NURS 6670 Reimbursement Rates Template and Medical Coding Paper

NURS 6670 Reimbursement Rates Template and Medical Coding Paper

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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 for NURS 6670 Reimbursement Rates Template and Medical Coding Paper

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 Rates Template and Medical Coding Paper

Reimbursement Rate Template

Type of Serviceeg. -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
Psychiatric DiagnosticEvaluation	90791	$123.4	$152.75	$ 117	$125.97
Individual psychotherapy (30 min)-Outpatient	90832	$ 60.0	$74.26	$35.68	$41.71
Family Therapy with patient present	90847	$99.9	$123.63	$66.95	$79.50
Group Therapy (not multi-family) 45-60 minutes	90853	$23.87	$29.52	$25.25	$25.76
Interactive Complexity	90870	$12.95	$16.02	$$12.79	$13.02

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. NURS 6670 Reimbursement Rates and Medical Coding Essay Assignment
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.

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

Psychiatric Mental Health Nurse Practitioner Role II: Adults and Older Adults

NURS 6670

Reimbursement Rate Template

 The American Medical Association (AMA) developed Current Procedural Terminology (CPT) a medical code system that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations. The CPT is a numerical coding methodology that accurately identifies the professional services provided by qualified healthcare professionals and to report those services in a way that can be universally understood by institutions, private and government payers, researchers, and others interested parties. The CPT is the most widely accepted medical nomenclature used to report medical procedures and services for processing claims, conducting research, evaluating healthcare utilization, and developing medical guidelines and other forms of healthcare documentation. (Dotson, 2013). CPT codes are an integral part of the billing process. CPT codes tell the insurance payer what procedures the health care provider would like to be reimbursed for It is used to track important health data and measure performance and efficiency reimbursement rates for mental health treatments sample essays.

CPT code is five characters long and may be numeric or alphanumeric, depending on which category the CPT code is in. (Detorie, Mahesh, Hevezi, 2016).

CPT is divided into three categories of codes which includes Category

I: Procedures that are consistent with contemporary medical practice and are widely performed. Category II: Supplementary tracking codes that can be used for performance measures.

Categor III: Temporary codes for emerging technology, services, and procedures.

The difference between CPT codes and ICD codes are that CPT codes are related to procedures and ICD codes are related to diagnoses. ICD codes the ‘category’ refers to the first three characters of the code, which describe the injury or disease documented by the healthcare provider.

The relationship between ICD-10 codes and CPT is important because the ICD- 10 codes identifying the diagnosis support the necessity of the procedure completed. This allows the procedure to be covered and the provider to be reimbursed (Thorwarth, 2008)

Type of Service eg. -New Office Visit-Established Office Visit-Inpatient hospital-individual psychotherapy-group psychotherapy (see examples below)

CPT code The private insurer reimbursement rate for PMHNP

The private insurer reimbursement rate for physicians Medicare the reimbursement rate for PMHNP Medicare the reimbursement rate for physician Psychiatric.

Diagnostic Evaluation

90791

$118.54

$138.26

$119.99

$159.0

Psychiatric Diagnostic Evaluation with Medical Services

90792

$125.13

$159.74

$116.58

$130.0

Psychotherapy, 30 minutes with patient and or family member

90832

$67.22

$96.52

$64.61

$76.10

Psychotherapy, 45 minutes with Patient and/or family member

90834

$89.88

$115.63

86.16

94.89

Psychotherapy for crisis; first 60 minutes

90839

140.66

$164.28

135.08

143.54

State of Maryland Department of Health and Mental Hygiene (2018) Reimbursement Rates Retrieved from;

https://mmcp.health.maryland.gov/Documents/physicianfeeJCRfinal1–14.pdf.

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 psych diagnostic 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. 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

Reference

Dotson, P. (2013). CPT®Codes: What Are They, Why Are They Necessary, and How Are They Developed? Advances in Wound Care, 2(10), 583–587. http://doi.org/10.1089/wound.2013.0483

Detorie, N, Mahesh, M, Hevezi, J (2016). CPT®Code 77370. Journal of American College of Radiology,5 (8), 937–93

Thorwarth, W.T. Jr.(2008). CPT®: An Open System That Describes All That You Do. J Am Coll Radiol. 5: 555–560. Retrieved from: https://www.jacr.org/article/S1546

3/references

State of Maryland Department of Health and Mental Hygiene (2018) Reimbursement Rates Retrieved from;

https://mmcp.health.maryland.gov/Documents/physicianfeeJCRfinal1–14.pdf.

