[B-0]22181[B-1]
[B-2]With a view to providing immediate and comprehensive care to beneficiaries regarding conditions requiring clinical psychology services, in December 2020, the Health Insurance Agency included these services in the GHS service package.[B-3] [B-4]Among other things, Clinical Psychologist services are for serious cases of patients whose condition significantly affects their functioning for a long period of time, or there is a sudden decline in their functioning due to certain conditions/conditions.[B-5] [B-6]Each beneficiary may have access to a clinical psychologist of their choice if referred by a Personal Physician or Specialist participating in the GHS, but not directly. The General Health System 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 care professional to whom they were initially referred [B-7][B-8][B-9] More specifically: [B-10][B-11] [B-12]Adult patients may receive up to 18 treatments, while children and adolescents may receive 24 treatments per year. These numbers are for all diagnoses covered by these services combined.[B-13] [B-14]In cases of patients where the clinical psychologist and physician determine that more treatments are needed, then they must jointly submit a request for a greater number of treatments which, if adequately documented, will be evaluated by the Agency.[B-15] [B-16][B-17] Visits and Referrals[B-18][B-19] [B-20]The number of treatments reimbursed by the GHC, depending on the beneficiary's diagnosis, is shown 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-21] [B-22]Currently there are 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.[B-23] [B-24]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.[B-25] [B-26]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 he or she is entitled, as defined by the Agency.[B-27] [B-28]It is also at the discretion of the provider to serve the patient at home, as it is not included in the agreed package of services. 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.B-29] [B-30]With respect 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 time span within the same day to ensure that quality health care services are provided to beneficiaries.[B-31] [B-32]Another parameter that arises 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 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 hospitalization in a GIS-contracted hospital, those services are reimbursed according to the DRG coding system in which they are included.[B-33] [B-34] (MB/IC)
[B-35]Contents of this article including associated images are owned by [B-36]PIO[B-37]
Views & opinions expressed are those of the author and/or [B-38]PIO[B-39][B-40]
[B-41]Source[B-42][B-43]
[B-2]With a view to providing immediate and comprehensive care to beneficiaries regarding conditions requiring clinical psychology services, in December 2020, the Health Insurance Agency included these services in the GHS service package.[B-3] [B-4]Among other things, Clinical Psychologist services are for serious cases of patients whose condition significantly affects their functioning for a long period of time, or there is a sudden decline in their functioning due to certain conditions/conditions.[B-5] [B-6]Each beneficiary may have access to a clinical psychologist of their choice if referred by a Personal Physician or Specialist participating in the GHS, but not directly. The General Health System 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 care professional to whom they were initially referred [B-7][B-8][B-9] More specifically: [B-10][B-11] [B-12]Adult patients may receive up to 18 treatments, while children and adolescents may receive 24 treatments per year. These numbers are for all diagnoses covered by these services combined.[B-13] [B-14]In cases of patients where the clinical psychologist and physician determine that more treatments are needed, then they must jointly submit a request for a greater number of treatments which, if adequately documented, will be evaluated by the Agency.[B-15] [B-16][B-17] Visits and Referrals[B-18][B-19] [B-20]The number of treatments reimbursed by the GHC, depending on the beneficiary's diagnosis, is shown 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-21] [B-22]Currently there are 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.[B-23] [B-24]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.[B-25] [B-26]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 he or she is entitled, as defined by the Agency.[B-27] [B-28]It is also at the discretion of the provider to serve the patient at home, as it is not included in the agreed package of services. 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.B-29] [B-30]With respect 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 time span within the same day to ensure that quality health care services are provided to beneficiaries.[B-31] [B-32]Another parameter that arises 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 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 hospitalization in a GIS-contracted hospital, those services are reimbursed according to the DRG coding system in which they are included.[B-33] [B-34] (MB/IC)
[B-35]Contents of this article including associated images are owned by [B-36]PIO[B-37]
Views & opinions expressed are those of the author and/or [B-38]PIO[B-39][B-40]
[B-41]Source[B-42][B-43]
