billing, reimbursement & documentation strategies for pediatric neuropsychological services
TRANSCRIPT
![Page 1: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/1.jpg)
Billing, Billing, Reimbursement & Reimbursement &
Documentation Documentation Strategies for Strategies for
Pediatric Pediatric Neuropsychological Neuropsychological
ServicesServices
![Page 2: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/2.jpg)
Antonio E. Puente, Ph.D.Antonio E. Puente, Ph.D.UNC-WilmingtonUNC-Wilmington
World Congress on Pediatric World Congress on Pediatric NeuropsychologyNeuropsychology
San Juan, Puerto RicoSan Juan, Puerto RicoMay 6-7, 2002May 6-7, 2002
![Page 3: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/3.jpg)
AcknowledgmentsAcknowledgments
NAN Board of Directors, Policy and Planning Committee, & PAOI Office
Division 40 Board of Directors & Practice Committee
Practice Directorate of the American Psychological Association
American Medical Association’s CPT Staff CMS Medical Policy Staff James Georgoulakis, Ph.D.
![Page 4: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/4.jpg)
BackgroundBackground
American Medical Association’s Current Procedural Terminology Committee
Health Care Finance Administration; Center for Medicare/Medicaid Services’ Medicare Coverage Advisory Committee
Development of NAN’s new PAIOConsultant with the State Medicaid Office;
Blue Cross/Blue Shield
![Page 5: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/5.jpg)
Purpose of PresentationPurpose of Presentation
Increase ReimbursementDecrease Fraud & AbuseProvide Professional GuidelinesIncrease Range, Type & Quality of Services
![Page 6: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/6.jpg)
Outline of PresentationOutline of Presentation
MedicareCurrent Procedural Terminology: Basic Current Procedural Terminology: RelatedRelative Value UnitsCurrent Problems & Possible SolutionsFuture DirectionsQuestions
![Page 7: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/7.jpg)
Outline: HighlightsOutline: Highlights
New CodesExpanding ParadigmsFraud, Abuse; Coding & DocumentationThe Problem with Testing
![Page 8: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/8.jpg)
Medicare: OverviewMedicare: Overview
Why MedicareMedicare ProgramLocal Medical Review
![Page 9: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/9.jpg)
Medicare: WhyMedicare: Why
The Standard – Coding– Value– Documentation
Approximately 50% for InstitutionsApproximately 33% for Outpatient Offices
– Less than 18 - Medicaid– Over 65 - Medicare
![Page 10: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/10.jpg)
Medicare: OverviewMedicare: Overview
New Name: HCFA now CMS– Centers for Medicare and Medicaid Services
New Charge: SimplifyNew Organization: Beneficiary, Medicare,
Medicaid
![Page 11: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/11.jpg)
Medicare: Local ReviewMedicare: Local Review
Local Medical Review PolicyCarrier Medical DirectorPolicy Panels
![Page 12: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/12.jpg)
Current Procedural Current Procedural Terminology: OverviewTerminology: Overview
Background Codes & Coding Existing Codes New Codes (effective 01.01.02; revised 03.15.02) Model System X Type of Problem Medical Necessity Documenting Time
![Page 13: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/13.jpg)
CPT: HighlightsCPT: Highlights
New CodesMedical NecessityDocumentation
![Page 14: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/14.jpg)
CPT: BackgroundCPT: Background
American Medical Association– Developed by Surgeons (& Physicians) in 1966 for
Billing Purposes– 7,500 Discrete Codes
HCFA/CMS– AMA Under License with CMS– CMS Now Provides Active Input into CPT
Congress– Trent Lott (2001)
![Page 15: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/15.jpg)
CPT: Background/DirectionCPT: Background/Direction
Current System = CPT 5Categories
– I= Standard Coding for Professional Services– II = Performance Measurement– III = Emerging Technology
![Page 16: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/16.jpg)
CPT: Applicable CodesCPT: Applicable Codes
Total = Approximately 40 to 60Sections = Five Separate Sections
– Psychiatry– Biofeedback– Central Nervous Assessment– Physical Medicine & Rehabilitation– Health & Behavior Assessment & Management
![Page 17: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/17.jpg)
CPT: PsychiatryCPT: Psychiatry
Sections– Interview vs. Intervention– Office vs. Inpatient– Regular vs. Evaluation & Management– Other
Types of Interventions– Insight, Behavior Modifying, and/or Supportive
vs. Interactive
![Page 18: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/18.jpg)
CPT: BiofeedbackCPT: Biofeedback
Psychophysiological TrainingBiofeedback
![Page 19: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/19.jpg)
CPT: CNS AssessmentCPT: CNS Assessment
Interview– 96115
Testing– Psychological = 96100; 96110/11– Neuropsychological = 96117– Other = 96105, 96110/111
![Page 20: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/20.jpg)
CPT: 96117 in DetailCPT: 96117 in Detail
Number of Encounters in 2000 = 293,000Number of Medical Specialties Using
96117 = over 40Psychiatry & Neurology = Approximately
3% eachClinics or Other Groups = 3%Unknown Data = Use of Technicians
![Page 21: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/21.jpg)
CPT: Physical Medicine & CPT: Physical Medicine & RehabilitationRehabilitation
97770 now 97532Note: 15 minute increments
![Page 22: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/22.jpg)
CPT: Health & Behavior CPT: Health & Behavior Assessment & Mngmt.Assessment & Mngmt.
