Memory Testing Procedure
Is a Referral Needed to get a NP Evaluation Done?
We ask you to always talk to your, or the patient’s, primary care provider (PCP) before calling to set up an appointment for a neuropsychological cognitive testing. A PCP will refine your problem statement, and will likely do blood labs to see if there is a “reversible” condition like a thyroid condition or low vitamin B12 before referring you to us. These days, a PCP will often give a screening test like the the Montreal Cognitive Assessment (MoCA). This test became famous, when Admiral Ronny Johnson, MD administered it to President Trump who then declared himself a genius for passing it. In truth, he passed a screen for dementia (not an IQ test) which only showed he met the minimal standards for an adult to likely not have dementia or mild cognitive impairment.
If any problem shows up and your labs are negative and/or if your complaints could indicate possible NCD then your PCP will follow-through with a referral to us for in-depth NP evaluation. Your PCP will fax a referral to us and automatically include a copy of your more recent visit’s note. That gives us you medical history and a list of your current prescribed medications. Then Craig can call you do describe the process, answer questions and set up an appointment.
Who Does the Testing?
Our evaluations are all supervised by a clinical neuropsychologist; i.e., a psychologist who specializes in brain/behavior relationships or geropsychologist who specializes in working with seniors. Drs. Eggleston and Elovitz supervise all the NP testing at Limbic Resources, Inc. Dr. Eggleston, a clinical psychologist with many years of experience brings strengths in emotional and personality assessment and diagnosis with many years experience at the VA. Emotional factors often exacerbate, or even cause, apparent NCD. He supervises our psychometrists who perform the majority of our evaluations. These skilled folks specialize in administering standardized testing. Typically they are doctoral level (or doctoral candidates) who bring a wide array of skills to the table. Note that all test analyses and diagnosing is done by the supervising psychologist, but the face-to-face services are usually managed by our psychometry staff in most cases.
What is the Procedure?
After we receive the referral fax from your PCP with their referral questions along with a copy of your last medical visit note, Craig, who manages all our testing, will then call you. He describes the procedures, confirms insurance and sets up an appointment. Currently, we ask that only one family member to accompany a patient. We see patients at either of our offices (in Hyannis or Buzzard’s Bay) for interviewing and testing, takes about 2.5 to 3 hours. Appointments are available every day at about 9:00 AM and 1:30 PM.
We don’t send questionnaires in advance to you which avoids a hassle in paperwork. Instead, we prefer to take information in person and we already have medical notes about your from the referring doctor. It is helpful if you bring all your medication bottles and any over-the-counter things you take like vitamins, sleep aides, etc. with you. Just put it all in a bag or box and bring it along. The lists we get are usually incomplete and often incorrect, so we ask you to just bring everything you take with you. Sometimes we count pills to make sure they are taken accurately… You get the idea? Forget lists, just bring all your medications and supplements with you. We often find over-the-counter pills (especially those for sleep and allergies) to be contributing or causing memory loss!
The Report
We follow-up with a 6-7 page report of findings, diagnostic impressions and recommendations. We can mail (email is not HIPAA allowed) the report to you, family, different doctors, etc. if you bring their mail addresses. We strive to get reports out to you within two weeks of your appointment. IMPORTANT: Set up an appointment with the PCP who referred you to us about a month after the testing date to review the results with them as part of your overall workup and treatment plan. The report’s recommendations are linked to more information at AgeSure.com.
Why So Long for an Appointment?
We can be backlogged a few months, as we accept Medicare and most other insurances which continue to cut the NP reimbursement. The reimbursement rate has been reduced by over 40% over the last several years, so there are few clinicians left doing this type of testing for Medicare. In Boston in can take many months just to get an appointment, and you may see a student in a large hospital-based training program and the report may arrive months after your appointment. So please be patient with us, we’ll explain why so few people are doing this important service.
Why Aren’t More Psychologists Working with Seniors?
The very low reimbursement rate allowed by Medicare makes it hard to attract any psychologist to work with seniors on Cape Cod, or anywhere. Medicare pays around $30-$40 less per hour then your car mechanic charges; and, then Medicare only pays 80% of that amount, making us chase some secondary insurer for the remaining 20% whose only goal is to avoid paying at all. There are about 60 secondary insurers and a large percentage of them change their mailing address every year, hoping small billers like psychologists and social workers will give up trying to balance bill them after receiving the 80% Medicare payment. Unbelievable, but true.
