Assignment 4: Week 6 Practicum Journal – Reimbursement Rates.

Posted: January 4th, 2023

Assignment 4: 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.

ORDER A PLAGIARISM-FREE PAPER HERE

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.Assignment 4: Week 6 Practicum Journal – Reimbursement 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
Introduction
Current Procedural Terminology (CPT) is a uniform medical coding system that is used to bill healthcare services and procedures provided to patients. Health care providers including PMHNPs should be aware of the CPT codes to ensure they make the correct billing for the provided care services; this will ensure full reimbursement for the provided services. This is because CPT codes inform insurance payers the procedures and services healthcare provider provided to their patients and would like reimbursement (Leslie-Mazwi et al, 2016).Assignment 4: Week 6 Practicum Journal – Reimbursement Rates.
Reimbursement Rates for various Treatment Modalities
Each state has a billing a financial worksheet for identifying current billing opportunities for services provided in healthcare integrated settings. Providers within the mental health settings mostly use the psychiatry subsection in the CPT manual that contained the codes between 90785 and 90899. The psychiatry codes have undergone significant changes since 2013 (Leslie-Mazwi et al, 2016). For example, the initial assessment with medical services performed by a physician 90792 and an initial evaluation performed by a non-physician 90791 were refined. While code 90792 is used to bill for diagnostic evaluation as well as the provided medical services, 90791 is only used to bill for diagnostic evaluation (Leslie-Mazwi et al, 2016).Assignment 4: Week 6 Practicum Journal – Reimbursement Rates.
Comparing NP Reimbursement Rates to other Provider Rates
Reimbursement rates for nurse practitioners and other providers are relatively different. For example, physicians have a higher reimbursement rate when compared to PMHNPs. Normally, each state determines the reimbursement rate for their healthcare providers and therefore it is vital for the providers and in this case PMHNPs know each state’s reimbursement rates to ensure correct billing (Chang, 2016). During practice, the most likely codes to be used include family psychotherapy (90847); individual therapy (90834); Individual psychotherapy with evaluation (90836); Group psychotherapy for 45-60 minutes (90853): and Psychiatric diagnostic evaluation (90791). The code 90847 is used in billing psychotherapy services that are provided to the client as well as some of the family members. Code 90834 is used in billing psychotherapy services provided to the client for 45 minutes and this can include a family member. Similarly, code 90836 is used in billing psychotherapy services provided to the client for 45 minutes and this code also include the evaluation and management care services provided to the client. Code 90853 is used in billing psychotherapy provided to a group of clients; each individual group member is billed separately. Code 90791 is used in billing diagnostic assessment provided to the client after the first contact with the therapist and does not include any care provided thereafter (Chang, 2016). The following template provides a comparison of reimbursement rates for nurse practitioners to other physician rates.Assignment 4: Week 6 Practicum Journal – Reimbursement Rates.
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
Psychiatric diagnostic evaluation 90791 $ 123.14 $ 152.32 $ 101.847

$119.82
Family Psychotherapy in presence of the patient 90847 $68.93 $81.09 $ 68.2 $ 72.97

Individual psychotherapy (45 min)-Outpatient 90834 $72.6 $95.8 $ 58.2165 $ 68.49

Individual psychotherapy for 45 minutes
90836 $70.703 $83.18 $34.0085 $ 40.01

Group psychotherapy (45-60 minutes)
90853
$27.83 $32.8 $ 24.70
$ 28.0672

Assignment 4: Week 6 Practicum Journal – Reimbursement Rates.