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REIMBURSEMENT FOR NEUROPSYCHOLOGICAL SERVICES

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Presentation on theme: "REIMBURSEMENT FOR NEUROPSYCHOLOGICAL SERVICES"— Presentation transcript:

1 REIMBURSEMENT FOR NEUROPSYCHOLOGICAL SERVICES
Antonio E. Puente UNC-Wilmington NAN: , San Antonio

2 OUTLINE ACKNOWLEDGMENT HISTORY & BACKGROUND MODEL FOR BILLING SERVICES
DIAGNOSES TESTS CODING DOCUMENTATION

3 OUTLINE II MEDICARE MODEL POLICY REIMBURSEMENT ISSUES AUDITS
ADDITIONAL CONCERNS CURRENT PROBLEMS SUMMARY FUTURE DIRECTIONS

4 ACKNOWLEDGMENTS AMERICAN PSYCHOLOGICAL ASSOCATION’S PRACTICE DIRECTORATE DIVISION 40 OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION NATIONAL ACADEMY OF NEUROPSYCHOLOGY

5 BACKGROUND/HISTORY NORTH CAROLINA PSYCHOLOGICAL ASSOCIATION (1988-89)
AMERICAN MEDICAL ASSOCIATION- CPT IV (1994) AMERICAN MEDICAL ASSOCIATION- CPT v (1997) MEDICARE COVERAGE ADVISORY COMMITTEE (1999)

6 MODEL BILLING DIAGNOSIS PROFESSIONAL SERVICE LOCATION OF SERVICE
PROVIDER

7 DIAGNOSIS SYSTEM (see NAN directory) RULE-OUT MULTIPLE DXs
DSM ( ) ICD (ALL OTHER DXs) RULE-OUT BY DESIGN BUT STATED MULTIPLE DXs ADVISABLE FOR MEDICALLY NECESSARY FIRST ONE IS MOST IMPORTANT

8 TESTS WHAT TESTS ARE BEING USED
HOW LONG DOES IT TAKE FOR EACH OF THESE TESTS ADDRESS MORE SPECIFICALLY PRE, DURING, AND POST PROFESSIONAL TIME

9 Outline of Presentation
I. Introduction II. Sample III. Results IV. Summary

10 Study Sample I Organization: National Academy of Neuropsychology
Description: Approximately 4,000 members Independent organization dedicated to clinical neuropsychology

11 Study Sample II Rationale:
Not an interest group (e.g., Division 40 of APA) Not multidisciplinary (e.g., International Neuropsychological Society)

12 Study Sample III Sample Description 2700= Total members of NAN in 1994
1200= Total # sampled 324= Initial response (27%) 242= Second response (20%) 566= Total responses (47%) 119= Reported <5hrs/week of evaluations 447= Total used from original sample

13 Introduction Rationale Prior Research HCFA/Third Party Reimbursers
Establish a baseline of test used with time values Prior Research Practice Surveys (e.g., Hartlage, et al; Putnam, et al) Test Surveys (e.g., Ball, et al; Lees-Haley, et al)

14 Results Hours Spent Testing Percentage of Batteries
Minutes to Administer Percentage of Testing with Computers Tests

15 Results I Time Spent Testing
Hours N % > No Response

16 Results II Number & % of Batteries
Practice Areas N % Adaptive Aphasia Behavioral Med Developmental Intellectual Neurobehavioral Neuropsychological Personality

17 Results III Minutes to Administer Test
Practice Areas Admin. Score Int. Adaptive Aphasia Behavioral Med Developmental Intellectual Neurobehavioral Neuropsych Personality

18 Results IV Testing with Computers
Activity % Administration 2 Scoring 10 Interpretation 3

19 Results V Test Frequency
Total # of tests= 102 Tests used exclusively by neuropsychologists= 8 Longest tests used= HRNB (400 mins.) Wechsler Scales (130 mins.)

20 Results V Top 26 Tests MMPI WAIS-R WMS-R TRAIL MAKING FAS WORD FLUENCY
FINGER TAPPING HRNB BOSTON NAMING CATEGORY TEST WRAT-R/III BECK DEPRESSION REY COMPLEX FIGURE TEST WISCONSIN CARD SORTING CALIFORNIA VERBAL LEARN. GROOVED PEGBOARD WISC-R/III APHASIA SCREENING TEST RORSCHACH INKBLOT HOOPER VISUAL ORGAN. HAND DYNAMOTER DEMENTIA RATING SCALE STROOP PASAT MILLON BENDER GESTALT THEMATIC APPERCEPTION

21 Summary First extended study on: Implications:
Tests used in clinical practice Overallratings Assessment of time values Implications: Clinical Practice Public Policy

22 CODING SYSTEMS ICD/WHO SNOMED CPT

23 CODING II DEFINITION OF CPT- CURRENT PROCEDURAL TERMINOLOGY USE OF CPT
LISTING OF DESCRIPTIVE TERMS FOR REPORTING PROFESSIONAL SERVICES USE OF CPT MOST WIDELY ACCEPTED NOMENCLATURE USED TO REPORT HEALTH SERVICES

24 CODING III DEVELOPMENT OF CPT DEVELOPED= AMA FIRST EDITION= 1966
CURRENT EDITION= 4TH NEXT EDITION= 5TH, 2002

25 CODING IV INTERVIEW TESTING PSYCHIATRIC= 90801 NEUROLOGICAL= 96115

26 CODING V INTERVENTION PSYCHIATRIC=908xx NEUROLOGICAl
Individual Vs Group Brief vs Regular vs Extended Inpatient vs Outpatient Regular vs Interactive NEUROLOGICAl Cognitive Rehab= (and others) Biofeedback= or 90901

