiencing that come up in your practice. And federal parity law. Additionally, difficulties enrolling, sometimes you may just forget please copy the APA on the email, billing or working with the that we are here to help you. But APAMemberparityviolations@ new LME/Managed Care that is one of the major purposes psych.org. Organizations. we serve. The NCPA staff is your staff in Raleigh. We represent your Include these details in your emails: issues at statewide stakeholder • Patient diagnosis public mental health system for meetings, we troubleshoot on your • Recommended treatment Medicaid. You’ve read much about behalf, we make delicate inquiries • Insurance company name this in past print and electronic related to policy implementation, • Employer through which the newsletters from NCPA. Please and we write letters on your coverage is provided (if known) call or email the NCPA office to let behalf, many times with the APA’s • Reason for denial (if known) or us know if you are experiencing help. whether no reason was given. difficulties enrolling, billing or It’s ok to submit a redacted copy working with the new LME/ We need your help NOW in of the denial letter. Managed Care Organizations. giving us and the APA feedback Many of these 10 organizations’ on several state and federal issues, Whether the company puts caps Medical Directors are NCPA specifically: whether parity is on the number of visits permitted, members, and they want to hear being properly implemented pulls a file for review after a given the problems their colleagues are in your area, how insurers are number of session is reached, or has experiencing with their agencies. responding to the new CPT codes, refused to pay psychiatrists for the Between NCPA, these Medical and how your practices are faring new psychotherapy add-on codes. Directors and Division of MH/ as the Medicaid waiver expansion DD/SA Medical Director Nena has moved to full capitation. How Are Insurers Handling Lekwauwa, M.D., D.F.A.P.A., we the New CPT Codes? can help resolve many of the issues plaguing you. Let us know! US Labor Department Isn’t NCPA and the APA tried to Hearing Parity Complaints help insurers be prepared for We Are Being Heard The APA has sent us an important the CPT coding changes before notice. Despite the APA hearing they went into effect January 1, In February, the NC Department of complaints from members on a but many companies across the Health and Human Services (DHHS) weekly basis related to the federal country weren’t prepared for the published a Request for Information parity rules not being carried out appropriate response. Please let (RFI) for recommendations to assist appropriate, particularly in ERISA- NCPA know if you are having the DHHS Division of Medical governed plans, the US Labor problems with an insurer-such as Assistance (DMA) in improving Department (DOL) is not hearing requiring double co-pays for the the efficiency and effectiveness of complaints been asked to urge add-on therapy codes, or unusually the state’s Medicaid program. members to go to the DOL website low rates, or denial of codes that to file a complaint against an ERISA are medically necessary. NCPA and NCPA Executive Council tasked plan. Visit http://www.dol.gov/ the APA have taken strong actions the Access to Care Task Force to edsa/aboutebsa/main.html and with a number of insurers and are draft the association response to click on “Consumer Complaints.” willing to do more. the RFI, which it voted to approve in time for it to be hand-delivered It would be most helpful if you Have You Decided Not to to DHHS on March 14, a day before would make a formal email Participate in Medicaid? the deadline. Drew Bridges, M.D., complaint whenever there is an As of March 1, the state is moving D.F.A.P.A., is to be commended for insurer who has denied mental completely to a statewide capitated his work and that of the Task Force.

page 13 NORTH CAROLINA Psychiatric Association | march 2013 NORTH CAROLINA Psychiatric Association | march 2013

