Week 6 Practicum Journal: Reimbursement Rates ✓ Solved
```html
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 office staffs, the providers of psychiatric care are run on 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 mentioning that 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 American Medical Association.
| Type of Service | CPT Code | Private Insurer Reimbursement Rate for PMHNP | Private Insurer Reimbursement Rate for Physicians | Medicare Reimbursement Rate for PMHNP | Medicare 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 |
From the reimbursement template above, it is clear that physicians get higher reimbursements compared to PMHNPs. Both private insurers and the government provide higher reimbursement rates to physicians than 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 better than the government (O’Donnell, Williams, & Kilbourne, 2013). Examples of these companies include United Behavioral Health, Blue Cross, and 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 another 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 location, the type of insurance cover that individuals have, and the level of education (Bishop, Press, Keyhani, & Pincus, 2014). Providers of mental health services with a high level of education receive higher reimbursement rates compared to those who are less educated (Kohler, 2015). This can be deduced from the reimbursement rate table above. Medical physicians take longer to complete their training compared to psychiatric mental health nurses. Their high education status enables them to perform complicated procedures that advanced registered practice psychiatric nurses do.
The only way that psychiatric mental health nurses can achieve better and higher reimbursement rates is by seeking employment in better-end locations such as 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 reimbursement rates has been discussed for a long time; however, little has been done to address it. Moreover, no one is willing to engage the relevant stakeholders to address the issue due to the nature of the two disciplines.
Paper For Above Instructions
The disparity in reimbursement rates between psychiatric mental health nurse practitioners (PMHNPs) and physicians is an emerging concern that reflects broader systemic inequities in healthcare. These differences not only affect the practices of mental health providers but also have significant implications for access to care for patients. Understanding the various treatment modalities and their associated reimbursement rates is essential for effective practice management in mental health settings.
According to the data presented in the reimbursement rate table, psychiatric diagnostic evaluations (CPT code 90791) exhibit significant variations in reimbursement rates. For PMHNPs, the reimbursement rate is approximately $80.61, whereas physicians receive $94.84 for the same service. The gap widens further when comparing Medicare reimbursement rates, with PMHNPs receiving $114.61, trailing behind physicians, who receive $154.71. This pattern is consistent across the majority of treatment modalities assessed, where PMHNPs earn considerably less than their physician counterparts.
When it comes to psychotherapy services, the differences are marginal at times but still present. For instance, for a 60-minute psychotherapy session (CPT code 90837), PMHNPs earn $82.95, while physicians earn $88.90. Medicare reimbursement rates also reflect this trend, with PMHNPs receiving $111.53 and physicians $115.70. In the context of short therapy sessions, such as individual psychotherapy for 30 minutes (CPT code 90832), PMHNPs earn $45.75, compared to $53.05 for physicians, which further emphasizes the trend of lower rates for nurse practitioners.
A critical analysis of reimbursement rates reveals underlying disparities that are reflective of educational attainment, training, and systemic biases. Given that physicians typically undergo longer and more intensive training periods as compared to PMHNPs, it's plausible that their higher education credentials are a principal factor contributing to the higher reimbursement rates they enjoy (Kohler, 2015). Research indicates that providers with advanced degrees can often command higher rates, which continues to perpetuate inequalities as health systems prioritize education as a key determinant of provider capability (Bishop et al., 2014).
This structure not only discredits the abilities of skilled PMHNPs but also inadvertently discourages many from entering the field or accessing advanced training, creating a cyclical issue where mental health providers are left undercompensated, leading to burnout and job dissatisfaction. In addressing these disparities, systemic reforms must aim to standardize reimbursement rates across disciplines, valuing mental health service providers in alignment with their clinical competencies rather than extrinsic factors such as their degree or type of professional training.
Furthermore, the geographical location plays a pivotal role in reimbursement rates, wherein metropolitan areas tend to have higher rates compared to rural settings. This disparity suggests additional challenges for PMHNPs working in underserved areas where reimbursement rates may not adequately reflect the cost of living or the complexity of cases encountered. The evidence suggests that PMHNPs in urban settings, such as New York City, may find better-paying opportunities, shifting the distribution of mental health professionals and potentially exacerbating care access issues in rural locations.
By broadening the discussion around mental health reimbursement rates, stakeholders can begin to address these disparities which impede not only the professional growth of PMHNPs but also patient access to critical mental health services. Engaging in dialogue with insurers, healthcare policy-makers, and educational institutions is essential for reforming the current landscape of mental health reimbursement. Increased collaboration can help drive legislative measures that advocate for equitable reimbursement practices that reward high-quality care irrespective of the provider's title.
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), 1951-1958. doi:10.1007/s11606-013-2577-3
- American Medical Association. (2017). CPT Professional Edition. Chicago, IL: American Medical Association.
- Gonzalez, L., & Anderson, C. (2017). Reimbursement Rates for Mental Health Services: Are There Disparities? Psychology Services, 14(3), 334-341.
- Rosenbaum, L. (2016). The Challenges of Mental Health Reimbursement: A Review of the Literature. Social Science & Medicine, 171, 233-241.
- Stein, G. (2019). Understanding Mental Health Care Reimbursement: A Comparison of Rates Across Providers. Journal of Mental Health Policy and Economics, 22(1), 15-22.
- Verduin, D. (2020). Barriers to Mental Health Care and the Role of Insurance Companies: A Study. Journal of Counseling Psychology, 67(4), 456-465.
- Thompson, K. (2018). Disparities in Mental health reimbursement - A Call for Reform. American Journal of Psychiatry, 175(11), 1061-1065.
- Mitchell, J. (2021). Exploring Payment Models for Mental Health Providers: Lessons Learned and Best Practices. Journal of Health Economics, 798-810.
```