Certain physician services in nursing homes and skilled nursing facilities fall under national screens so it is possible that parameters are being developed for psychologists in nursing homes as well. There are most definitely local screens for psychological services. It is a good idea to know the screens for your services and to carefully document why additional services were reasonable and necessary. National screens are of public record in the form of national policies. However, because local screens vary from carrier to carrier and because they change over time, they are not readily available at a national level.
Providers usually learn the screens when their claims are rejected or reduced.
Some carriers provide information on screens upon request or through Internet access. State psychological associations may also have this information. Also services that Medicare does not deem to be reasonable and necessary will not be reimbursed under Medicare. Occasionally, psychologists will find that a claim is denied although the service is clearly a reasonable and necessary covered service. In this case, there may be an error in the HCFA 1500 claim form.