Mental & Behavioral Health

The post defines ghost networks as insurance directories that appear to list many in-network mental health providers but include disconnected numbers, out-of-network providers, offices not accepting new patients, or unavailable listings. Patients may be delayed, pushed toward out-of-pocket care, or unable to find treatment even though their plan appears to offer access. The post argues that directory accuracy and network adequacy must be enforced.

The post explains that physical therapy assistants work under the supervision of a physical therapist and, in Florida, must be licensed after completing appropriate training and passing the licensure exam. For Medicare billing in a physical therapist private practice setting, direct supervision means the therapist is in the same office suite and immediately available. The post also states that a physician cannot independently hire a PTA unless a supervising PT is present.

The post explains that the American Taxpayer Relief Act of 2012 extended the outpatient therapy cap exceptions process through December 31, 2013. Providers had to use the KX modifier when requesting an exception for medically necessary services. The post also states that claims above the $3,700 threshold would be automatically pulled for prepayment medical review rather than handled through the prior preauthorization process.