Medical Billing Forum

General Category => General Questions => Topic started by: Csinsay on October 28, 2010, 11:37:38 AM

Title: Billing for Psychiatrist
Post by: Csinsay on October 28, 2010, 11:37:38 AM
Hello,

I was wondering if someone can give me their opinion on billing for Psychiatrist.  Pros and Cons?  Processes?  Difficulties?  Any other tips and suggestions?   

Thanks!

-Conrad
Title: Re: Billing for Psychiatrist
Post by: Michele on October 28, 2010, 11:51:17 AM
Love it!


Oh, sorry, did you want me to elaborate a little? 

Usually they only use 2 codes, initial eval 90801 and medication management 90862.  They see several patients, and they are repeat patients.  Some plans require authorization or referrals.  I'm simplifying things, but they really don't get too complicated.  I personally love billing psychiatric.

Michele
Title: Re: Billing for Psychiatrist
Post by: Meli on October 31, 2010, 05:14:05 PM
Same here.  This is the easiest specialty I currently bill for.
Title: Re: Billing for Psychiatrist
Post by: jcbilling on November 01, 2010, 04:07:11 PM
Hi there,

I have never marketed to psychiatrists and am interested in what I'm hearing as far as the simplicity of their billing. However, I have heard and even experienced a reduction in reimbursement when the visit to a family doctor is diagnosed with a psychiatric primary DX. So I'm trying to understand if their reimbursement is lower across the board or what the average payment for a visit would be...any thoughts?

Thanks,
Charity
Title: Re: Billing for Psychiatrist
Post by: Michele on November 02, 2010, 08:13:04 AM
Some carriers do have the psychiatric reduction, but even then the reimbursement is still fairly good.  And they see more patients per hour than a psychologist or social worker, so it works out.

Title: Re: Billing for Psychiatrist
Post by: jcbilling on November 02, 2010, 09:40:40 PM
I see - forgive my ignorance, but what is the difference between a psychiatrist and a psychologist?

Title: Re: Billing for Psychiatrist
Post by: Michele on November 03, 2010, 07:15:58 AM
Not ignorance!  It's only ignorance if you choose not to be educated!

Psychiatrist  -  can prescribe medications, usually sees patients for about 15 minutes to review medications and see how patient is doing.

Psychologist  -  cannot prescribe medications, see patients for psychotherapy, usually appts are 50 minutes to an hour.

 :)

Michele
Title: Re: Billing for Psychiatrist
Post by: PMRNC on November 03, 2010, 09:25:34 AM
Mental health falls under reductions in cases where states have not adapted Mental Health Parity laws, however there are now federal mental health parity laws which you can research to find out the reductions if any. Parity provides patients with access to mental health as any other illness ie; if medical is covered at 80/20 so than should mental health, With Medicare they are easing towards it year by year which you should also research.

In regards to the specialty in general, I love mental health because you can consult with your clients about other services they can provide to increase their revenue. I have mental health clients that do court testimonies, prison intakes,visits, nursing home consults, and other specialty group services. I have one client who spent 7 days a week seeing patients and when we got him into other things he was making twice as much money and spending less time/money on insurance.
Title: Re: Billing for Psychiatrist
Post by: jcbilling on November 03, 2010, 01:40:45 PM
Wow - thanks for the info...it gives me something to think about as far as our marketing efforts are concerned.

I appreciate it.
Title: Re: Billing for Psychiatrist
Post by: rdmoore2003 on November 03, 2010, 05:01:29 PM
okay michelle, 

i disagree about the differences.  New Mexico and Louisiana now have Medical Psychologists.  Which means that a psychologist with prescriptive rights.

I work for a medical psychologist which has been prescribing now for a couple of years.  Another difference, is that psychologists do testing.    I cant tell you how often we have referrals from all over the state and other states from psychiatrists that are misdiagnosing patients and often prescribing medication that is inaffective.
Title: Re: Billing for Psychiatrist
Post by: oneround on November 03, 2010, 06:48:42 PM
Medical Psychologists are a fairly new breed of post doctoral level correct RD?.  Thing is that these doc's if I'm not mistaken are not licensed under the state psychology board but rather the medical board and very well above your normal basic and applied psychology degree, which can not prescribe scripts.

