Reimbursement Rates Discussion Paper

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. Reimbursement Rates Discussion Paper
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.

Please use the template provided in uploads. I have chosen the codes I want used in the template.

Please list references you used to find the information for reimbursement rates
The CPT is a code used in denoting health services that healthcare providers render. Accordingly, it is important for a healthcare provider to ensure correct procedure coding in order to get suitable insurance reimbursement (Forward Health Update, 2018). The focus of this assignment is to research reimbursement rates for different treatment modalities and compare reimbursement rates for NPs and physicians by completing the Reimbursement Rate Template for the selected five services.

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90791: This is code for diagnostic assessment for psychiatric health. This code covers assessment for chief complaint, systems review, MSE, diagnostic tests and patient’s history.

90832: This code covers psychotherapy provided for a patient, with a family member. This code is used in billing when the psychotherapy is provided for 30 minutes (American Medical Association, 2016).

90847: This code covers family psychotherapy in presence of the patient. The therapy is provided to the client as well as the client’s family member. This code also covers therapy provided to couples (Coleman, 2017).

90839: This code is used for billing psychotherapy services provided when the client is in crisis. Billable services include urgent client assessment, psychotherapy treatment, resource mobilization for defusing crisis and restoring safety; as well as care used in minimizing emotional trauma. This code covers psychotherapy crisis provided for 60 minutes estimated as 30-74 minutes (Coleman, 2017).

90833: This code is used to bill payment for psychotherapy provide to the client and/or a member of the family if the patient is also assessed and management services provided as well (Coleman, 2017). Reimbursement Rates Discussion Paper

Finally, the comparison of reimbursement rates for PMHNPs and physicians for the above treatment modalities provided by private insurances and Medicaid is provided in the reimbursement template.

References

American Medical Association. (2016). Mental Health Codes and Maximum Adjusted FFS Rate by Date of Rate Change. American Medical Association.

MH Procedure CPT or HCPC Codes and Rates 2018. American Medical Association.

https://mn.gov/dhs/assets/2018-mh-fee-rates_tcm1053-314495.pdf

Coleman M. (2017). Most Frequently Used CPT* Codes by Clinical Social Workers. Washington: The National Association of Social Workers. https://www.socialworkers.org/includes/newIncludes/homepage/PRA-NL-27117.CPT-Codes-PP.pdf

Forward Health Update. (2018). Increased Reimbursement and Changes to Claims Submission Requirements for Outpatient Behavioral Health Services. Forward Health Update. https://www.forwardhealth.wi.gov/kw/pdf/2017-41.pdf Reimbursement Rates Discussion Paper

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