Most clinical neuropsychologists stay in Boston or the metropolitan area where they can work on salary with the 20+ hospitals in the city who have contracts with the major insurers.
Why is the Medicare Reimbursement so Low?
Medicare is entirely paid for by the payroll tax (FICA) the federal deduction that came out of your paycheck all your working life. FICA is split with 7.65% of your gross pay is withheld from every paycheck. You might not realize it but your employer matched that, having to also pay 7.65% of your pay to the government. If you were self employed, maybe a plumber or a private accountant, you got a double-hit having pay 15.3% of your gross income since you had no employer to match your contribution. OK, of that 15% everyone pays (up to $170,000 income per yer), 12.4% goes into funding Social Security and 2.9% goes to fund Medicare. This isn’t a bad thing when you realize that over 14% of retirees rely on SS for almost of their retirement income, while over 40% depending on it for more than half their income.
So how does this result in NP testing reimbursement being reduced every year by Medicare? Well, first recognize it is all mental health spending (psychiatry, counseling, and psychological testing) that is getting reduced. There is no way FICA can get more funding without increasing both individual payroll taxes on working Americans and on their employers and at over 7% that tax is already high. But, it is very low compared to all other countries. It takes an act of Congress to increase taxes and neither party wants to increase taxes on average working folks who are not, although it was just reported in 2026 that in just six years (2032) SS will only be able to fund 78% of scheduled benefits. Some new revenue source will be required to fund SS (seniors vote!) but any new money will go to the SS portion, rather than Medicare.
How that Affect Who is Left doing Testing?
Medicare is now “gatekeeper” driven, as you need a referral from your PCP for almost any procedure before your insurance will pay for it. That means when your PCP (e.g., your family doctor) threatens to drop out of Medicare unless their reimbursement is increased, Medicare must find a way to satisfy them. Losing PCPs kills the Medicare system, so PCPs have all the power. Since Medicare is revenue neutral (they can’t raise more money) they can only reduce rates for someone in the system in order to increase the rates for the gatekeepers, and that always falls on the weakest providers – us mental health specialists. So we tend to get hit the hardest when “specialist” rates are reduced to increase the generalist gatekeepers.
Of the 7% of all healthcare providers who drop out of accepting Medicare, the majority are mental health providers like psychiatrists and psychologists. Medicare has reduced our fees for testing by more than 40% over the last 15 years, which is how they afford to give PCPs increases to stay in the Medicare system. Currently, the Medicare pays less for testing than MassHealth (Medicaid) pays for testing services to indigent people. It’s just that simple, and I think we’ve convinced you it won’t get better in the near future. So there just aren’t many mental health providers left who can afford to accept Medicare.
So. How Does Limbic Resources Stay in Business?
So, how does Limbic Resources we manage to survive and continue to do this testing? We make a tiny percentage profit on each testing, but we have a very high volume of folks thanks to using our psychometrists to do the direct testing. Our provincial Cape Cod practice, to the best of our knowledge, is the largest provider of Medicare-paid NP testing in the US. Which makes sense when you realize Barnstable County (Cape Cod) is a retirement capital in the US, with a median age of 56 well above the national median of 39 – we’re even older, by about seven years, then Pinellas County (Tampa, Clearwater, etc.) in Florida!
Anyway, MacDonald’s survives on a profit of ~ six cents per hamburger by selling billions every year. Tacky as it is, they are our business role model. As long as we can pay the rent, and pass most of the Medicare payment on to our staff, we just keep trucking.
Do You do Home Visits or Video (Zoom) Meetings?
We can only do NP testing in person. And, no, there is no AI involved with out process. After the COVID-19 crisis we became focused on in-office visits to maintain proper sanitation. We have offices in Hyannis near the hospital and in Buzzard’s Bay just over the Bourne bridge. On some occasions we can still do a home visit, so you can ask about that option when you talk with Craig. We will try to accommodate folks, as we know the population we serve is older and less mobile.
