Week 6 Practicum Journal – Reimbursement Rates

Reimbursement rates and medical coding can be almost as complicated as treating some mental illnesses. As a PMHNP, you will be faced with varying rates that may be different than other health care providers you may work with.

In this Practicum Journal Assignment, you will analyze reimbursement rates for mental health treatments you will likely use in your practice and compare those rates to other provider rates.

  • Analyze reimbursement rates for mental health treatments

To prepare for this Practicum Journal:

  • Research reimbursement rates for various treatment modalities.
  • Compare NP rates to other provider rates.

For this Practicum Journal:

Complete the Reimbursement Rate Template in your Learning Resources using the five types of services you are likely to use in your practice.

NURS 6670

Reimbursement Rate Template

Type of Serviceeg. -New office visit-Established office visit-Inpatient hospital-individual psychotherapy-group psychotherapy (see examples below)CPT codePrivate insurer reimbursement rate for PMHNPPrivate insurer reimbursement rate for physiciansMedicarereimbursement rate for PMHNPMedicarereimbursement rate for physician

As the PMHNP becomes proficient in diagnosing and treating, it is also important to learn how to bill for your time. The CMS sets up codes to identify the type of service you are providing. You will generally complete this task at the end of the visit as you are documenting the visit with the client. Here are examples of the codes to know:

CPT Codes for Psychiatric and Psychological Procedures

HMSA recognizes the following service codes for the reporting of psychiatric and psychological services. (See Code Books for information on how to obtain the books.)

CPT CodeFootnote(s)Description
907911Psychiatric diagnostic evaluation
907921,3Psychiatric diagnostic evaluation with medical services
908322Psychotherapy, 30 minutes with patient and/or family member
908332,3Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service
908344Psychotherapy, 45 minutes with patient and/or family member
908363,4Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service
908376Psychotherapy, 60 minutes with patient and/or family member
908383,6Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service
908396Psychotherapy for crisis; first 60 minutes
908402each additional 30 minutes
908464Family psychotherapy (without the patient present)
908474Family psychotherapy (conjoint psychotherapy) (with patient present)
908494Multiple-family group psychotherapy
908534Group psychotherapy (other than of a multiple-family group)
908701, 5Electroconvulsive therapy (includes necessary monitoring)
961011Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, e.g., WAIS-R, Rorschach, MMPI) with interpretation and report, per hour. Note: All hours of psychological testing done on a single day will be counted as one visit (either inpatient or outpatient as appropriate) toward the patient’s inpatient or outpatient visit maximum. However, payment will be made to the participating provider on a per-hour basis.
961181Neuropsychological testing battery (e.g., Halstead-Reitan, Luria, WAIS-R) with interpretation and report, per hour Note: All hours of psychological testing done on a single day will be counted as one visit (either inpatient or outpatient as appropriate) toward the patient’s inpatient or outpatient visit maximum. However, payment will be made to the participating provider on a per-hour basis.

Links to websites that discuss this:

https://www.psychiatry.org/psychiatrists/practice/practice-management/coding-reimbursement-medicare-and-medicaid/coding-and-reimbursement

http://www.mb-guide.org/medical-coding-guidelines.html

Running head: WEEK 6 PRACTICM JOURNAL: REIMBURSEMENT RATES 1

Week 6 Practicum Journal: Reimbursement Rates Student’s Name

Institution Affiliation Date

This study source was downloaded by 100000759512435 from CourseHero.com on 04-11-2021 17:07:22 GMT -05:00

https://www.coursehero.com/file/36957918/Week-6-Practicum-Journal-Reimbursement-Ratesdocx/

Th is

stu dy

re so

ur ce

w as

sh ar

ed v

ia C

ou rs

eH er

o. co

mhttps://www.coursehero.com/file/36957918/Week-6-Practicum-Journal-Reimbursement-Ratesdocx/

