The American Psychiatric Association is committed to achieving fair and adequate reimbursement for psychiatrists’ services and helping psychiatrists successfully participate in quality performance programs. The Department of Reimbursement Policy advises federal agencies, assists with other advocacy, and educates APA members regarding quality, coding, and federal reimbursement policies and issues. These policies involve mental health and substance use services provided by psychiatrists, hospitals, and health centers under Medicare, Medicare Advantage, Medicaid, and other federal programs.
Reporting to the Director of Reimbursement Policy, the Associate Director of Payment Policy will be responsible for providing expertise, advocacy, and member education regarding payment policies and payment reform under Medicare, Medicare Advantage, and Medicaid. The incumbent will play a leading role on issues regarding the Medicare Quality Payment Program (Merit-Based Incentive Payment System and Advanced Alternative Payment Model Incentives), and other alternative payment models. The Associate Director will work collaboratively with other APA colleagues, departments, and members, as well as outside organizations, in addition to representing the APA before the Centers for Medicare and Medicaid Services (CMS), Medicare Payment Advisory Commission (MedPAC), Medicaid and CHIP Payment and Access Commission (MACPAC), and other relevant federal agencies.
The Associate Director of Payment Policy assists the Director of Reimbursement Policy in support of Department of Reimbursement Policy (DRP) responsibilities. The Associate Director assists with payment reform and reimbursement issues involving Medicare, Medicare Advantage, and Medicaid, including payment for physician services, accountable care organizations (ACOs) and other alternative payment models, and relevant hospital payment issues. This includes taking a leading role on the new Medicare Quality Payment Program. He/she will work with other DRP staff to identify and respond to the needs of APA members as they relate to payment reform and reimbursement policies affecting psychiatric practice and patient care. They assist in the development and implementation of special projects and background research in support of DRP responsibilities.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Assists the Director of Reimbursement Policy with payment reform and reimbursement issues involving Medicare, Medicare Advantage, and Medicaid, including payment for physician services, accountable care organizations (ACOs) and other alternative payment models, hospitals, inpatient psychiatric facilities, community mental health centers, federally qualified health centers, and rural health centers. Takes a leading role on the Medicare Quality Payment Program (Merit-Based Incentive Payment System and incentives for Advanced Alternative Payment Models).
- Liaison with and representation of APA member interests with CMS, MedPAC, MACPAC, PTAC, and other federal agencies of jurisdiction regarding core issues of significance for psychiatrists including but not limited to:
- Medicare Quality Payment Program (Merit-Based Incentive Payment System and incentives for Advanced Alternative Payment Models)
- Medicare Physician fee schedules and alternative reimbursement methods
- Medicare Hospital Inpatient and Outpatient Payment Systems
- Inpatient Psychiatric Facilities
- Community Mental Health Centers
- Federally Qualified Health Centers
- Rural Health Centers
- Medicare Advantage
- Reviews, analyzes, and interprets information and trends relating to payment reform and reimbursement policy for mental health care (e.g., within Medicare, Medicaid, alternative payment models, and quality reporting).Assists with policy development and background research around mental health parity implementation and enforcement.
- Drafts relevant APA regulatory comments for leadership approval. Triaging and coordination with the appropriate APA governance components and interdepartmental collaboration as appropriate.
- Coordinates with Department of Government Relations on legislative activities and assists as needed.
- Attends coalition meetings and develops/maintains relationships with relevant staff at allied organizations.
Identifies and responds to the needs of APA members as they relate to quality and payment reform, and reimbursement policies, affecting psychiatric practice and patient care and assists in the development and marketing of products and services to meet those needs.
- Identifies the needs of APA members as they relate to payment reform and reimbursement issues; develops an effective strategy to meet those needs including the identification and evaluation of current educational activities of the APA and other organizations and development of additional programs/services/resources where appropriate.
- Takes a leading role in education of members on the Medicare Quality Payment Program (Merit-Based Incentive Payment System and incentives for Advanced Alternative Payment Models).
- Works with other APA departments to coordinate the development of educational materials for distribution to APA members.
- Responds to, and assists other staff with, member inquiries on relevant payment reform and reimbursement issues, including queries through the DRP’s mailbox (QualityandPayment@psych.org) and the APA Practice Management Help Line.
Staff liaison and assistance with relevant Councils and Committees within the Policy Division
- Serves as staff liaison to the APA Committee on Reimbursement.
- Develops meeting schedules and agendas, analyzes, and prepares meeting materials, attends meetings, prepares meeting minutes, and advises Committee of opportunities for engagement and input.
- Provides background materials and reports (and other assistance) as needed to APA councils.
Other duties as assigned
- Assists other staff and with other work of the Department of Reimbursement Policy and the Policy Division as needed (and as other duties allow).
- This may include assistance with coverage of meetings, contributing to written materials, providing editorial assistance, etc.