Nursing Reimbursement Rates
Nursing Reimbursement Rates Sample Essay
Nursing Reimbursement Rates Sample Essay
Assignment 2: 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. Nursing Reimbursement Rates Sample Essay
For this Practicum Journal:
Complete the Reimbursement Rate Template (see attachment) in your Learning Resources using the five types of services you are likely to use in your practice.
Current Procedural Terminology (CPT) refers to the system that third-payers utilize to designate and describe the offered health care services numerically in order to facilitate reimbursement from Medicaid and other medical insurance firms. The billing requirements of mental health providers differ from other healthcare providers. Therefore, mental health practitioners use CPT codes to bill specific health services and to describe the provided inpatient and outpatient mental health services(Leslie-Mazwi et al, 2016). Accordingly, this assignment will analyze and present reimbursement rates for some mental health services that are most likely to be provided during my practice. In addition, a comparison of the reimbursement rates for the PMHNPs done against reimbursement rates for physicians. Nursing Reimbursement Rates Sample Essay
90791: Mental health practitioners use this code to bill for individual diagnostic assessments performed for the client. However, the provided medical services should not be billed using this code. The diagnostic assessments covered by this code consist of the chief complaint, review of systems, mental state examination, family history, history of present illness, medical/health history, and assessment of the diagnostic outcomes (Katz & Eileen, 2018).
90834: This code is used by mental health practitioners to bill for psychotherapy provided to the client alone or with the family members. The key person is the client and hence even if the family members participate in the psychotherapy, the client’s presence is always required during psychotherapy. However, as long as the client manages to attend the majority of the psychotherapy sessions, the time spent with the members of the family is considered as the requirement for this code, regardless of the client’s absence (Katz & Eileen, 2018). This code is used to bill psychotherapy services provided for 45 minutes.
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90833: Comparable to code 90834, mental health practitioners use this code to bill psychotherapy services for the client with members of the family. In addition, the client must be present for most of the psychotherapy sessions. Practitioners use this code to bill for psychotherapy services provided for 30 minutes(American Psychiatric Association, 2019).
90836: This code is used by the mental health practitioners to bill for psychotherapy services provided for the client even though the family member may be present. The psychotherapy aims to change the behavior of the client and at the same time support the client. In addition, apart from the psychotherapy, this code also covers the assessment and management services provided to the client. This code bills for individual psychotherapy provided for 45 minutes and hence the time range for this code is between 38-52 minutes (Chang, 2016). Nursing Reimbursement Rates Sample Essay
90847: Mental health practitioners can use this code to bill for phone or face-face psychotherapy services that are provided to the client’s family and in the presence of the client. The code bills for family psychotherapy provided for 26 minutes and above. According to Katz & Eileen (2018), family therapy includes the psychotherapy that is provided to the client’s family members in order to improve communication and help to resolve conflicts in the client’s family; all this focus to facilitate the client’s improvement.
American Psychiatric Association (2019). Coding Reimbursement Medicare Medicaid.
Chang J. (2016). CPT 101: An Introduction to Coding and Reimbursement. Journal of the American Academy of Child & Adolescent Psychiatry, 55(10), S34.
Current Procedural Terminology (CPT) Codes in Psychiatry. https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/compliance-office/education-tools/compliance/documents/PsychiatryCPTCodesUpatedfor2013.pdf
Katz S & Eileen P. (2018). Update on Relative Value Units and the Cognitive Physician Visit. Gastroenterology Hepatol (N Y). 14(1), 41–43. Nursing Reimbursement Rates Sample Essay
Leslie-Mazwi T, Nicola G, Donovan W &Barr H. (2016). Current Procedural Terminology: History, Structure, and Relationship to Valuation for the Neuroradiologist. American Journal of Neuroradiology. 37 (11), 1972-1976.
Medical Coding Guidelines – Learn the Basic Rules