Assignment 3: 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 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.

Links to websites that discuss this:

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

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

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Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

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Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. Assignment 3: Week 6 Practicum Journal – Reimbursement Rates

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Assignment 3: Week 6 Practicum Journal – Reimbursement Rates