WEEK 6 PRACTICM JOURNAL: REIMBURSEMENT RATES 2

The reimbursement rates for mental health professionals are different from

those of other providers of care. Unlike the medical practitioners who are fully

equipped and with large offices office staffs, the providers of psychiatric care are run

or a smaller financial strength (O’Donnell, Williams, & Kilbourne, 2013). The result

of this disparity is a discipline that is overburdened and unable to execute its

professional mandate effectively. Besides this problem, it is worth to mention the fact

that the mental health facilities do not collect a significant amount of money that they

are owed from insurance firms (Kohler, 2015). This paper seeks to analyze the reimbursement rates for a variety of mental

health treatments that I can utilize at my workplace. Currently, the reimbursement

rates for five treatment modalities are available at the facility. The five treatment

approaches include psychiatric diagnostic evaluation; psychotherapy, 60 minutes with

patient and family member; individual psychotherapy 30 minutes with patient and

family member; psychotherapy, 45 minutes with a patient or family member; and

group psychotherapy other than of a multiple-family group. The Reimbursement Rate

Template is completed using the eight aforementioned forms of mental health services

that are provided at my place of work. The template is obtained from the America

Medical Association. Table 1: Reimbursement Rate (American Medical Association, 2017)

Type of Service CPT code

Private insurer reimbursem ent rate for PMHNP

Private insurer reimburseme nt rate for physicians

Medicare Reimbursem ent rate for PMHNP

Medicare Reimbursem ent rate for physician

Psychiatric diagnostic evaluation

9079 1

$80.61 $94.84 $114.61 $154.71

Psychotherapy, 60 minutes with patient and/or family member

9083 7

$82.95 $88.90 $111.53 $115.70

Individual psychotherapy

9083 2

$45.75 $53.05 $55.96 $51.05

This study source was downloaded by 100000759512435 from CourseHero.com on 04-11-2021 17:07:22 GMT -05:00

https://www.coursehero.com/file/36957918/Week-6-Practicum-Journal-Reimbursement-Ratesdocx/

Th is

stu dy

re so

ur ce

w as

sh ar

ed v

ia C

ou rs

eH er

o. co

mhttps://www.coursehero.com/file/36957918/Week-6-Practicum-Journal-Reimbursement-Ratesdocx/

WEEK 6 PRACTICM JOURNAL: REIMBURSEMENT RATES 3

30 minutes with patient and/or family member Psychotherapy, 45 minutes with patient and/or family member

9083 4

$63.82 $65.50 $74.39 $92.76

Group psychotherapy (other than of a multiple-family group)

9085 3

$19.30 $20.75 $22.46 $25.25

From the reimbursement template above, it is clear that get higher

reimbursements compared to PMHNPs. Both the private insurers and the government

provide higher reimbursement rates to physicians than the way they do for nurse

practitioners. However, it can be seen that the reimbursement rates for private insurers

vary significantly. There are those that pay nurse practitioners well than the

government (O’Donnell, Williams, & Kilbourne, 2013). Examples of these companies

include the United Behavioral Health, Blue Cross and the Blue Shield firms. The

reimbursement rates indicated in the table are based on the rates by Blue Shield and

Blue Cross companies and vary from one state to the other within the republic. Several studies have been conducted to determine the criteria through which

mental health reimbursement rates are performed. The typical findings of these

studies reveal factors such as the location, the type of insurance cover that individuals

have, and the level of education (Bishop, Press, Keyhani, & Pincus, 2014). The

providers of mental health services with a high level of education will receive high

reimbursement rates compared to those who are less educated (Kohler, 2015). This

can be deducted from the reimbursement rate table above. Medical physicians take

longer to complete their training compared to psychiatric mental health nurses. Their

high education status makes them perform complicated procedures that advanced

registered practice psychiatric nurses do. The only way that psychiatric mental health

This study source was downloaded by 100000759512435 from CourseHero.com on 04-11-2021 17:07:22 GMT -05:00

https://www.coursehero.com/file/36957918/Week-6-Practicum-Journal-Reimbursement-Ratesdocx/

Th is

stu dy

re so

ur ce

w as

sh ar

ed v

ia C

ou rs

eH er

o. co

mhttps://www.coursehero.com/file/36957918/Week-6-Practicum-Journal-Reimbursement-Ratesdocx/

WEEK 6 PRACTICM JOURNAL: REIMBURSEMENT RATES 4

nurses can do to get better and higher reimbursement rates is by seeking employment

in better-end locations such as in Manhattan or the city of New York. There is an apparent lack of clarity on the role of the health insurance type on

the rate reimbursement rates. The disparity in the reimbursement rates has been

discussed for a long time, but nothing substantial has been done. Besides, no one is

willing to engage the relevant stakeholders in addressing the issue due to the nature of

the two disciplines.

