How much does Telepsych pay?

[surfguy84]

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Got into a debate with a cousin of mine who just completed residency in an unrelated field. He was telling me telepsych rates are in the 170-200 range...which just seems insane to me. Anyone with experience in tele psych able to comment?

 

[keifernny2]

I haven't seen rates that high for tele psych.


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[surfguy84]

I haven't seen rates that high for tele psych.


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What ballpark have you seen?

 

[J ROD]

are we talking per hr? 100/hr

 

[dl2dp2]

Here's the current rate from Insight Telepsychiatry: $50 for 99213 (15-min) and $120 for intake (30-min). 40 hours a month minimum commitment.

A full time job of this type would make your panel go up very quickly--roughly 500 patients. I would say you'd need a administrative team to take care of your billing/PA, etc.

 

[deleted736562]

Any information about residency issues?

Many companies say doctors can work anywhere in the world and the only requirement is to be licensed in the state the patient is, but it's not clear if they have to be US citizens/permanent residents or if they need a US visa to get the job. I am also not sure if telepsych positions can work as a J1 waiver if the hospital/patient is in an underserved area, though apparently they can be used for loan repayment if you're a US citizen.

 

[michaelrack]

Here's the current rate from Insight Telepsychiatry: $50 for 99213 (15-min) and $120 for intake (30-min). 40 hours a month minimum commitment.

A full time job of this type would make your panel go up very quickly--roughly 500 patients. I would say you'd need a administrative team to take care of your billing/PA, etc.

those rates are low if you have to pay out the expenses of billing (sending statements, etc). I wouldn't do it

 

[dl2dp2]

those rates are low if you have to pay out the expenses of billing (sending statements, etc). I wouldn't do it

They do direct billing to the patients. You get a 1099. That's it. I'm talking about keeping track of visits and billing the agency. This still takes work.

I agree the rates are low. Sadly, reimbursements for public facilities/insurance based facilities are just LOW period. 15-min med checks are awful, and I don't know how sick these people are. Plus you are not getting support for calling PAs, answering phone calls/E-mails, etc. I personally wouldn't do this job if I can get away with it.

I do wonder how many people are gonna do this and if this company would survive in the long run.

 

[PsyDr]

Any information about residency issues?

Many companies say doctors can work anywhere in the world and the only requirement is to be licensed in the state the patient is, but it's not clear if they have to be US citizens/permanent residents or if they need a US visa to get the job. I am also not sure if telepsych positions can work as a J1 waiver if the hospital/patient is in an underserved area, though apparently they can be used for loan repayment if you're a US citizen.

If you are billing Medicare/Medicaid, you must physically be in the USA per CMS guidelines.

 

[deleted736562]

If you are billing Medicare/Medicaid, you must physically be in the USA per CMS guidelines.

True, but I guess not all work requires seeing Medicare/Medicaid patients. Or not?

 

[nexus73]

Here's the current rate from Insight Telepsychiatry: $50 for 99213 (15-min) and $120 for intake (30-min). 40 hours a month minimum commitment.

A full time job of this type would make your panel go up very quickly--roughly 500 patients. I would say you'd need a administrative team to take care of your billing/PA, etc.

Behold horrible psych care.

 

[dl2dp2]

Behold horrible psych care.

Yup lol. I actually think Insight hasn't worked this out correctly. The new model is 99213+90833, and that reimburses relatively well for 30 min. 20-30 min follow-up isn't unreasonable. They can't do that currently--don't know why. Also, I suspect that with the CMHC coverage the cases can often be billed 99214 or even 99215. Also you can schedule very frequent follow-ups for risky cases. If you bill two 99214+90833 per hour on a consistent basis, plus a 30% overhead from Insight, I think your rates would improve.

However, they set their rates too low for that right now for this to happen.

The other way is to set it up as a real "group practice without walls". I.e. if the participating psychiatrists would pay a membership but then get equity for profit sharing. Now I don't know how that would all work out with Stark Law and such, but this would incentivize community providers to join.

 

[sweetlenovo88]

Yup lol. I actually think Insight hasn't worked this out correctly. The new model is 99213+90833, and that reimburses relatively well for 30 min. 20-30 min follow-up isn't unreasonable. They can't do that currently--don't know why. Also, I suspect that with the CMHC coverage the cases can often be billed 99214 or even 99215. Also you can schedule very frequent follow-ups for risky cases. If you bill two 99214+90833 per hour on a consistent basis, plus a 30% overhead from Insight, I think your rates would improve.

However, they set their rates too low for that right now for this to happen.

The other way is to set it up as a real "group practice without walls". I.e. if the participating psychiatrists would pay a membership but then get equity for profit sharing. Now I don't know how that would all work out with Stark Law and such, but this would incentivize community providers to join.

Is the problem with the 99213 (for a 15 min visit) reimbursing $50 that they too much of a cut of what Medicare pays for 99213 or that this model creates a high patient load? I thought 99213 generally reimburse $70 or so?

 

[milesed]

We pay the same per hour as we pay for in-person salary. It will depend directly on who hires you, how much of a need there is and their funding. $150-200 sounds about right for contract docs with no benefits.

 

[dl2dp2]

Is the problem with the 99213 (for a 15 min visit) reimbursing $50 that they too much of a cut of what Medicare pays for 99213 or that this model creates a high patient load? I thought 99213 generally reimburse $70 or so?

