Each beneficiary may have access to a clinical psychologist of his or her choice if referred by a Personal Physician or Specialist participating in the GSCS, but not directly, according to an OAS fact sheet. The General Health System, it adds, covers a specific maximum number of sessions per diagnosis and per beneficiary per year, and there is an option for each beneficiary to change the health professional to whom he or she was initially referred.
More specifically, as noted, adult patients may receive up to 18 treatments, while children and adolescents may receive 24 treatments per year. These numbers are for a combined total of all diagnoses covered by these services.
In cases of patients where the clinical psychologist and the doctor consider that they need more treatments, they will have to submit a joint request for a higher number of treatments which, if sufficiently documented, will be evaluated by the Agency.
Visits and Referrals
According to the OAS, the number of treatments reimbursed by the SHI, depending on the beneficiary's diagnosis, is listed in the tables of covered diagnoses. At this time, the computer system does not limit the number of referrals that can be issued, but only specifies whether the referral has been used. However, if a physician issues a referral to a patient who has exceeded the maximum number of visits, the referral will not be valid and will not be reimbursed.B-13]
Note that there are currently two types of referrals, short-term and medium-term. A short-term referral is issued for 3 treatments and has a 6-month time frame to be executed. A medium-term prescription is issued for 6 treatments and has a time limit of 6 months to be fulfilled. Each referral is valid for a single diagnosis.The total number of each beneficiary's visits to a Clinical Psychologist is now available through the computer system and relates to visits made to either the same or a different provider. The number of visits for each patient is updated at each change in time. The treatments a beneficiary is entitled to receive under the GHC are calculated from the beginning of each calendar year.Where a beneficiary does not hold or produce a valid referral then they are deemed to be receiving services outside of the GHC framework. The provider has the option to accommodate the beneficiary by informing the beneficiary of his or her financial obligations at the outset. The same applies in cases where the beneficiary has exhausted the maximum number of visits to which the beneficiary is entitled, as determined by the Agency.B-19]It is also at the discretion of the provider to serve the patient at home, as it is not included in the agreed service package. In cases where the beneficiary's condition is such that home care is required, the provider should note this information in the clinical notes. In all cases, one of the existing activities should be used. It is important to note that, any home visits will likely include additional reimbursement outside of the GHS framework.
With regard to weekend services, the Health Insurance Agency does not specify the days/hours of operation for each provider. However, it is important that claims have a reasonable total length of time within the same day to ensure that quality health care services are provided to beneficiaries.
Another aspect that arises, the OAS reports, is the instances of clinical psychology services being provided through GIS in hospitals not contracted with the OAS for inpatient cases. In cases of a patient who is hospitalized in an inpatient facility not contracted with OAS that does not have a referral for clinical psychology services either, then the provider may continue to offer services outside of a GIS setting. If services are provided during a beneficiary's inpatient stay in a GIS-contracted hospital, those services are reimbursed in accordance with the DRG coding system in which they are included.B-25]
Cyprus Times
.Views & opinions expressed are those of the author and/or Cyprus Times
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