We ask you to always talk to your, or the patient’s, primary care provider (PCP) before calling to set up an appointment for a neuropsychological cognitive testing. A PCP will refine your problem statement, and will likely do blood labs to see if there is a “reversible” condition like a thyroid condition or low vitamin B12 before referring you to us. These days, a PCP will often give a screening test like the the Montreal Cognitive Assessment (MoCA). This test became famous, when Admiral Ronny Johnson, MD administered it to President Trump who then declared himself a genius for passing it. In truth, he passed a screen for dementia (not an IQ test) which only showed he met the minimal standards for an adult to likely not have dementia or mild cognitive impairment.
If any problem shows up and your labs are negative and/or if your complaints could indicate possible NCD then your PCP will follow-through with a referral to us for in-depth NP evaluation. Your PCP will fax a referral to us and automatically include a copy of your more recent visit’s note. That gives us you medical history and a list of your current prescribed medications. Then Craig can call you do describe the process, answer questions and set up an appointment.
Who Does the Testing?
Our evaluations are all supervised by a clinical neuropsychologist; i.e., a psychologist who specializes in brain/behavior relationships or geropsychologist who specializes in working with seniors. Drs. Eggleston and Elovitz supervise all the NP testing at Limbic Resources, Inc. Dr. Eggleston, a clinical psychologist with many years of experience brings strengths in emotional and personality assessment and diagnosis with many years experience at the VA. Emotional factors often exacerbate, or even cause, apparent NCD. He supervises our psychometrists who perform the majority of our evaluations. These skilled folks specialize in administering standardized testing. Typically they are doctoral level (or doctoral candidates) who bring a wide array of skills to the table. Note that all test analyses and diagnosing is done by the supervising psychologist, but the face-to-face services are usually managed by our psychometry staff in most cases.
What is the Procedure?
After we receive the referral fax from your PCP with their referral questions along with a copy of your last medical visit note, Craig, who manages all our testing, will then call you. He describes the procedures, confirms insurance and sets up an appointment. Currently, we ask that only one family member to accompany a patient. We see patients at either of our offices (in Hyannis or Buzzard’s Bay) for interviewing and testing, takes about 2.5 to 3 hours. Appointments are available every day at about 9:00 AM and 1:30 PM.
We don’t send questionnaires in advance to you which avoids a hassle in paperwork. Instead, we prefer to take information in person and we already have medical notes about your from the referring doctor. It is helpful if you bring all your medication bottles and any over-the-counter things you take like vitamins, sleep aides, etc. with you. Just put it all in a bag or box and bring it along. The lists we get are usually incomplete and often incorrect, so we ask you to just bring everything you take with you. Sometimes we count pills to make sure they are taken accurately… You get the idea? Forget lists, just bring all your medications and supplements with you. We often find over-the-counter pills (especially those for sleep and allergies) to be contributing or causing memory loss!
The Report
We follow-up with a 6-7 page report of findings, diagnostic impressions and recommendations. We can mail (email is not HIPAA allowed) the report to you, family, different doctors, etc. if you bring their mail addresses. We strive to get reports out to you within two weeks of your appointment. IMPORTANT: Set up an appointment with the PCP who referred you to us about a month after the testing date to review the results with them as part of your overall workup and treatment plan. The report’s recommendations are linked to more information at AgeSure.com.
Why So Long for an Appointment?
We can be backlogged a few months, as we accept Medicare and most other insurances which continue to cut the NP reimbursement. The reimbursement rate has been reduced by over 40% over the last several years, so there are few clinicians left doing this type of testing for Medicare. In Boston in can take many months just to get an appointment, and you may see a student in a large hospital-based training program and the report may arrive months after your appointment. So please be patient with us, we’ll explain why so few people are doing this important service.
Why Aren’t More Psychologists Working with Seniors?
The very low reimbursement rate allowed by Medicare makes it hard to attract any psychologist to work with seniors on Cape Cod, or anywhere. Medicare pays around $30-$40 less per hour then your car mechanic charges; and, then Medicare only pays 80% of that amount, making us chase some secondary insurer for the remaining 20% whose only goal is to avoid paying at all. There are about 60 secondary insurers and a large percentage of them change their mailing address every year, hoping small billers like psychologists and social workers will give up trying to balance bill them after receiving the 80% Medicare payment. Unbelievable, but true.
