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The article reports on the reimbursement for telephone sessions conducted by managed care organizations (MCOs) and commercial health plans with patients. Providers and provider organizations believe that they should be reimbursed for telephone sessions with patients, however, this article presents the reasons why MCOs and health plans will not pay for telephonic sessions.

The article discusses the coverage of family and marital therapy by managed care organizations in the U.S. in 2006. While managed care organizations generally recognize family and marital therapy as a vital modality in the treatment of certain individuals, they need to enforce coverage rules when managing the health plans of other entities. Thus, they deny family and marital therapy as non-covered services for other patients in some cases.

The article discusses psychotherapy notes withheld by managed care organizations (MCO). MCO and other insurance companies sometimes require chart notes before deciding on a reimbursement. These chart notes hold confidential information of patients. Keeping confidentiality of these records is the big challenge for providers. However, most providers do it by distinguishing psychotherapy notes from medical or treatment notes and releasing the later to MCO instead of the confidential files.

The article discusses issues concerning the medical reviews required by managed care organizations (MCOs) and insurance companies and whether they can be done after rather than during treatment. If reviews are not read until after treatment, MCOs and insurance companies are not aware of the services until they receive the claim. If reviews are done retrospectively, the MCOs could audit the charts and the documentation, find discrepancies, and possibly rescind authorization.

Reports on the role of managed care organizations in determining whether services are medically necessary in the U.S. Likelihood of provider organizations to be reimbursed for behavioral health services to managed care patients; Requirement that clinicians note a patient's Global Assessment of Functioning score; Consideration of the endpoint of treatment to be when a patient is capable of tolerating his or her symptoms.

Focuses on the phone etiquette during managed care review. Use of written reports by managed care organizations (MCOs); Process of telephone reviews; Effect of handling phone reviews to MCOs. INSET: A Message from the Editor.

Looks into the necessity of managed care as a factor for revenue increase plans by behavioral health providers in the U.S. Demand seen in the use of managed care by the public; Importance of managed care organizations among the providers; Key in maximizing reimbursement; Need for the providers to understand medical necessity.

The article presents the 14 rules for chemical dependency service providers to be paid well by managed care organizations (MCO). The rules are set to help a chemical dependency service provider collect a maximized reimbursement from an MCO. This guides a provider to the right strategies that help attend to the exact needs of an MCO.

The article reports on the likelihood for behavioral health providers and provider organizations in the U.S. to receive denials from managed care organizations and insurance companies. Prevention is a better approach to denials. When denials do happen, the appeal process is a nice approach to reverse them and get reimbursed.