Assignment 2-WK6DUWK7- Reimbursement Rates

NURS 6670 Reimbursement Rates Template and Medical Coding Paper – 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.

Practicum Journal: Reimbursement Rates

Analyze reimbursement rates for mental health treatments

The Healthcare Common Procedure Coding System (HCPCS), built up in 1978, is an institutionalized framework to portray explicit things and administrations gave in health services conveyance, (IBHP, 2019). This coding framework was produced to guarantee that claims for Medicare, Medicaid, and other medical coverage programs are prepared reliably reimbursement rates for mental health treatments sample essays. At first, utilization of the codes was willful, however with the approach of HIPAA in 1996 (Health Insurance Portability and Accountability Act of 1996), the codes wound up required (IBHP,2019). This paper will break down repayment rates for mental wellness treatment and repayment rates for different treatment modalities and looks at NP rates to other supplier rates.

The outlook of reimbursement rates for various treatment modalities.

The Center for Health Care Solutions has developed Billing and Financial Worksheets for each state that identify current billing opportunities for services in integrated settings. The most frequently used code by the psychiatrists can be found in psychiatry subsection of the medicine section of the CPT manual (codes 90785-90899). In 2005–2006, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA), with guidance from the Centers for Medicare & Medicaid Services (CMS),(2018), jointly sponsored a study to identify the barriers to, and possible solutions for, reimbursement of mental health services provided in primary care settings (Danna et., al 2008). Significant changes to the psychiatry codes were seen in the year 2013 whereby refinement was made between an initial evaluation with medical services carried out by a doctor 90792 and a first assessment done by a non-physician 90791.There’s one major difference between 90791 and 90792: the use of medical services. Whereas both codes are used for psychiatric diagnostic evaluations, 90791 can’t include medical services and 90792 can.

Contrasting NP reimbursement rates to other provider rates.

In contrasting NP repayment rates with other supplier rates, it is perfect to see how to legitimately bill and code for services given by NPPs is basic to running a savvy and effective medical practice. Outlining and documentation necessities must be met. Most importantly, states set their own rates at which they repay suppliers, where you practice is taken cognizance of and my affect the outcome. In a few states, suppliers remain to benefit most by treating patients protected through Medicare reimbursement rates for mental health treatments sample essays. In different states, treating patients guaranteed through Medicaid designs produces the most income, (IBHP,2019).

Directions fluctuate by insurance agencies and states, so both the doctor and the NPP’s must remain current with training rules and progressing changes. Nurse Practitioners and Physician Assistants have progressively turned into a staple in most medical practices. NPs are nurses who hold a graduate degree or Doctor of Nursing Practice (DNP). PAs are affirmed (PA-C), generally holding a graduate degree also. There are a few reasons that therapeutic practices use these mid-level suppliers: reduced Salary expenses (as compared to a physician); lower overhead costs; higher patient volumes; and reduced insurance and liability costs (Tufts Health Plan, 2018)

NURS 6670 Reimbursement Rates Template and Medical Coding Paper – Psychiatric Business Template

Reimbursement Rate Template

Type of Service	CPT code	Private insurer reimbursement rate for PMHNP	Private insurer reimbursement rate for physicians	Medicarereimbursement rate for PMHNP	Medicarereimbursement rate for physician
Psychiatric diagnosis evaluation	90791	$135.42	$159.32	$117.76	$138.54
Psychiatric diagnostic evaluation with medical services	90792	$135.42	$159.32	$117.76	$138.54
Electroconvulsive therapy (includes necessary monitoring)	90870	$155.10	$182.47	$97.25	$114.41
Psychological testing, interpretation and reporting per hour by a psychologist	96101	$83.24	$97.93	$72.38	$85.16
Neuropsychological testing, interpretation and reporting by a psychologist	96118	$98.15	$115.47	$85.35	$100.41

Various minutes are allotted to each evaluation to attract the stipulated amount of money.

Reference

Centers for Medicare and Medicaid Services (CMS), (2018). Physician Fee Schedule.

Retrieved from https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/

Danna Mauch,D., Kautz, C.,Smith, S. (2008). Reimbursement of Mental Health Services in Primary Care Settings.

