Psychiatric practice drops MaineCare

Posted Oct. 17, 2010, at 9:52 p.m.
Last modified Oct. 19, 2010, at 3:13 p.m.

BANGOR, Maine — A Bangor psychiatric practice that serves thousands of area residents will stop seeing MaineCare patients next month, citing an untenable reduction in payments from the MaineCare program.

MaineCare is the name of Maine’s Medicaid program for low-income and disabled patients. It is funded with both state and federal dollars.

A state official says the payment reduction at Bangor Psychiatric Associates simply corrects a billing error that shouldn’t have existed in the first place.

Psychiatric nurse practitioner Michelle Henneberry, the owner of Bangor Psychiatric Associates on State Street and one of five psychiatric nurse practitioners who work there, said Friday that when the state switched in September to a new computer billing and record-keeping system for MaineCare, the practice’s billing status was downgraded.

Instead of getting paid 100 percent of allowable charges for the evaluation, counseling and medication management services they provide, the practitioners now are being paid only 60 percent of the allowable amount, she said.

That means, for example, that a 30-minute visit that previously would have generated a $70 MaineCare payment now brings in just $42, Henneberry said. The loss in revenues is too great to absorb.

“We just can’t do it anymore,” Henneberry said.

In Maine, nurse practitioners are allowed to practice and prescribe independently without the supervision of a physician. But reimbursements to nurse practitioners are lower than those paid to physicians, said Brenda Harvey, commissioner of the Maine Department of Health and Human Services. The new rates being paid to Bangor Psychiatric Associates are appropriate, she said, and it’s up to Henneberry and her colleagues whether they want to continue participating in MaineCare.

“We have corrected who they are, and their claims are being processed correctly,” she said Friday. DHHS staff is working with other providers in the area to facilitate the transfer of MaineCare patients from Bangor Psychiatric Associates to new providers, Harvey said.

Henneberry estimated that there are about 5,000 regular patients at Bangor Psychiatric Associates, about half of whom are enrolled in MaineCare. She said the MaineCare patients would be referred to nonprofit clinics in the area for mental heath services. Henneberry and her sister, psychiatric nurse practitioner Cathleen Barrett, will continue to serve patients with private insurance, retaining one registered nurse and one other employee from the current practice. The three other nurse practitioners and several other employees at Bangor Psychiatric Associates are exploring other options, she said.

Bangor Psychiatric Associates was formerly known as the offices of psychiatrist Takeo Kawamura, who voluntarily relinquished his medical license in 2008 after allegations of professional misconduct. Also in 2008, the practice was investigated for allegations of fraudulent billing practices. For the past two years, the practice has been staffed only with nurse practitioners, Henneberry said.

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