The issue is mainly of patient load and time spent per patient. I think because the context with which they do this, they can't afford to pay >$50 per 99213, which makes sense to me. However, anyone who completed residency would know that doing 4 15-min med checks an hour is not very good care. Currently the in-network billing rate for Medicare for 99213+90833 ~ $175, which is somewhat more reasonable--> given a 30% overhead this would yield about $250 per hour. So cut another $50 out you'd get about $200 an hour for 2 30 min med check + "therapy". This is more sustainable.

Ideally, I'd like to do 45 min 99213+90836, plus 30 min 99213+90833. If I can do those with an average pay out of $200 an hour with some admin support (i.e. appointment scheduling, PA requisition, etc) such that all patient calls get routed the other way, then I think it's a job that's worth considering.

 

[sweetlenovo88]

The issue is mainly of patient load and time spent per patient. I think because the context with which they do this, they can't afford to pay >$50 per 99213, which makes sense to me. However, anyone who completed residency would know that doing 4 15-min med checks an hour is not very good care. Currently the in-network billing rate for Medicare for 99213+90833 ~ $175, which is somewhat more reasonable--> given a 30% overhead this would yield about $250 per hour. So cut another $50 out you'd get about $200 an hour for 2 30 min med check + "therapy". This is more sustainable.

Ideally, I'd like to do 45 min 99213+90836, plus 30 min 99213+90833. If I can do those with an average pay out of $200 an hour with some admin support (i.e. appointment scheduling, PA requisition, etc) such that all patient calls get routed the other way, then I think it's a job that's worth considering.

Thanks for the informative reply, would most private insurances match those rates and not have any issues billing therapy add ons? I am assuming medicaid HMOs would not pay like this?

 

[WingedOx]

FWIW, VA work with tele out to the CBOCs is a growing thing.

 

[yanks26dmb]

"170-200" seems way too high, but what do I know..

What's a more realistic expectation for doing telework with one of those big companies always looking for docs?

 

[notdeadyet]

FWIW, VA work with tele out to the CBOCs is a growing thing.

Big time. And it's definitely growing.

 

[WingedOx]

Big time. And it's definitely growing.

I'd do it full time if I could. Right now it's only 2 days a week for me, but I've already established a full schedule for my in-person clinic that would be hard to ditch now. Doing things like AIMS is a pain in the ass, via tele, but dealing with things like telling someone "no, I'm done prescribing that because you've abused it" is easier when you don't have to worry about removing them from your office.

Also had a power outage last month during a tele session. That was fun.

 

[neraknerak]

If you are billing Medicare/Medicaid, you must physically be in the USA per CMS guidelines.

Do you have a link to this please?
I am interested in telepsychiatry. Does anyone have any experience working with any of the companies: InSight, Arcadian, American Telepsychiatrists, or JSA? can recommend a telepsychiatry company?

 

[nancysinatra]

I'd do it full time if I could. Right now it's only 2 days a week for me, but I've already established a full schedule for my in-person clinic that would be hard to ditch now. Doing things like AIMS is a pain in the ass, via tele, but dealing with things like telling someone "no, I'm done prescribing that because you've abused it" is easier when you don't have to worry about removing them from your office.

Also had a power outage last month during a tele session. That was fun.

I have had internet outages or other technical glitches nearly every single day for a year now. (They're on the clinic's end, not my end.) Sometimes they are so bad we have to shut the clinic down. The rest of the time we just put up with a second rate connection. Aside from quitting my job I don't see a way around it. I work for an underfunded clinic in a part of the country that in addition to a psychiatrist shortage, also apparently has a shortage of competent IT people. It gets interesting. I get paid a salary and I can't remember how much it works out to per hour, but when I exceed my salaried hours, I get $100/hr.

In addition to AIMS being a pain, so are dementia evaluations. But I still like telemedicine. It has its advantages and disadvantages. If you want to make big time money though, there are probably better ways.

 

[keifernny2]

I've had a few outages over the last 2 years that simply result in me cancelling the patients and not getting paid, which is fine for a side job, but would be very frustrating if it was an ongoing thing.


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[daru1]

I work telepsych 2 days per week, and although it is not locums work, I'd say the 170-200 is fairly accurate for the area in which I practice. No, I'm not going to tell you where that is, but the point is that the rates are probably different in different areas of the country and very much based on supply/demand for service.

 

[Leo Aquarius]

I work telepsych 2 days per week, and although it is not locums work, I'd say the 170-200 is fairly accurate for the area in which I practice. No, I'm not going to tell you where that is, but the point is that the rates are probably different in different areas of the country and very much based on supply/demand for service.

Who is your payor, private insurance or government?

 

[daru1]

Define government. State, yes. Federal, no. I'd say 90/10 mix of state/private major insurance.

 

[finalpsychyear]

The issue is mainly of patient load and time spent per patient. I think because the context with which they do this, they can't afford to pay >$50 per 99213, which makes sense to me. However, anyone who completed residency would know that doing 4 15-min med checks an hour is not very good care. Currently the in-network billing rate for Medicare for 99213+90833 ~ $175, which is somewhat more reasonable--> given a 30% overhead this would yield about $250 per hour. So cut another $50 out you'd get about $200 an hour for 2 30 min med check + "therapy". This is more sustainable.

Ideally, I'd like to do 45 min 99213+90836, plus 30 min 99213+90833. If I can do those with an average pay out of $200 an hour with some admin support (i.e. appointment scheduling, PA requisition, etc) such that all patient calls get routed the other way, then I think it's a job that's worth considering.

Where is medicare paying 175 for 99213+90833... The most are places like Manhattan, SF, and LA and they are paying 150-160 for those places. Everywhere else its closer to 130-140. Unless this is a hospital based clinic.