...continued from page 1 features by callers. Patients will The majority of edits you will make an assigned username and even be able to sort results based on will be via the Member Home password. The password will be distance. Page under the Member Center able to be changed by the member menu on www.ncpsychiatry.org. after logging on the first time. It’s important that NCPA keeps the From there, you will find tutorials Find-A-Doctor database as up-to- on how to make changes to your If you do not receive the letter that date as possible. It’s not unheard profile and quick links to important means the NCPA office probably of for staff to provide information articles and resources housed on doesn’t have up-to-date contact from the referral database search the website for NCPA members. information for you. Please call the to a patient, only to receive a call Staff members are also able to office to update your information back saying that the information make updates to member profiles, provided was no longer current. One so of course, members may call Planning Underway for the 2013 Annual Meeting of the great benefits of membership in their updates; the NCPA office ...we value your time is our ability to provide your staff can be reached at 919-859- and participation in the & Scientific Session information to patients seeking a 3370. It is strongly suggested that association and want all members log on to the website Asheville | Renaissance Asheville Hotel physician; however, we rely on the to make NCPA your first information provided to make these to confirm their information and September 19-22, 2013 connections. If you are accepting determine if their Find-A-Doctor stop when a professional new patients, please make sure referral information is accurate— question or concern Make your travel plans now! your profile information is current are you included or not included in arises. so our Find-A-Doctor tool reflects the search tool? Is your information The 2013 Annual Meeting & Nationally and Internationally Known Speakers Take your information accurately. accurate for a patient seeking a Scientific Session in Asheville Center Stage at 2013 Annual Meeting! referral? will provide plenty of learning Insight in Mental Illness Marijuana Dependence: Policy Updates Made Easy and receive your login credentials, opportunities and social activities. Joe Goldberg, M.D., D.F.A.P.A. Implications and Advances in Members can also sign up for 919-859-3370. Recently named “Beer City, USA,” Another selling point of the Mount Sinai Hospital Treatment E-lists and adjust communication downtown Asheville is an eclectic MemberClicks database software Kevin Gray, M.D., F.A.P.A. preferences, such as the preferred The behind-the-scenes transition mix of art deco architecture, great is the ease of information sharing Managing Psychotropic Side The Medical University of South method for receiving committee to the new system has been mostly food and drinks, arts and culture. It between members and the Effects Carolina notifications. smooth, with NCPA staff learning lies in the heart of the Great Smoky Association. With a few clicks, Joe Goldberg, M.D., D.F.A.P.A. new software tricks and tips along Mountains with easy access to members can easily update their Mount Sinai Hospital Rational Use of Antipsychotic Login Information Sent the way. We want to pass along hiking and rafting, the beautifully profiles to include current contact Medications for Schizophrenia: Separately these tips and tricks to members scenic Blue Ridge Parkway, information, Find-A-Doctor Innovative Interviewing Techniques A Maintenance of Certification so that members’ transitions into Biltmore Estate and more! information, committee information Around the time members receive for Moving from Medication (MOC) Workshop the new website platform are as and communication preferences. this issue of NCPA News, a separate The lineup of nationally-recognized Nonadherence to Medication Joe McEvoy, M.D. seamless as possible. For help Likewise, NCPA staff can easily mailer should also arrive in speakers and opportunity to make Interest Duke University with logging in, updating profile send notices, set up groups, update mailboxes. This letter will contain professional connections is the Shawn Shea, M.D. information, or anything else, member profiles and more. login credentials for the member to main reason to attend this year’s Dartmouth College Update on CPT Coding please contact NCPA, 919-859-3370 use on www.ncpsychiatry. conference, but spending time in Venkata “Amba” Jonnalagadda, or [email protected]. org, including Asheville and taking in all the city Top 10 Research Findings of the M.D. has to offer is a close second! Past Year Greenville, NC Throughout this project, the goal Sy Saeed, M.D., D.F.A.P.A. has been to develop a database and Make your travel arrangements East Carolina University Update on DSM-5 website that allows office staff to now! The Asheville Renaissance Sy Saeed, M.D., make NCPA as helpful and useful Hotel is reserving a block of rooms Asperger’s Disorder D.F.A.P.A. to our members as possible— for the Annual Meeting. Mention Christopher McDougle, M.D., East Carolina we value your time and the NC Psychiatric Association to D.F.A.P.A. University participation in the association Registration receive the discounted room rate of Lurie Center for Autism at and want to make NCPA your $159 per night; reservations must be Massachusetts General Hospital Opens in June! first stop when a professional made by August 26, 2013 to receive question or concern arises. the discount. Bipolar Disorder: A Personal Perspective To make reservations, contact Norma-Jean Wilkes Marriott at 800-468-3571.

page 14 page 15 North Carolina Psychiatric Association A District Branch of the American Psychiatric Association

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