I'd be interested in obtaining some more information on this if you have some available RD because this topic here has sparked alot of attention.  i also agree on the misdiagnosis deal witht he Psy's  I have reviwed many files and had to really question if these providers even actually spent anytime with the pt. to know what the heck they were prescribing to them.  very interested in what you can pass along on this subject
Title: Re: Billing for Psychiatrist
Post by: billingmom on November 03, 2010, 10:39:06 PM
Well i did billing for a psychiatrist and it was easy...  Basically I billed electronically, some cash patients but mainly insurance.  I had no complaints.
Title: Re: Billing for Psychiatrist
Post by: PMRNC on November 04, 2010, 06:05:54 AM
They are being certified in areas where psychiatrists are hard to come by.
Title: Re: Billing for Psychiatrist
Post by: Michele on November 04, 2010, 06:57:24 AM
RD is correct, there are now 2 states in the country, New Mexico & Louisiana that allow psychologists who meet specific training requirements to prescribe medications.  The following was taken from:  http://psyris.com/pages/text/a5.html


"Psychologists receive graduate training in psychology and pursue either a Ph.D. or Psy.D. in clinical or counseling psychology. Doctorate programs typically take five to seven years to complete and most states require an additional one or two year long internship in order to gain licensure. Other states require an additional year or two of supervised practice before granting full licensure.

In the United States, there are a handful of psychologists who are authorized by the Department of Defense to provide prescription medications for the treatment of mental illness. The U.S. military recognizes the need to have psychologists fully involved in the treatment of mental disorders."

"Psychologists licensed in the States of New Mexico and Louisiana can also provide prescription medications. To do so, they must meet very specific training requirements and be supervised by a physician."



I also found the following info on the topic from http://psychology.about.com/od/psychotherapy/f/psychvspsych.htm:


The title of "psychologist" can only be used by an individual who has completed the above education, training, and state licensure. Informal titles such as "counselor" or "therapist" are often used as well, but other mental health care professionals such as licensed social workers can also claim these titles.

Psychiatrists are physicians to have specific training in the assessment, diagnosis, treatment, and prevention of mental illnesses. Psychiatrists attend medical school and receive an M.D. After completing medical training, they complete an additional four years of residency training in mental health. In addition to this, some receive additional training in a specific area of interest such as geriatric psychiatry, child and adolescent psychiatry, addictions and other areas.
Prescribing Medications

A second important distinction between the two careers is that psychiatrists can prescribe medication, while psychologists cannot. There has been a recent push to grant prescribing powers to psychologists, with states such as New Mexico and Louisiana now allowing psychologists to write prescriptions after consulting with a psychiatrist."

In my response I was only stating the difference, I wasn't implying that I thought either was better than the other, just that they have distinct services that they provide.  Yes some psychologists also do psychological testing, but not all do.  I was only answering the question from a billing standpoint.

Michele

Title: Re: Billing for Psychiatrist
Post by: oneround on November 04, 2010, 10:33:14 AM
Thank you Michele, this is good onfor for me to study.
Title: Re: Billing for Psychiatrist
Post by: rdmoore2003 on November 04, 2010, 10:42:03 AM
In Louisiana, before 2010, a medical psychologist was licensed thru the state board of psychology.  Starting in 2010, now thru state medical board.   My office has the medical psychologist, lpc's, ph.d. interns, and counseling interns.   Under state law, my M.P. does have to coordinate benefits with a primary care provider of each patient that he sees for medication.   It does not require him to contact a psychiatrist.   In our state, there is more psychiatrists than psychologists, however, as stated before, psychiatrists charge a large fee, hand you a Rx, and out the door you go.  All in about 5 minutes.   We continue to have referrals, from our state and other states, that are showing numerouse over medicated patients and over medicated with wrong medications prescribed by psychiatrists and your "general" md's.     One issue in mental health, I find that most do not take any insurance at all, whether psychiatrist or psychologist.   In this economy, who can afford anything......
Title: Re: Billing for Psychiatrist
Post by: Michele on November 04, 2010, 07:23:23 PM
I think it's a shame when a patient gets meds but doesn't get counseling.  Unfortunately I have seen this with my own family members.   :'(
Title: Re: Billing for Psychiatrist
Post by: PMRNC on November 05, 2010, 06:27:12 AM
One of the thing I have to educate my psychiatrists on is the use of M0064 VS. 90862  especially in nursing home settings. If a psychiatrist is seeing you and doing a simple and quick med check or prescription they should NOT be coding the visit with a 90862!!

