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.
***Research reimbursement rates for various treatment modalities.
Compare NP rates to other provider rates.
Analyze reimbursement rates for mental health treatments
To prepare 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.
Example
Practicum Journal Reimbursement Rates
A PMHNP should be responsible and aware of the reimbursement process as well as the existing rates. Reimbursement rates for PMHNP differs from those of other healthcare professionals. Psychiatric mental health professional usually operates on a minimal financial strength unlike other established healthcare professionals who operate on a relatively large budget. This disparity in reimbursement rates may affect effective delivery of health services. One of the commonly used reimbursement methods is Medicare. The table below shows the reimbursement rates for physician and PMHNP.
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 |
1. Medicare
2. reimbursement rate for physician |
|
Psychiatric diagnostic evaluation |
90791 | $117 | $270 | $ 26 per unit | $210 per unit |
| Psychotherapy, 30 minutes with patient and/or family member
|
90832 | $58 | $113 | $ 24 per unit | $173 per unit |
| Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service | 90833 | $62 | $75 | $ 23 per unit | $75 per unit |
| Psychiatric diagnostic evaluation with medical services
|
90792 | $131 | $223 | $ 25 per unit | $217 per unit |
| Family psychotherapy (without the patient present)
|
90846 | $93 | $133 | $ 22 per unit | $141 per unit |
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:
Usually, PMHNP receives 80% of the of the fee set by the practice or have a may receive up to 85 of the Medicare physician schedule fees. Medicare gives the lowest possible charge, which is its main disadvantage.
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