This study source was downloaded by 100000759512435 from CourseHero.com on 04-11-2021 17:07:22 GMT -05:00

https://www.coursehero.com/file/36957918/Week-6-Practicum-Journal-Reimbursement-Ratesdocx/

Th is

stu dy

re so

ur ce

w as

sh ar

ed v

ia C

ou rs

eH er

o. co

mhttps://www.coursehero.com/file/36957918/Week-6-Practicum-Journal-Reimbursement-Ratesdocx/

WEEK 6 PRACTICM JOURNAL: REIMBURSEMENT RATES 5

References Bishop, T. F., Press, M. J., Keyhani, S., & Pincus, H. A. (2014). Acceptance of

Insurance by Psychiatrists and the Implications for Access to Mental

Health Care. JAMA Psychiatry, 71(2), 176.

doi:10.1001/jamapsychiatry.2013.2862 Kohler, C. (2015). Physician Practice Billing From A to Z. Brentwood, TN: HCPro, a

division of BLR. O’Donnell, A. N., Williams, M., & Kilbourne, A. M. (2013). Overcoming

Roadblocks: Current and Emerging Reimbursement Strategies for

Integrated Mental Health Services in Primary Care. Journal of General

Internal Medicine, 28(12), 1667-1672. doi:10.1007/s11606-013-2496-z

This study source was downloaded by 100000759512435 from CourseHero.com on 04-11-2021 17:07:22 GMT -05:00

https://www.coursehero.com/file/36957918/Week-6-Practicum-Journal-Reimbursement-Ratesdocx/

Th is

stu dy

re so

ur ce

w as

sh ar

ed v

ia C

ou rs

eH er

o. co

m

Powered by TCPDF (www.tcpdf.org)https://www.coursehero.com/file/36957918/Week-6-Practicum-Journal-Reimbursement-Ratesdocx/http://www.tcpdf.org

Order a similar paper and get 15% discount on your first order with us

Dr. Padma Myers
Dr. Padma Myers
98% Success Rate
Read More
“Hello, I deliver nursing papers on time following instructions from the client. My primary goal is customer satisfaction. Welcome for plagiarism free papers”
Stern Frea
Stern Frea
98% Success Rate
Read More
Hi! I am an English Language and Literature graduate; I have written many academic essays, including argumentative essays, research papers, and literary analysis.
Dr. Ishid Elsa
Dr. Ishid Elsa
98% Success Rate
Read More
"Hi, count on me to deliver quality papers that meet your expectations. I write well researched papers in the fields of nursing and medicine".
Dr. Paul P. Klug
Dr. Paul P. Klug
99% Success Rate
Read More
"A top writer with proven reliability and experience. I have a 99% success rate, overall rating of 10. Hire me for quality custom written nursing papers. Thank you"

How Our Essay Writing Service Works

Tell Us Your Requirements

Fill out order details and instructions, then upload any files or additional materials if needed. Then, confirm your order by clicking “Place an Order.”

Make your payment

Your payment is processed by a secure system. We accept Mastercard, Visa, Amex, and Discover. We don’t share any informati.on with third parties

The Writing Process

You can communicate with your writer. Clarify or track order with our customer support team. Upload all the necessary files for the writer to use.

Download your paper

Check your paper on your client profile. If it meets your requirements, approve and download. If any changes are needed, request a revision to be done.

Recent Questions

Stay In Touch!

Leave your email and get discount promo codes and the best essay samples from our writers!