Most clinical neuropsychologists stay in Boston or the metropolitan area where they can work on salary with the 20+ hospitals in the city who have contracts with the major insurers.
Why is the Medicare Reimbursement so Low?
Medicare is entirely paid for by the payroll tax (FICA) the federal deduction that came out of your paycheck all your working life. FICA is split with 7.65% of your gross pay is withheld from every paycheck. You might not realize it but your employer matched that, having to also pay 7.65% of your pay to the government. If you were self employed, maybe a plumber or a private accountant, you got a double-hit having pay 15.3% of your gross income since you had no employer to match your contribution. OK, of that 15% everyone pays (up to $170,000 income per yer), 12.4% goes into funding Social Security and 2.9% goes to fund Medicare. This isn’t a bad thing when you realize that over 14% of retirees rely on SS for almost of their retirement income, while over 40% depending on it for more than half their income.
So how does this result in NP testing reimbursement being reduced every year by Medicare? Well, first recognize it is all mental health spending (psychiatry, counseling, and psychological testing) that is getting reduced. There is no way FICA can get more funding without increasing both individual payroll taxes on working Americans and on their employers and at over 7% that tax is already high. But, it is very low compared to all other countries. It takes an act of Congress to increase taxes and neither party wants to increase taxes on average working folks who are not, although it was just reported in 2026 that in just six years (2032) SS will only be able to fund 78% of scheduled benefits. Some new revenue source will be required to fund SS (seniors vote!) but any new money will go to the SS portion, rather than Medicare.
How that Affect Who is Left doing Testing?
Medicare is now “gatekeeper” driven, as you need a referral from your PCP for almost any procedure before your insurance will pay for it. That means when your PCP (e.g., your family doctor) threatens to drop out of Medicare unless their reimbursement is increased, Medicare must find a way to satisfy them. Losing PCPs kills the Medicare system, so PCPs have all the power. Since Medicare is revenue neutral (they can’t raise more money) they can only reduce rates for someone in the system in order to increase the rates for the gatekeepers, and that always falls on the weakest providers – us mental health specialists. So we tend to get hit the hardest when “specialist” rates are reduced to increase the generalist gatekeepers.
Of the 7% of all healthcare providers who drop out of accepting Medicare, the majority are mental health providers like psychiatrists and psychologists. Medicare has reduced our fees for testing by more than 40% over the last 15 years, which is how they afford to give PCPs increases to stay in the Medicare system. Currently, the Medicare pays less for testing than MassHealth (Medicaid) pays for testing services to indigent people. It’s just that simple, and I think we’ve convinced you it won’t get better in the near future. So there just aren’t many mental health providers left who can afford to accept Medicare.
So. How Does Limbic Resources Stay in Business?
So, how does Limbic Resources we manage to survive and continue to do this testing? We make a tiny percentage profit on each testing, but we have a very high volume of folks thanks to using our psychometrists to do the direct testing. Our provincial Cape Cod practice, to the best of our knowledge, is the largest provider of Medicare-paid NP testing in the US. Which makes sense when you realize Barnstable County (Cape Cod) is a retirement capital in the US, with a median age of 56 well above the national median of 39 – we’re even older, by about seven years, then Pinellas County (Tampa, Clearwater, etc.) in Florida!
Anyway, MacDonald’s survives on a profit of ~ six cents per hamburger by selling billions every year. Tacky as it is, they are our business role model. As long as we can pay the rent, and pass most of the Medicare payment on to our staff, we just keep trucking.
Do You do Home Visits or Video (Zoom) Meetings?
We can only do NP testing in person. And, no, there is no AI involved with out process. After the COVID-19 crisis we became focused on in-office visits to maintain proper sanitation. We have offices in Hyannis near the hospital and in Buzzard’s Bay just over the Bourne bridge. On some occasions we can still do a home visit, so you can ask about that option when you talk with Craig. We will try to accommodate folks, as we know the population we serve is older and less mobile.
