Nurs 6670 Reimbursement Rate Template

Introduction

The reimbursement rates for mental health practitioners, when compared to the other healthcare providers, vary significantly. Providers of mental health care do not have much financial strength as other medical professionals who have higher financial strength with big offices and staff. This is due to the disparity in the reimbursement where medical practitioners have higher pay when compared to PMHNPs (Evans, 2018). This paper will provide an analysis of the reimbursement rates for various mental health interventions for PMHNPs and compare them to the reimbursement rates for the physicians.

Reimbursement Rate according to the American Medical Association

Type of Service

 

CPT code Private insurer reimbursement rate for PMHNP Private insurer reimbursement rate for physicians Medicare

The reimbursement rate for PMHNP

Medicare

The reimbursement rate for physician

 

Psychiatric diagnostic evaluation

90791 $80.61 $94.84 $114.61 $154.71
Psychotherapy, 60 minutes with patient and/or family member 90837 $82.95 $88.90 $111.53 $115.70
Individual psychotherapy 30 minutes with patient and/or family member 90832 $45.75 $53.05 $55.96 $51.05
Psychotherapy, 45 minutes with patient and/or family member 90834 $63.82 $65.50 $74.39 $92.76
Group psychotherapy (other than of a multiple-family group) 90853 $19.30 $20.75 $22.46 $25.25

 

The above reimbursement rate shows PMHNPs have a lower reimbursement rate. The government and other private insurers offer higher rates to physicians than nurse practitioners (NPs). Nonetheless, it is notable that there is a significant variation for private insurers because there are private insurers that have higher pay for NPs than the government. Private that have good reimbursement rates for NPs include the Blue Shield and Blue Cross companies as shown by the reimbursement rates in the above template.

Many studies have been performed to establish the criteria used to determine the reimbursement rates for mental health providers. The findings show that factors like the type of insurance cover patients have, the location, as well as the education level, play a major role in determining the reimbursement rates for mental health providers (Kilbourne et al., 2018). Mental healthcare providers with higher educational levels tend to have higher reimbursement rates. This could be attributable to the fact that medical physicians spend more time during their training when compared to PMHNPs. Through higher educational levels, they are able to provide more complex services and procedures providers by advanced registered practice psychiatric nurses (Kohler, 2015). Therefore, through higher education, psychiatric mental health nurses are likely to have higher reimbursement rates.

Conclusion

There is generally a lack of clarity regarding the role of the type of health insurance on the rate of reimbursement rates. Even though the reimbursement rates for advanced practice nurses like PMHNPs have been lower when compared to physicians, nothing substantial has been done to address the situation. Therefore, it is important for the policymakers, together with the support of NPs and nurse practitioner organizations to address this issue and come up with policies that support better reimbursement rates for PMHNPs.

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References

Evans, K. (2018). Treating financial difficulty–the missing link in mental health care? Journal of Mental Health, 27(6), 487-489.

Kilbourne, A. M., Beck, K., Spaeth-Rublee, B., Ramanuj, P., O’Brien, R. W., Tomoyasu, N., & Pincus, H. A. (2018). Measuring and improving the quality of mental health care: a global perspective. World psychiatry: official journal of the World Psychiatric Association (WPA), 17(1), 30–38. https://doi.org/10.1002/wps.20482

Kohler, C. (2015). Physician Practice Billing From A to Z. Brentwood, TN: HCPro, a division of BLR.

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