Quote
I think it's a shame when a patient gets meds but doesn't get counseling.

I have to disagree, this world is TOO medication happy. Many are under impression there is a mental health provider shortage and I would have agreed with them up to a few years ago, there are many qualified counselor's, psychologists, therapists and psychotherapists, people want the dr in the white coat to prescribe the happy pills.  JMO
Title: Re: Billing for Psychiatrist
Post by: DMK on November 05, 2010, 10:29:52 AM
Chiming in with my humble opinion only.  Counseling and lifestyle and diet changes should come first.  Meds should only be used in extreme conditions or as the last resort.  Unfortunately too many people think a pill will fix everything.

Our country is so dependent on anti-depressants (and aren't always getting the right one for them, there are BIG differences between them) and all they do is stop the low lows.  They do NOT bring you up, they are not happy pills, they only keep you from going way down.  Several studies have shown that a 15 minute walk, twice a day, or 30 minutes once a day is as effective as any anti-depressant.  The only down side is you have to get motivated to get up and go walk!

In our practice, everyday we come across people taking a laundry list of drugs and still not feeling any better.  We work with them and their family doctor to east them off the meds, or find more appropriate options.

Pain meds are even worse!  Please remember that pain relievers should not be a way of life!  And if the ones you're taking aren't relieving the pain, try something different!  There are many kinds of pain, and no one pain reliever can do it all!

I don't have any other forum to get this out to as many people as I'd like to, but we have to take control of our own lives and find every way we can to make our lives happy and healthy!!!

JMHO

Dina
Title: Re: Billing for Psychiatrist
Post by: rdmoore2003 on November 05, 2010, 02:13:57 PM
I agree fully.     Our office policy is that a patient must go thru an entire evaluation before the M.P. will even consider doing medication.  He requires drug tests and close collaboration with pain doctors if they are a pain patient.   Also, we require that therapy be part of the treatment plan for medications to be given.    Ex:  evaluation shows severe bipolar d/o and mediation is required.   The patient must complete a weekly therapy visit and 1 monthly medication visit.    To often, we see drug seekers, and those that want a disability check rather than work, manipulators, etc.   A little common sense goes along way.
Title: Re: Billing for Psychiatrist
Post by: Michele on November 08, 2010, 06:43:51 AM
Dina,

     AMEN SISTER!  I just wish some of my close family members were on the forum to read that.
Title: Re: Billing for Psychiatrist
Post by: Alice Scott on November 09, 2010, 04:35:53 AM
Not me - She's not talking about me!! :o
Alice
Title: Re: Billing for Psychiatrist
Post by: jcbilling on November 09, 2010, 05:21:04 PM
LOL!!

Sometimes I think I'm going crazy for choosing this field to work in :)
Title: Re: Billing for Psychiatrist
Post by: Alice Scott on November 10, 2010, 04:32:10 AM
I've always said that people in the mental health field are drawn to it for a reason. ;)
Title: Re: Billing for Psychiatrist
Post by: rdmoore2003 on November 10, 2010, 02:35:04 PM
lol    yeah it takes one to know one  ;D
Title: Re: Billing for Psychiatrist
Post by: QueenAlicia on December 31, 2010, 10:10:57 PM
I am glad I went back started reading some responses. I am thinking about doing mental health billing.  Thanks for all the information.