27 CODING VI MATCH THE DX WITH THE RX PSYCHIATRIC= DSM WITH 90801
NEUROLOGICAL= ICD WITH 96115

28 DOCUMENTATION GENERAL VS SPECIFIC IMPORTANCE OF DOCUMENTING

29 DOCUMENTATION II PSYCH INTERVIEW HISTORY CHIEF COMPLAINT MENTAL STATUS
DISPOTION COMMUNICATION WITH OTHERS ORDERING OR INTERPRETING TESTS DIAGNOSIS

30 DOCUMENTATION III PSYCH THERAPEUTIC PROCEDURES
PURPOSE= RESOLVING PROBLEMS OR ALLEVIATING OF EMOTIONAL DISTURBANCES, OR CHANGING MALADAPTIVE PATTERNS OF BEHAVIOR, OR ENCOURAGING PERSONAL GROWTH AND DEVELOPMENT

31

32 DOCUMENTATION IV APPROACHES=
REGULAR- DEVELOPMENT OF INSIGHT OR AFFECTIVE UNDERSTANDING, THE USE OF BEHAVIOR MODIFICATION TECHNIQUES, THE USE OF SUPPORTIVE INTERACTIONS, THE USE OF COGNITIVE DISCUSSION OF REALITY… INTERACTIVE= THE USE OF PHSYICAL AIDS OR NON-VERBAL COMMUNICATION

33 DOCUMENTATION V (Psy) SPEECH LANGUAGE THOUGHT PROCESS INSIGHT JUDGMENT
RELIABILITY REASONING PERCEPTIONS SUICIDALITY VIOLENCE MOOD & AFFECT ORIENTATION MEMORY ATTENTION INTELLIGENCE MIN-MENTAL STATUS

34 DOCUMENTATION VI COMPLETE AND LEGIBLE ASSESSMENT, IMPRESSION, OR DX
PLAN FOR CARE DATE & IDENTITY OF OBSERVER TESTING RATIONALE SHOULD BE CLEAR RISK FACTORS SHOULD BE IDENTIFIED CONFIDENTIALITY

35 DOCUMENTATION VII TESTING DATE REASON FOR SERVICE NAME OF TESTS USED
INTERPRETATION OF TESTS RESULTS IMPRESSION/DIAGNOSIS DISPOSITION IDENTITY OF OBSERVER TIME

36 DOCUMENTATION VIII- neurobehavioral status
DATE REASON FOR SERVICE ATTENTION MEMORY VISUAL-SPATIAL LANGUAGE PLANNING IMPRESSION/DX DISPOSITION IDENTITY OF OBSER. TIME

37 DOCUMENTATION IX PSYCH THERAPY COG REHAB DATE REASON INTERVENTION
RESULTS IMPRESSION DISPOSITION IDENTITY TIME COG REHAB DATE REASON TRAINING ACTIVITY IDENTITY TIME

38 MODEL POLICY BACKGROUND APPLICATION CODE CATEGORY INDICATION
DESCRIPTION DOCUMENTATION COMMENTS

39 MODEL POLICY II NEUROPSYCHOLOGICAL TESTING
DESCRIPTION= INTEGRITY OF THE BRAIN TIME= 5-7 HOURS, IF OVER 11 HOURS THEN A REPORT SHOULD BE SUBMITTED DIAGNOSES= ICD

40 REIMBURSEMENT MEDICARE RATES 90801= 127.81 90806= 88.57 96100= 68.77
90806= 96100= 96115= 96117= 97770=

41 AUDITS BACKGROUND CODING & DOCUMENTATION MEDICALLY NECESSARY
Balanced Budget Act CODING & DOCUMENTATION MEDICALLY NECESSARY Is the service rendered needed for the question considered?

42 TIME DEFINING TIME professional time- pre, during, post
not patient activity alone (e.g., MMPI)

43 ADDITIONAL CONCERNS GENERAL MEDICAL EDUCATION DEFINING SCOPE
TRAINING OF HEALTH-CARE PROFESSIONALS PROVISION OF SERVICES FOR INDIGENT SCOPE INTERNS POST-DOCTORAL FELLOWS

44 ADDITIONAL CONCERNS II
INCIDENT TO DEFINING EXTENSION OF PROFESSIONAL SERVICES SCOPE APPLIES ONLY TO MEDICARE SERVICE CAN BE DONE BUT WILL NOT BE REIMBURSED NO INCIDENT TO IN INPATIENT SETTINGS INCIDENT TO IN “OUTPATIENT” SETTINGS IS ACCEPTABLE

45 CURRENT PROBLEMS AUDITING (CODING/DOCUMENTATION)
DECREASED REIMBURSEMENT GREATER LIMITS ON WHAT IS MEDICALLY NECESSARY MENTAL HEALTH VS MEDICAL & CARVE-OUTS NON-PSYCHOLOGISTS (BOTH MDs AND NON-MDS)

46 SUMMARY MODELSYSTEM EACH CARRIER HAS UNIQUE SYSTEM
EDUCATION IS CRITICAL LITIGATION MAY BE NECESSARY

47 FUTURE DIRECTIONS CODING GREATER ACCOUNTABILITY
LESS REIMBURSEMENT FOR STANDARD CLINICAL SERVICES SPILL-OVER INTO RELATED AREAS INCLUDING FORENSICS, NON-NEUROLOGICAL MEDICINE, SPORTS, INDUSTRY

48 FUTURE DIRECTIONS II CONTRACTS & CONSULTATION VS FEE FOR SERVICE
USE OF TECHNICIANS SHOULD BE OR WILL BE FURTHER CLARIFIED DECREASE OF PRACTICE EXPENSES INCREASED USE OF INFORMATION SYSTEMS & ELECTRONIC OFFICES DECREASED INSTITUTIONAL ACTIVITY


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