Purpose: Medical DiagnosisTime: 15 Minute IncrementsAssessment
– 96150; initial– 96151; re-assessment
Intervention– 96152; individual– 96153; group– 96154; family (with patient present)– 96155; family (without patient present)
![Page 23: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/23.jpg)
CPT: Model SystemCPT: Model System
PsychiatricNeurologicalNon-Neurological Medical
![Page 24: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/24.jpg)
CPT: Psychiatric ModelCPT: Psychiatric Model(Children & Adult)(Children & Adult)
Interview– 90801
Testing– 96100, or– 96110/11
Intervention– e.g., 90806– The challenge of New Mexico
![Page 25: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/25.jpg)
CPT: Neurological ModelCPT: Neurological Model(Children & Adult)(Children & Adult)
Interview– 96115
Testing– 96117
Intervention– 97532
![Page 26: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/26.jpg)
CPT: Non-Neurological CPT: Non-Neurological Medical ModelMedical Model
(Children & Adult)(Children & Adult)Interview & Assessment
– 96150 (initial)– 96151 (re-evaluation)
Intervention– 96152 (individual)– 96153 (group)– 96154 (family with patient)– 96155 (family without patient)
![Page 27: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/27.jpg)
CPT: New ParadigmsCPT: New Paradigms
Initial PsychiatricNext NeurologicalNow MedicalMedical as Evaluation & Management
![Page 28: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/28.jpg)
CPT: Evaluation & CPT: Evaluation & ManagementManagement
Role of Evaluation & Management Codes– Procedures– Case Management
Limitations Imposed by AMA’s House of Delegates
Health & Behavior Codes as an Alternative to E & M Codes
![Page 29: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/29.jpg)
CPT: DiagnosingCPT: Diagnosing
Psychiatric– DSM
The problem with DSM and neuropsych testing of developmentally-related neurological problems
Neurological & Non-Neurological Medical– ICD
![Page 30: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/30.jpg)
CPT: Medical NecessityCPT: Medical Necessity
Scientific & Clinical NecessityLocal Medical Review or Carrier Definition
of NecessityNecessity Dictates Type and Level of
ServiceNecessity Can Only be Proven with
Documentation
![Page 31: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/31.jpg)
CPT: DocumentingCPT: Documenting
PurposePayer RequirementsGeneral PrinciplesHistoryExaminationDecision Making
![Page 32: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/32.jpg)
Documentation: PurposeDocumentation: Purpose
Medical NecessityEvaluate and Plan for TreatmentCommunication and Continuity of CareClaims Review and PaymentResearch and Education
![Page 33: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/33.jpg)
Documentation: Payer Documentation: Payer RequirementsRequirements
Site of ServiceMedical Necessity for Service ProvidedAppropriate Reporting of Activity
![Page 34: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/34.jpg)
Documentation: General Documentation: General PrinciplesPrinciples
Rationale for ServiceComplete and LegibleReason/Rationale for ServiceAssessment, Progress, Impression, or
DiagnosisPlan for CareDate and Identity of ObserveTimelyConfidential
![Page 35: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/35.jpg)
Documentation: Chief Documentation: Chief ComplaintComplaint
Concise Statement Describing the Symptom, Problem, Condition, & Diagnosis
Foundation for Medical NecessityMust be Complete & Exhaustive
![Page 36: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/36.jpg)
Documentation: Ethical IssuesDocumentation: Ethical Issues
How Much and To Whom Should Information be Divulged
Medical Necessity vs. Confidentiality
![Page 37: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/37.jpg)
TimeTime
Defining– Professional (not patient) Time Including:
pre, intra & post-clinical service activities
Interview & Assessment Codes– Generally use hourly increments– For new codes, use 15 minute increments
Intervention Codes– Use 15, 30, or 60 minute increments
![Page 38: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/38.jpg)
Time: DefinitionTime: Definition
AMA Definition of Time
Physicians also spend time during work, before, or after the face-to-face time with the patient, performing such tasks as reviewing records & tests, arranging for services & communicating further with other professionals & the patient through written reports & telephone contact.
