Wednesday, September 26, 2007

Let's talk turkey: what the clinical doctoral psychologist gets paid to see clients

There was a suggestion that providers are making so much money that they are able to construct buildings (!).

What I see is providers seeing clients in their homes; renting office space for cheap; obtaining funding for office re: the United Way.

I believe it is very important for people to talk about money. The non talking of it allows the payors to screw the payees.

Let's overview what Medicaid pays. For a PhD psychologist, with 4 yrs of college; 6 years of post-graduate training, for 90808 CPT code (70-90 min therapy), wherein the psychologist goes out to the client's home, utilizing modifier codes of AH and AQ (clinical psychologist; impoverished area of service), the pay is approx $136.00. What is usually billed is for $150.00 in that it is in keeping with Medicaid/ medicare outline as legitimate for a doctoral psychologist. That does not include the co-pay. No medicaid client has a co-pay. Its either eat or gather up the co-pay. Most psychologists would only bill for 90806, 45-60 min of therapy, as to bill for the 90808, I'm told, is to risk audit.

Now duh: why do I see my clients in their homes? A no show client is a non-billable client. This is not the private, for-fee world that people seem to think exists.

Bear in mind that private insurance follows suit in terms of what they will pay----always looking to see what Medicare and Medicaid are doing. You then get some idea why psychologists go into forensic work, so they can get on the stand and bill for what they should be paid (and then some).

Let's overview what Medicare pays. Medicare pays 62.5% of the above CPT code. However, if you have a client who has medical issues, and these are outlined in the notes, the psychologist or social worker may use 96152, Behavioral Health CPT code. That pays at the medical rate of 80%. That means for the 90808 you get .80 x 150 or 80% of the 150.

Let overview what state funded clients pay----which is very grim indeed. These are the clients who cannot obtain Medicare or Medicaid; these are people w/o children, over 21, and under 62. Yes, they can file for social security disability, wait for that to go through for 2-3 yrs; get an attorney who for the life of the social security disability takes a percentage----- and then if they don't get too much social security disability (more than 600-700$$/ month in Social Security Disability), they can get access to Medicaid. Otherwise, they hit the 'doughnut' and cannot get to Medicaid which overlaps with Medicare. Medicare is always billed first.

Shall I tell you how long it took me to figure out how to use Medicare Claims Express 3.2, interfacing with dial up modem vis a vis EDI? There's no pay for that.

I digress: for CPT code 90808, wherein the clinical doctoral psychologist goes to the client's home, has therapy with the client for approx 1.5 hrs., bills the LME under Community Support restrictions (modifier codes don't matter: you could be 100 miles inj the sticks w/ no transportation and there would be no modifiercodes) you obtain authorization at 90808 but the LME then morphs the code into something that allows them to pay you approx $92. That's almost a 50% loss of fee.

You take it off your income taxes at the end of the year as a loss. I haven't tried this before but I'll be doing this time around.

Come and get me IRS.


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