Retrieved from

https://www.integration.samhsa.gov/Reimbursement_of_Mental_Health_Services_in_Primary_          Care_Settings.pdf

Integrated Behavioral Health Partner IHBP (2019). Billing, Reimbursement and Financing. Retrieved from

http://www.ibhpartners.org/get-started/procedures/billing-reimbursement-and-financing/

Tufts Health Plan. (2018). Nurse Practitioner and Physician Assistant Professional Payment Policy            Retrieved from https://tuftshealthplan.com/documents/providers/payment-policies/np-pa-

Quintero-Howard, C. (2019). Child and Adult Psychiatry Business Plan Template. Townson, MD.

NURS 6670 Reimbursement Rates Template and Medical Coding Paper

Reimbursement Rate Template

Type of Serviceeg. -New office visit   -Established office visit -Inpatient hospital -individual psychotherapy -group psychotherapy (see examples below)

CPT code

 

 

 

SAMPLE ANSWER

Reimbursement Rates and Medical Coding

Introduction

If you’re a medical professional, you’ve probably heard of reimbursement rates. But what exactly are they and how do they affect your practice? In this post, we’ll explore the basics of how reimbursement rates work and why they matter in your clinic or hospital.

Why Reimbursement Rates Matter

Reimbursement rates are a key component of your practice’s bottom line. They have an impact on how well you can afford to provide care and they affect the quality of care you’re able to provide. When it comes to reimbursement rates, there are three main factors that will impact your bottom line:

• The amount that Medicare pays for certain procedures or services

• The price at which other health insurers will reimburse you for these same procedures and services (these amounts may vary based on the insurer)

• Whether or not there is some form of governmental mandate about providing particular treatments

How Much Should You Be Getting Paid?

The amount you should be getting paid for the medical service you provide depends on many factors, including:

• The type of insurance company that provides coverage

• The state where the medical procedure was performed

There are also several other factors that may affect your reimbursement rate. For example, if a patient is covered by Medicare and Medicaid, their provider may receive less money than if he or she were to be treated by an out-of-network practitioner (i.e., someone who isn’t in their network). That’s because Medicare pays less than private insurance companies do—and sometimes even less than individuals pay themselves!

Billing for Specialists

The reimbursement rate for specialists is higher than the reimbursement rate for GPs. There are many factors that determine the amount of money a specialist will be paid per visit:

• The specialty and geographic location in which they practice.

• Their specialty’s average gross income per patient. This can be found by looking at Medicare claims data or consulting with your state’s Medicaid agency (or both).

• Whether or not there are any limits on how much you can bill per hour. For example, if you’re an orthopedic surgeon and you have an office visit with a patient who wants knee surgery done immediately but doesn’t have insurance coverage yet, then it might make sense to charge less than $500/hour since this would bring down your total cost quickly once insurance coverage kicks in later on down the road! Of course, this depends entirely upon your own personal preferences as well as those of other members of staff within whatever organization may require such services–but let’s just say that some hospitals charge upwards$100k+per year just so doctors wouldn’t feel pressured into providing unnecessary care simply because patients are asking nicely enough without necessarily knowing what else could’ve happened besides them needing some extra help around here somewhere…

Reimbursement for Office Visits

Reimbursement for office visits is based on the type of visit. Some insurance companies may reimburse a visit to the doctor for a vaccination, while others may not. To find out what your insurance company will pay for an office visit, contact them and ask about reimbursement rates for specific services.

Reimbursement rates can vary by geographic location as well; there are also regional variations within each state that affect how much you’ll be reimbursed by your health plan or employer based on where you live (e.g., rural versus urban). If you’re planning on traveling across state lines during the year (or even just taking trips abroad), it’s important to know whether these geographical differences will have any impact on your medical billings before making travel plans so that everyone involved knows what their responsibilities are ahead of time!

Reimbursement rates are complex and change over time.

Reimbursement rates are complex and change over time. The rate you pay for a service can vary depending on the type of insurance company providing coverage, your age, and what type of patient you are.

In addition to considering reimbursement rates when determining whether or not a procedure is worth doing, it’s important to understand how those rates change over time. For example: if the initial cost of an outpatient surgery is $1 million but the annualized cost after five years is $10 million due to inflation alone (and other factors), then this cost might still seem reasonable even though it would have made sense at one point in time but not so much anymore because there has been significant inflation since then!

Conclusion

As you can see, reimbursement rates are complex and change over time. It’s important to understand how they work in order to be fully prepared for your next doctor visit or procedure.