![Page 39: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/39.jpg)
Time (continued)Time (continued)
Communicating further with othersFollow-up with patient, family, and/or
othersArranging for ancillary and/or other
services
![Page 40: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/40.jpg)
Time: TestingTime: Testing
Quantifying Time– Round up or down to nearest increment– Testing = 15 or 60 (probably soon 30)
Time Does Not Include– Patient completing tests, forms, etc.– Waiting time by patient– Typing of reports– Non-Professional (e.g., clerical) time– Literature searches, new techniques, etc.
![Page 41: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/41.jpg)
Time (continued)Time (continued)
Preparing to See Patient Reviewing of Records Interviewing Patient, Family, and Others When Doing Assessments:
– Selection of tests– Scoring of tests– Reviewing results– Interpretation of results– Preparation and report writing
![Page 42: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/42.jpg)
Time: Example of 96117Time: Example of 96117
Pre-Service– Review of medical records– Planning of testing
Intra-Service– Administration
Post-Service– Scoring, interpretation, integration with other
records, written report, follow-up...
![Page 43: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/43.jpg)
Relative Value Units: Relative Value Units: OverviewOverview
ComponentsUnitsValuesCurrent Problems
![Page 44: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/44.jpg)
RVU: ComponentsRVU: Components
Physician Work Resource ValuePractice Expense Resource ValueMalpracticeGeographicConversion Factor
![Page 45: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/45.jpg)
RVU: ValuesRVU: Values
Psychotherapy:– Prior Value =1.86– New Value = 2.0+ (01.01.02)
Psych/NP Testing: – Work value= 0– Hsiao study recommendation = 2.2– New Value = undetermined
Health & Behavior– .25 (per 15 minutes increments)
![Page 46: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/46.jpg)
RVU: AcceptanceRVU: Acceptance
MedicareBlue Cross/Blue Shield 87%Managed Care 69%Medicaid 55%Other 44%New Trends: Compensation Formulas
![Page 47: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/47.jpg)
Current Problems Current Problems Definition of Physician Incident to Supervision Face-to-Face Time Work Values Qualification of Technicians Practice Expense Payment Prospective Payment System Focus for Fraud & Abuse
![Page 48: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/48.jpg)
Current Problems: HighlightsCurrent Problems: Highlights
Work ValueProvision & Coding of Technical Services
(e.g., who is qualified to provide them)Mental vs. Physical Health
![Page 49: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/49.jpg)
Problem: Defining PhysicianProblem: Defining Physician
Definition of a Physician– Social Security Practice Act of 1980– Definition of a Physician– Need for Congressional Act– Likelihood of Congressional Act– The Value of Technical Services of a
Psychologist is $.83/hour (second highest after physicist)
![Page 50: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/50.jpg)
Problem: Incident toProblem: Incident to
Definition of Physician Extender– How– Limitations
Definition of In vs. Outpatient– Geographic Vs Financial
Why No Incident to (DRG) Solution Available for Some Training Programs Probably no Future to Incident to
![Page 51: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/51.jpg)
Problem: More Incident toProblem: More Incident to
When is Incident to Acceptable:– Testing (Cognitive Rehabilitation; Biofeedback)– Psychotherapy
Definition– Commonly furnished service– Integral, though incidental to psychologist– Performed under the supervision– Either furnished without charge or as part of the
psychologist’s charge
![Page 52: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/52.jpg)
Problem:SupervisionProblem:Supervision
Supervision– 1.General = overall direction– 2.Direct = present in office suite– 3.Personal = in actual room– 4.Psychological = when supervised by a
psychologist
![Page 53: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/53.jpg)
Problem: Face-to-FaceProblem: Face-to-Face
ImplicationsTechnical versus Professional ServicesSurgery is the Foundation for CPT (and
most work is face-to-face)Hard to Document & Trace Non-Face-to-
Face Work
![Page 54: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/54.jpg)
Problem: TimeProblem: Time
Time Based Professional ActivityCurrent =15, 30, 60, & 90 Expected = 15 & 30
![Page 55: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/55.jpg)
Problem: Work ValueProblem: Work Value
Physician Activities (e.g., Psychotherapy) Result in Work Values
Psychological Based Activities (I.e., Testing) Have no Work Values
RVUs are Heavily Based on Practice Expenses (which are being reduced)
Net Result = Maybe Up to a Half Lower
![Page 56: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/56.jpg)
Problem: Qualification of Problem: Qualification of TechnicianTechnician
What is the Minimum Level of Training Required for a Technician?– Bachelor’s vs. Masters– Intern vs. Postdoctoral
Will a Registry be Available?
