Presentation is loading. Please wait.

Presentation is loading. Please wait.

REIMBURSEMENT FOR NEUROPSYCHOLOGICAL SERVICES Antonio E. Puente UNC-Wilmington NAN: 11.03.99, San Antonio.

Similar presentations


Presentation on theme: "REIMBURSEMENT FOR NEUROPSYCHOLOGICAL SERVICES Antonio E. Puente UNC-Wilmington NAN: 11.03.99, San Antonio."— Presentation transcript:

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

2 OUTLINE zACKNOWLEDGMENT zHISTORY & BACKGROUND zMODEL FOR BILLING SERVICES zDIAGNOSES zTESTS zCODING zDOCUMENTATION

3 OUTLINE II zMEDICARE MODEL POLICY zREIMBURSEMENT ISSUES zAUDITS zADDITIONAL CONCERNS zCURRENT PROBLEMS zSUMMARY zFUTURE DIRECTIONS

4 ACKNOWLEDGMENTS zAMERICAN PSYCHOLOGICAL ASSOCATIONS PRACTICE DIRECTORATE zDIVISION 40 OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION zNATIONAL ACADEMY OF NEUROPSYCHOLOGY

5 BACKGROUND/HISTORY zNORTH CAROLINA PSYCHOLOGICAL ASSOCIATION ( ) zAMERICAN MEDICAL ASSOCIATION- CPT IV (1994) zAMERICAN MEDICAL ASSOCIATION- CPT v (1997) zMEDICARE COVERAGE ADVISORY COMMITTEE (1999)

6 MODEL BILLING zDIAGNOSIS zPROFESSIONAL SERVICE zLOCATION OF SERVICE zPROVIDER

7 DIAGNOSIS zSYSTEM (see NAN directory) yDSM ( ) yICD (ALL OTHER DXs) zRULE-OUT yBY DESIGN BUT STATED zMULTIPLE DXs yADVISABLE FOR MEDICALLY NECESSARY yFIRST ONE IS MOST IMPORTANT

8 TESTS zWHAT TESTS ARE BEING USED zHOW LONG DOES IT TAKE FOR EACH OF THESE TESTS zADDRESS MORE SPECIFICALLY PRE, DURING, AND POST PROFESSIONAL TIME

9 Outline of Presentation zI. Introduction zII. Sample zIII. Results zIV. Summary

10 Study Sample I zOrganization: National Academy of Neuropsychology zDescription: y Approximately 4,000 members yIndependent organization dedicated to clinical neuropsychology

11 Study Sample II zRationale: yNot an interest group (e.g., Division 40 of APA) yNot multidisciplinary (e.g., International Neuropsychological Society)

12 Study Sample III zSample Description y2700= Total members of NAN in 1994 y1200= Total # sampled y 324= Initial response (27%) y 242= Second response (20%) y 566= Total responses (47%) y 119= Reported <5hrs/week of evaluations y 447= Total used from original sample

13 Introduction zRationale yHCFA/Third Party Reimbursers yEstablish a baseline of test used with time values zPrior Research yPractice Surveys (e.g., Hartlage, et al; Putnam, et al) yTest Surveys (e.g., Ball, et al; Lees-Haley, et al)

14 Results zHours Spent Testing zPercentage of Batteries zMinutes to Administer zPercentage of Testing with Computers zTests

15 Results I Time Spent Testing zHoursN% z z z z z> zNo Response 4 1

16 Results II Number & % of Batteries zPractice AreasN% zAdaptive19443 zAphasia20546 zBehavioral Med12728 zDevelopmental11527 zIntellectual35479 zNeurobehavioral22851 zNeuropsychological42795 zPersonality 35379

17 Results III Minutes to Administer Test zPractice AreasAdmin.Score Int. zAdaptive zAphasia zBehavioral Med zDevelopmental zIntellectual zNeurobehavioral zNeuropsych zPersonality

18 Results IV Testing with Computers zActivity% zAdministration 2 zScoring10 zInterpretation 3

19 Results V Test Frequency zTotal # of tests= 102 zTests used exclusively by neuropsychologists= 8 zLongest tests used= yHRNB (400 mins.) yWechsler Scales (130 mins.)

20 Results V Top 26 Tests zMMPI zWAIS-R zWMS-R zTRAIL MAKING zFAS WORD FLUENCY zFINGER TAPPING zHRNB zBOSTON NAMING zCATEGORY TEST zWRAT-R/III zBECK DEPRESSION zREY COMPLEX FIGURE TEST zWISCONSIN CARD SORTING z CALIFORNIA VERBAL LEARN. z GROOVED PEGBOARD z WISC-R/III z APHASIA SCREENING TEST z RORSCHACH INKBLOT z HOOPER VISUAL ORGAN. z HAND DYNAMOTER z DEMENTIA RATING SCALE z STROOP z PASAT z MILLON z BENDER GESTALT z THEMATIC APPERCEPTION

21 Summary zFirst extended study on: yTests used in clinical practice yOverallratings yAssessment of time values zImplications: yClinical Practice yPublic Policy

22 CODING zSYSTEMS yICD/WHO ySNOMED yCPT

23 CODING II zDEFINITION OF CPT- CURRENT PROCEDURAL TERMINOLOGY yLISTING OF DESCRIPTIVE TERMS FOR REPORTING PROFESSIONAL SERVICES zUSE OF CPT yMOST WIDELY ACCEPTED NOMENCLATURE USED TO REPORT HEALTH SERVICES

