Journal: Reimbursement Rates – Coursework Geeks

Assignment 2: 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.
Learning Objectives
Students will:
· 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 Service
eg. -New office visit
-Established office visit
-Inpatient hospital
-individual psychotherapy
-group psychotherapy (see examples below)
CPT code
Private insurer reimbursement rate for PMHNP
Private insurer reimbursement rate for physicians
Medicare
reimbursement rate for PMHNP
Medicare
reimbursement 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   Code
Footnote(s)
Description
 
90791
1
Psychiatric   diagnostic evaluation
 
90792
1,3
Psychiatric diagnostic evaluation with medical services
 
90832
2
Psychotherapy, 30 minutes with patient and/or family member
 
90833
2,3
Psychotherapy, 30 minutes with patient and/or family member when   performed with an evaluation and management service
 
90834
4
Psychotherapy, 45 minutes with patient and/or family member
 
90836
3,4
Psychotherapy, 45 minutes with patient and/or family member when   performed with an evaluation and management service
 
90837
6
Psychotherapy,   60 minutes with patient and/or family member
 
90838
3,6
Psychotherapy, 60 minutes with patient and/or family member when   performed with an evaluation and management service
 
90839
6
Psychotherapy for crisis; first 60 minutes
 
90840
2
each additional 30 minutes
 
90846
4
Family psychotherapy (without the patient present)
 
90847
4
Family psychotherapy (conjoint psychotherapy) (with patient   present)
 
90849
4
Multiple-family group psychotherapy
 
90853
4
Group psychotherapy (other than of a multiple-family group)
 
90870
1, 5
Electroconvulsive therapy (includes necessary monitoring)
 
96101
1
Psychological   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.
 
96118
1
Neuropsychological   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.
 
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