![Page 57: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/57.jpg)
Practice Expense: The Practice Expense: The Problem with TestingProblem with Testing
Five Year ReviewsPrior MethodologyCurrent MethodologyCurrent Value = approximately 1.5 of 1.75
is practiceExpected Value = closer to 50% of total
value
![Page 58: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/58.jpg)
Problem: PaymentProblem: Payment
Refilling– 51% require refilling
Errors– 54% = plan administrator– 17% = provider– 29% = member
State Legislation– www.insure.com/health/lawtool.cfm
![Page 59: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/59.jpg)
Problem: PaymentProblem: Payment
Use of HMOs & Third Party– Shift in Practice Patterns by Psychiatry (14% increase)– Exclusion of MSW, etc.– Worst Hit Are Psychologists (2% decrease)
Compensation– Gross Charges– Adjusted Charges– RVUs– Receivables
![Page 60: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/60.jpg)
Problem: PPSProblem: PPS
Application of PPS (inpatient rehab)Traditional ReimbursementCurrent UnbundlingPotential Situation
![Page 61: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/61.jpg)
Problem: Fraud & Abuse Problem: Fraud & Abuse 26 Different Kinds of Fraud TypesMental HealthPsychological TestingNursing HomesEstimates of Less Than 10% RecoveredPsychotherapy Estimates/Day = 9.67 hoursProblems with Methodology;
– MS level and RN– Limited Sampling
![Page 62: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/62.jpg)
Problem: Mental vs. PhysicalProblem: Mental vs. Physical
Historical vs. Traditional vs. Recent Diagnostic Trends
Recent Insurance Interpretations of Dxs Limitations of the DSM The Endless Loop of Mental vs. Physical
NOTE: Important to realize that LMRP is almost always more restrictive than national guidelines
![Page 63: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/63.jpg)
Possible SolutionsPossible Solutions Better Understanding & Application of CPT More Involvement in Billing Comprehensive Understanding of LMRP More Representation/Involvement with AMA, CMS,
& Local Medical Review Panels Meetings with CMS Survey for Testing Codes APA: Increased Staff & Relationship with CAPP NAN: New PAOI Development of State or Local Neuropsychological
Interest Groups or Associations
![Page 64: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/64.jpg)
Possible Solutions: ResourcesPossible Solutions: Resources
Web Sites– Naonline.org– Div40.org– Cms.org– clinicalneuropsychology.com
Publications– Testing Times: Camara, Puente, & Nathan (2000)– General CPT: NAN & Div 40 Newsletters
![Page 65: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/65.jpg)
Future PerspectivesFuture Perspectives Income
– Steadier (if economy does not further erode)– Probable incremental declines, up to 10-20%– If Medicaid dependent (25% or more), then declines could be
even higher– “Final” stabilization by 2005
Recognition– Physician Level– Mental vs. Physical Health
Paradigms– Industrial vs. Boutique– Health vs. Non-Health– Primary Care vs. Consulting
![Page 66: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/66.jpg)
Future PerspectivesFuture Perspectives
New Paradigm = Change
![Page 67: Billing, Reimbursement & Documentation Strategies for Pediatric Neuropsychological Services](https://reader035.vdocuments.us/reader035/viewer/2022070409/56649e8d5503460f94b90df9/html5/thumbnails/67.jpg)
Questions? Answers…Questions? Answers…
QuestionsNew NAN PAOI Office
Consultation Time: Wednesday 11-1 EST
910.962.3812
Website: nanonline.org/paio