Assignment 3: Week 6 Practicum Journal – Reimbursement Rates

Running head: WEEK 6 PRACTICM JOURNAL: REIMBURSEMENT RATES 1

Week 6 Practicum Journal: Reimbursement Rates Student’s Name

Institution Affiliation Date

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WEEK 6 PRACTICM JOURNAL: REIMBURSEMENT RATES 2

The reimbursement rates for mental health professionals are different from

those of other providers of care. Unlike the medical practitioners who are fully

equipped and with large offices office staffs, the providers of psychiatric care are run

or a smaller financial strength (O’Donnell, Williams, & Kilbourne, 2013). The result

of this disparity is a discipline that is overburdened and unable to execute its

professional mandate effectively. Besides this problem, it is worth to mention the fact

that the mental health facilities do not collect a significant amount of money that they

are owed from insurance firms (Kohler, 2015). This paper seeks to analyze the reimbursement rates for a variety of mental

health treatments that I can utilize at my workplace. Currently, the reimbursement

rates for five treatment modalities are available at the facility. The five treatment

approaches include psychiatric diagnostic evaluation; psychotherapy, 60 minutes with

patient and family member; individual psychotherapy 30 minutes with patient and

family member; psychotherapy, 45 minutes with a patient or family member; and

group psychotherapy other than of a multiple-family group. The Reimbursement Rate

Template is completed using the eight aforementioned forms of mental health services

that are provided at my place of work. The template is obtained from the America

Medical Association. Table 1: Reimbursement Rate (American Medical Association, 2017)

Type of Service CPT code

Private insurer reimbursem ent rate for PMHNP

Private insurer reimburseme nt rate for physicians

Medicare Reimbursem ent rate for PMHNP

Medicare Reimbursem ent rate for physician

Psychiatric diagnostic evaluation

9079 1

$80.61 $94.84 $114.61 $154.71

Psychotherapy, 60 minutes with patient and/or family member

9083 7

$82.95 $88.90 $111.53 $115.70

Individual psychotherapy

9083 2

$45.75 $53.05 $55.96 $51.05

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WEEK 6 PRACTICM JOURNAL: REIMBURSEMENT RATES 3

30 minutes with patient and/or family member Psychotherapy, 45 minutes with patient and/or family member

9083 4

$63.82 $65.50 $74.39 $92.76

Group psychotherapy (other than of a multiple-family group)

9085 3

$19.30 $20.75 $22.46 $25.25

From the reimbursement template above, it is clear that get higher

reimbursements compared to PMHNPs. Both the private insurers and the government

provide higher reimbursement rates to physicians than the way they do for nurse

practitioners. However, it can be seen that the reimbursement rates for private insurers

vary significantly. There are those that pay nurse practitioners well than the

government (O’Donnell, Williams, & Kilbourne, 2013). Examples of these companies

include the United Behavioral Health, Blue Cross and the Blue Shield firms. The

reimbursement rates indicated in the table are based on the rates by Blue Shield and

Blue Cross companies and vary from one state to the other within the republic. Several studies have been conducted to determine the criteria through which

mental health reimbursement rates are performed. The typical findings of these

studies reveal factors such as the location, the type of insurance cover that individuals

have, and the level of education (Bishop, Press, Keyhani, & Pincus, 2014). The

providers of mental health services with a high level of education will receive high

reimbursement rates compared to those who are less educated (Kohler, 2015). This

can be deducted from the reimbursement rate table above. Medical physicians take

longer to complete their training compared to psychiatric mental health nurses. Their

high education status makes them perform complicated procedures that advanced

registered practice psychiatric nurses do. The only way that psychiatric mental health

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WEEK 6 PRACTICM JOURNAL: REIMBURSEMENT RATES 4

nurses can do to get better and higher reimbursement rates is by seeking employment

in better-end locations such as in Manhattan or the city of New York. There is an apparent lack of clarity on the role of the health insurance type on

the rate reimbursement rates. The disparity in the reimbursement rates has been

discussed for a long time, but nothing substantial has been done. Besides, no one is

willing to engage the relevant stakeholders in addressing the issue due to the nature of

the two disciplines.

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WEEK 6 PRACTICM JOURNAL: REIMBURSEMENT RATES 5

References Bishop, T. F., Press, M. J., Keyhani, S., & Pincus, H. A. (2014). Acceptance of

Insurance by Psychiatrists and the Implications for Access to Mental

Health Care. JAMA Psychiatry, 71(2), 176.

doi:10.1001/jamapsychiatry.2013.2862 Kohler, C. (2015). Physician Practice Billing From A to Z. Brentwood, TN: HCPro, a

division of BLR. O’Donnell, A. N., Williams, M., & Kilbourne, A. M. (2013). Overcoming

Roadblocks: Current and Emerging Reimbursement Strategies for

Integrated Mental Health Services in Primary Care. Journal of General

Internal Medicine, 28(12), 1667-1672. doi:10.1007/s11606-013-2496-z

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