Medicare, Medicaid, Pvt Insurance, Workers' Comp, etc.

[Therapist4Chnge]

So…I'd like a general thread to talk about dealing with Medicare, Medicaid, pvt insurance companies, workers' comp, etc. I know people get skittish about "collusion", but this isn't an organized effort to set pricing, it is simply a discussion about insurance, how people make it work, etc.

I'll kick it off…I was just asked (again) to consider taking Medicaid for neuropsych evals. The numbers just don't make sense to even consider it, but I wanted to ask others if they take Medicaid and if/how they make it work…whether it is for therapy or neuropsych assessment.

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[WisNeuro]

I'm a VA clinician, so I don't deal with it anymore. But, when I was at an AMC, we only had several slots a month in the department for these cases since they generally only kind of broke even after the hassle of getting paid.

 

[smalltownpsych]

Medicaid reimbursements vary from state to state so what makes sense in one might not be the same in another. As I look at reimbursement for various tasks, I factor in the difficulty, potential for legal issues, no-show rate, ability to plug in the task to fill gaps in schedule, and benefit to the community and individual.

 

[PsyDr]

I have a part time clinical practice.

Medicare: I just take what they give. In inpatient work, there is essentially no take home other than the interview after paying techs. In outpatient work, it is okayish money.

Medicaid: I won't touch it. The pay is less than costs and in my state, the justice system uses it to get backdoor court ordered evals. While I like helping the needy, I think that the risks far outweigh the rewards (e.g., driving away higher paying patients, having desperate people coming in and acting disorderly, increased threat of lawsuits, etc).

Private insurances: mostly it is a stupid game. Billing has me call and argue with them fairly regularly.

Workers comp: eh, I do it case by case. When it works like an insurer, I won't touch it anymore. Too many file reviewers dictating how I can practice, while assuming none of the risk if I do it their way. My informed consent has several clauses to make sure I am paid my forensic rate if I am called to a hearing.

If I had to use this money for a living, I would probably follow it much more.

 

[bcliff]

When I was working with insurance, what always got me was the concept of balance billing. Some insurance providers would explicitly approve or deny specific tests, which was fine because it, allowed us to bill the patient out of pocket (at their insurance's contracted rates) if they were still interested in the full evaluation. Other insurance companies would technically 'approve' all of our testing, but would give us less time than had been requested. For example, 1o units/hours of psych testing may have been requested, but only 6 hours were approved. If I remember correctly, our practice could either provide the services and take the hit, or explain to the patient that we would be unable to provide services at all because it was illegal for us to bill the patient for the difference.

I spent countless hours back and forth with insurance companies (medicaid and private insurance) and it really was a headache. I'm happy to have the skills though in case I ever do go into PP

 

[Therapist4Chnge]

Medicaid: I won't touch it. The pay is less than costs and in my state, the justice system uses it to get backdoor court ordered evals. While I like helping the needy, I think that the risks far outweigh the rewards (e.g., driving away higher paying patients, having desperate people coming in and acting disorderly, increased threat of lawsuits, etc).

This basically encompasses my concerns too. I also don't take the cases because I don't want to reinforce that the pittance they pay is acceptable. Instead, I take a pro-bono case here or there because it cuts out the hoops of documentation and billing and it also allows me to vet a case and less "surprise" stuff pops up.

Workers comp: eh, I do it case by case. When it works like an insurer, I won't touch it anymore. Too many file reviewers dictating how I can practice, while assuming none of the risk if I do it their way. My informed consent has several clauses to make sure I am paid my forensic rate if I am called to a hearing.

That's interesting about your informed consent has those clauses. I know it varies by state, but I didn't think in my state we are allowed to require payment from the patient related to a worker's claim? As part of my intake I document the difference between clinical v. forensic and I also document this in the report, but I wonder if I should/could put something in for informed consent too? Time to talk to legal.