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.

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:

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

12/29/2020 Rubric Detail – Blackboard Learn

https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16781899_1&rubric_id=_2083044_1 1/2

Rubric Detail Select Grid View or List View to change the rubric’s layout.

Excellent Good Fair Poor

Quality of Work Submitted: The extent of which work meets the assigned criteria and work re�ects graduate level critical and analytic thinking.

27 (67.5%) – 30 (75%)

Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics.

24 (60%) – 26 (65%)

Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics.

21 (52.5%) – 23 (57.5%)

Assignment meets most of the expectations. One required topic is either not addressed or inadequately addressed.

0 (0%) – 20 (50%)

Assignment super�cially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed.

Quality of Work Submitted: The purpose of the paper is clear.

5 (12.5%) – 5 (12.5%)

A clear and comprehensive purpose statement is provided which delineates all required criteria.

4 (10%) – 4 (10%)

Purpose of the assignment is stated, yet is brief and not descriptive.

3.5 (8.75%) – 3.5 (8.75%) Purpose of the assignment is vague or o� topic.

0 (0%) – 3 (7.5%)

No purpose statement was provided.

Name: PRAC_6670_Week7_Assignment3_Rubric EXIT

Grid View List View

 

 

12/29/2020 Rubric Detail – Blackboard Learn

https://class.waldenu.edu/webapps/bbgs-deep-links-BBLEARN/app/course/rubric?course_id=_16781899_1&rubric_id=_2083044_1 2/2

Excellent Good Fair Poor

Written Expression and Formatting

Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, �ow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused– neither long and rambling nor short and lacking substance.

5 (12.5%) – 5 (12.5%)

Paragraphs and sentences follow writing standards for structure, �ow, continuity and clarity

4 (10%) – 4 (10%)

Paragraphs and sentences follow writing standards for structure, �ow, continuity and clarity 80% of the time.

3.5 (8.75%) – 3.5 (8.75%) Paragraphs and sentences follow writing standards for structure, �ow, continuity and clarity 60%- 79% of the time.

0 (0%) – 3 (7.5%)

Paragraphs and sentences follow writing standards for structure, �ow, continuity and clarity < 60% of the time.

Total Points: 40

Name: PRAC_6670_Week7_Assignment3_Rubric

EXIT

 
Do you need a similar assignment done for you from scratch? We have qualified writers to help you. We assure you an A+ quality paper that is free from plagiarism. Order now for an Amazing Discount!
Use Discount Code "Newclient" for a 15% Discount!

NB: We do not resell papers. Upon ordering, we do an original paper exclusively for you.