24 CODING III zDEVELOPMENT OF CPT yDEVELOPED= AMA yFIRST EDITION= 1966 yCURRENT EDITION= 4TH yNEXT EDITION= 5TH, 2002

25 CODING IV zINTERVIEW yPSYCHIATRIC= yNEUROLOGICAL= zTESTING yPSYCHIATRIC= yNEUROLOGICAL= 96117

26 CODING V zINTERVENTION yPSYCHIATRIC=908xx xIndividual Vs Group xBrief vs Regular vs Extended xInpatient vs Outpatient xRegular vs Interactive yNEUROLOGICAl xCognitive Rehab= (and others) xBiofeedback= or 90901

27 CODING VI zMATCH THE DX WITH THE RX yPSYCHIATRIC= DSM WITH yNEUROLOGICAL= ICD WITH 96115

28 DOCUMENTATION zGENERAL VS SPECIFIC zIMPORTANCE OF DOCUMENTING

29 DOCUMENTATION II zPSYCH INTERVIEW yHISTORY yCHIEF COMPLAINT yMENTAL STATUS yDISPOTION yCOMMUNICATION WITH OTHERS yORDERING OR INTERPRETING TESTS yDIAGNOSIS

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

31

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

33 DOCUMENTATION V (Psy) zSPEECH zLANGUAGE zTHOUGHT PROCESS zINSIGHT zJUDGMENT zRELIABILITY zREASONING zPERCEPTIONS z SUICIDALITY z VIOLENCE z MOOD & AFFECT z ORIENTATION z MEMORY z ATTENTION z INTELLIGENCE z MIN-MENTAL STATUS

34 DOCUMENTATION VI zCOMPLETE AND LEGIBLE zASSESSMENT, IMPRESSION, OR DX zPLAN FOR CARE zDATE & IDENTITY OF OBSERVER zTESTING RATIONALE SHOULD BE CLEAR zRISK FACTORS SHOULD BE IDENTIFIED zCONFIDENTIALITY

35 DOCUMENTATION VII zTESTING yDATE yREASON FOR SERVICE yNAME OF TESTS USED yINTERPRETATION OF TESTS RESULTS yIMPRESSION/DIAGNOSIS yDISPOSITION yIDENTITY OF OBSERVER yTIME

36 DOCUMENTATION VIII- neurobehavioral status zDATE zREASON FOR SERVICE zATTENTION zMEMORY zVISUAL-SPATIAL zLANGUAGE z PLANNING z IMPRESSION/DX z DISPOSITION z IDENTITY OF OBSER. z TIME

37 DOCUMENTATION IX zPSYCH THERAPY yDATE yREASON yINTERVENTION yRESULTS yIMPRESSION yDISPOSITION yIDENTITY yTIME z COG REHAB yDATE yREASON yTRAINING ACTIVITY yIDENTITY yTIME

38 MODEL POLICY zBACKGROUND zAPPLICATION yCODE yCATEGORY yINDICATION yDESCRIPTION yDOCUMENTATION yCOMMENTS

39 MODEL POLICY II zNEUROPSYCHOLOGICAL TESTING yDESCRIPTION= INTEGRITY OF THE BRAIN yTIME= 5-7 HOURS, IF OVER 11 HOURS THEN A REPORT SHOULD BE SUBMITTED yDIAGNOSES= ICD

40 REIMBURSEMENT zMEDICARE RATES y90801= y90806= y96100= y96115= y96117= y97770=

41 AUDITS zBACKGROUND yBalanced Budget Act zCODING & DOCUMENTATION zMEDICALLY NECESSARY yIs the service rendered needed for the question considered?

42 TIME zDEFINING TIME yprofessional time- pre, during, post ynot patient activity alone (e.g., MMPI)

43 ADDITIONAL CONCERNS zGENERAL MEDICAL EDUCATION yDEFINING xTRAINING OF HEALTH-CARE PROFESSIONALS xPROVISION OF SERVICES FOR INDIGENT ySCOPE xINTERNS xPOST-DOCTORAL FELLOWS

44 ADDITIONAL CONCERNS II zINCIDENT TO yDEFINING xEXTENSION OF PROFESSIONAL SERVICES ySCOPE xAPPLIES ONLY TO MEDICARE xSERVICE CAN BE DONE BUT WILL NOT BE REIMBURSED xNO INCIDENT TO IN INPATIENT SETTINGS xINCIDENT TO IN OUTPATIENT SETTINGS IS ACCEPTABLE

45 CURRENT PROBLEMS zAUDITING (CODING/DOCUMENTATION) zDECREASED REIMBURSEMENT zGREATER LIMITS ON WHAT IS MEDICALLY NECESSARY zMENTAL HEALTH VS MEDICAL & CARVE- OUTS zNON-PSYCHOLOGISTS (BOTH MDs AND NON-MDS)

46 SUMMARY zMODELSYSTEM zEACH CARRIER HAS UNIQUE SYSTEM zEDUCATION IS CRITICAL zLITIGATION MAY BE NECESSARY

47 FUTURE DIRECTIONS zCODING zGREATER ACCOUNTABILITY zLESS REIMBURSEMENT FOR STANDARD CLINICAL SERVICES zSPILL-OVER INTO RELATED AREAS INCLUDING FORENSICS, NON- NEUROLOGICAL MEDICINE, SPORTS, INDUSTRY

48 FUTURE DIRECTIONS II zCONTRACTS & CONSULTATION VS FEE FOR SERVICE zUSE OF TECHNICIANS SHOULD BE OR WILL BE FURTHER CLARIFIED zDECREASE OF PRACTICE EXPENSES zINCREASED USE OF INFORMATION SYSTEMS & ELECTRONIC OFFICES zDECREASED INSTITUTIONAL ACTIVITY


Download ppt "REIMBURSEMENT FOR NEUROPSYCHOLOGICAL SERVICES Antonio E. Puente UNC-Wilmington NAN: 11.03.99, San Antonio."

Similar presentations


Ads by Google