Medical Billing for Post-docs

[szf105]

How do hospitals bill for unlicensed psychologists? Is there a way to bill through medical insurance that reimburses for a post-doc? I am wondering about how it would work if I took a position in a private Dr's office and how they could be reimbursed for my services as a post-doc.

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[erg923]

How do hospitals bill for unlicensed psychologists? Is there a way to bill through medical insurance that reimburses for a post-doc? I am wondering about how it would work if I took a position in a private Dr's office and how they could be reimbursed for my services as a post-doc.

Medicaid and Medicare will not pay for unlicensed persons, and neither will most insurance panels. This varies by state, but this is the general rule in the vast majority of the 50 states. Hence why post-docs in PP setting are compensated so low, if compensated at all. Unless all their revenue comes from contracts (rather than insurance or out of pocket), then you will be looking at a poverty level stipend.

 

[PsychScience]

How do hospitals bill for unlicensed psychologists? Is there a way to bill through medical insurance that reimburses for a post-doc? I am wondering about how it would work if I took a position in a private Dr's office and how they could be reimbursed for my services as a post-doc.

I think this is going to vary drastically by state and state regulations. I work in a hospital- and some of my hours (and the list of billable services is very specific) can be billed, but they are billed under my supervisor's license, my status as an "unlicensed person with graduate training in psychology" is made very clear, and my supervisor must sign off on everything that I sign. However, I also work at a hospital that is established as a training hospital, and so it is pretty common for residents to see patients and faculty/attendings to sign off on these services. If I were to work in a private practice in the exact same state, I would not be able to bill for any of my clinical hours. I would need to accrue all of my supervised hours through self-pay clients. I know several people who have attempted to go this route, and it is far from an easy path to take toward licensure.

 

[PHD12]

How do hospitals bill for unlicensed psychologists? Is there a way to bill through medical insurance that reimburses for a post-doc? I am wondering about how it would work if I took a position in a private Dr's office and how they could be reimbursed for my services as a post-doc.

I researched this in the past and found out that post-docs in PP settings were generally only seeing private pay patients, which is a pretty tough group to find. For the first few months they weren't earning an income---so expect an income of 10-25K for the year. In some situations, the post-doc can earn an hourly fee or a salary for the year (this will vary extensively so there are no averages really). Your income will be 100% dependent on how many patients get referred to you and continue in treatment.

 

[PsychScience]

Medicaid and Medicare will not pay for unlicensed persons, and neither will most insurance panels. This varies by state, but this is the general rule in the vast majority of the 50 states. Hence why post-docs in PP setting are compensated so low, if compensated at all. Unless all their revenue comes from contracts (rather than insurance or out of pocket), then you will be looking at a poverty level stipend.

Sounds about right.

Medicaid and several other insurance companies have a contract within the hospital that allows very specific services that are provided by supervised psychology trainees to be billed. I mentioned that it varies by state, but erg brought up a very good point, it also varies by hospital. Regardless, this would not be in the case in a private practice.

 

[PsychScience]

I researched this in the past and found out that post-docs in PP settings were generally only seeing private pay patients, which is a pretty tough group to find. For the first few months they weren't earning an income---so expect an income of 10-25K for the year. In some situations, the post-doc can earn an hourly fee or a salary for the year (this will vary extensively so there are no averages really). Your income will be 100% dependent on how many patients get referred to you and continue in treatment.

I will add that in addition to having an unpredictable income, it is also an unpredictable way to accrue hours.

 

[Doctor Eliza]

My experience is pretty different from what others are describing. I have worked at the same PP since graduation. I first worked as a "psychological resident" (i.e., informal postdoc) and then as a licensed psychologist and a supervisor. Several major panels allow supervision (bill supervisee's under their supervisor's license). There are at least 2 major panels that are popular in the area that don't.

Granted, one of the reasons that this PP is willing to hassle with unlicensed folks is that it is a pretty poor split (50-50) and since it is so hard to find a gig as an UL psychologist, it is a good way to find a bunch of suckers willing to work for them. I would expect that most PP's find it to be more hassle than it is worth.

Dr. E

 

[Sanman]

It really depends on the state, I am able to bill Medicaid/medicare for psychotherapy as long as all notes are cosigned, but I cannot do a 90801. I am also able to bill insurance third party though my supervisor's license in PP. This is with a limited license.

 

[MBellows]

It really depends on the state, I am able to bill Medicaid/medicare for psychotherapy as long as all notes are cosigned, but I cannot do a 90801. I am also able to bill insurance third party though my supervisor's license in PP. This is with a limited license.

I was about to say, this is why you should do internship/post-doc in Texas. You can get an LPA and make monies.

 

[bmedclinic]

It really depends on the state, I am able to bill Medicaid/medicare for psychotherapy as long as all notes are cosigned, but I cannot do a 90801. I am also able to bill insurance third party though my supervisor's license in PP. This is with a limited license.

does it seem odd to anyone else that you can do a 90806 but not a 90801?
Any logical reasoning for this? What would preclude you from being competent in doing an intake and not psychotherapy at the post-doc level?

 

[PsychScience]

I was about to say, this is why you should do internship/post-doc in Texas. You can get an LPA and make monies.

I think Michigan also has a limited license that allows this...

There is just so much between state variability in how things can be billed and what can be billed and who can do the billing, it really needs to be examined on a by state basis. Like I said, in my current state I can bill within a hospital as an unlicensed trainee, but could not in a private practice. If I were to hop over just a few states, I could get my license as soon as I passed the EPPP without any supervised postdoc hours.

 

[IT514]

Posting under this thread as the title sort of fits, though my question is a bit different.

I'm about five months from finishing my neuropsych fellowship. I will be licensed within a few days here. I'm thinking about applying to Medicare and have a few options for partnering with someone in PP, so I would have a different PP location than my fellowship hospital. Thinking about doing a few weekend evals. The ops manager for my hospital department doesnt seem to think this would be a problem as long as billing is conducted correctly, and my work in PP and billing address would be seperate from my fellowship.

Just wondering if anyone has tried this? I've posted elsewhere but not getting much of a response. I plan on calling Medicare but just wondering if anyone has personal experience with this.

 

[smalltownpsych]

Our hospital has a policy that all moonlighting has to be approved by the executive committee so just make sure that you are in compliance with their own policy. Other than that, it should not be a problem to bill separately for that work outside of your current employment.