Medicare/Medicaid Reimbursement for psychiatrists

[BobA]

I've noticed that there are about zero private practice psychiatrists in my area who take either Medicare or Medicaid, whereas PCP's generally do Medicare/Medicaid.

Do these government insurance programs pay more for a med check by a PCP than they do for a med check by a psychiatrist?

Either way, does anyone know where I could find a document explaining all of this (code xyz = $payment). Thanks!

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[hippiedoc13]

Let's first acknowledge that it's all much more complicated than it probably should be. Reimbursements vary by geographic area. So you are never going to find one simple document that says code xxx = $payment. Because in actuality that doesn't really exist. BUT, for any doctor in a given area, a given code (eg, 99213) will be reimbursed the same amount, no matter the specialty.

I agree with you anecdotally that it seems I know of more psychiatrists who won't take Medicaid/Medicare, than I do primary care docs who refuse it. However-- (1) while there are plenty of psychiatrists who are truly in private practice, in my experience there are many fewer primary care docs who are in truly private practice, and most seem to work in a group or clinic of some sort, and thus may have less control over determining the payor mix. (2) That being said, I do know several FM and IM primary care docs and/or medical groups who will no longer take new Medicare or Medicaid patients. This includes the FM group at my own university hospital where I am doing residency. This is directly related to the poor reimbursements and the many hassles with obtaining reimbursement.

 

[michaelrack]

BUT, for any doctor in a given area, a given code (eg, 99213) will be reimbursed the same amount, no matter the specialty.

.

It used to be that medicare reimbursed less (50%)for psychiatric diagnoses, but I think it has reached parity in the last several years

 

[carlosc1dbz]

It used to be that medicare reimbursed less (50%)for psychiatric diagnoses, but I think it has reached parity in the last several years

Hopefully the momentum continues in the same direction.

 

[tennreb]

At my university MUSC, Medicaid/Medicare supposedly reimburses better for outpatient care and variably for inpatient care (much lower for children, higher for chronic patients). However, MUSC has a special "rehab" contract with CMS that pays higher rates and allows for more services. Very few private psychiatrists in the area take Medicaid. I think only one large group does. Despite higher reimbursement, there is a lot more paperwork and criteria to be met that some see isn't worth the hassle. For example, you can't charge for no shows. If they come late, you can only charge for face-to-face time.

 

[AboroClinician]

What I have noticed with my practice and our coordination with PCP care is that with Caid/Care clients and the inability to charge for no-show has resulted in a large degree of burnout by general practice docs and by psychiatrists in the area. Despite that, our billing manager says that a large amount of psychiatric services in other insurances are based upon billable caid/care rates. Although we're a psychological-based service, he says that this applies to medical as well in many cases.

I know we have a billable chart with the rates/payouts for all code types we offer so I imagine that a caid/care office could provide you that (although I admit not knowing where they initially obtained that list)

 

[Manicsleep]

It is difficult to do as a single provider but once you are large enough you can do this by using mid levels.

Have a separate office with medicare and see 100% medicare patients there. Pre screen with mid levels and optimize your time. Yes, you will be seen as the doctor who just comes in to give meds but thats what medicare allows.

Private patients are seen in a separate clinic and are billed in a different way. You can also spend a little more time. Insurance patients are seen in the same clinic with the private but get less time.

 

[carlosc1dbz]

It is difficult to do as a single provider but once you are large enough you can do this by using mid levels.

Have a separate office with medicare and see 100% medicare patients there. Pre screen with mid levels and optimize your time. Yes, you will be seen as the doctor who just comes in to give meds but thats what medicare allows.

Private patients are seen in a separate clinic and are billed in a different way. You can also spend a little more time. Insurance patients are seen in the same clinic with the private but get less time.

Can they at least share the same waiting room to save money?

 

[Manicsleep]

Honestly, I don't see psychiatry patients that are medicare because of other responsibilities but I think they cannot share the waiting room. I think it has something to do with the way medicare reimbursement works. It has to be 100% medicare, I think. But don't quote me on this. Medicare is complicated and its important to have an office manager do the legwork or take a course in this on a regular basis and stay updated.

I do know that since instituting the psych tech model and removing psychologists it has been significantly more efficient and cost effective.

 

[aesposito]

Sorry to resurrect an old thread, but I have a related question:

My goal is to be an outpatient Child and Adolescent Psychiatrist. One reason behind that is a very very long time ago in a galaxy far away, my (now nearly grown) daughter needed a CAP and we were on medicaid due to some hard times. Finding a medicaid CAP was impossible, with the closest one some 200 miles away. I finally paid out of pocket after getting a loan from my parents.

Fast-forward several years. I have this idealistic idea that to honor my past and my daughter, I could see medicaid patients as well as the more traditional insurance and self-pay patients. But am I kidding myself? Is there any difference between how medicaid handles kids vs. adult psychiatry? I live in Illinois if that makes any difference.

A

 

[OldPsychDoc]

Sorry to resurrect an old thread, but I have a related question:

My goal is to be an outpatient Child and Adolescent Psychiatrist. One reason behind that is a very very long time ago in a galaxy far away, my (now nearly grown) daughter needed a CAP and we were on medicaid due to some hard times. Finding a medicaid CAP was impossible, with the closest one some 200 miles away. I finally paid out of pocket after getting a loan from my parents.

Fast-forward several years. I have this idealistic idea that to honor my past and my daughter, I could see medicaid patients as well as the more traditional insurance and self-pay patients. But am I kidding myself? Is there any difference between how medicaid handles kids vs. adult psychiatry? I live in Illinois if that makes any difference.

A

I applaud your goals and motivations, but based on your timetable, you're finishing CAP in 2022--so any advice offered you about the state of psychiatric reimbursement is as conjectural as my prediction of who will win the NCAA National Football Championship in 2021...

Do it because you sincerely love the field and want to make a difference. The rest will follow.

 

[carlosc1dbz]

I applaud your goals and motivations, but based on your timetable, you're finishing CAP in 2022--so any advice offered you about the state of psychiatric reimbursement is as conjectural as my prediction of who will win the NCAA National Football Championship in 2021...

Do it because you sincerely love the field and want to make a difference. The rest will follow.

Interesting that this post is back up on the top after so long. I was actually thinking how medicaid reimburses for psychiatry, and I was about to post the question, when I saw this old post. Anyway, does anyone know a good website to find reimbursement rates for psych codes in certain zip codes? That would be great. I am curious, how much they reimburse for a new patient, a follow up, and a med check. As well as how that compares to family medicine or internal medicine.

 

[michaelrack]

Medicaid differs from state to state, but generally reimburses poorly whether billing a medical or psychiatric diagnosis.

 

[zac16125]

The peds doc I rotated with took care of a ton of medicaid patients, the large majority of her practice actually. One day while trying to deal with one of the many hassels of medicaid and speaking of the low reimbursments she said, "take care of the poor, and you'll end up poor". That being said she seemed very happy in her practice. There is something to be said about serving low income patients, who often need the medical care more the the affluent. It seems very rewarding. And remember, doctors don't go hungry. Life's not all about personal economic advancement.

 

[aesposito]

The peds doc I rotated with took care of a ton of medicaid patients, the large majority of her practice actually. One day while trying to deal with one of the many hassels of medicaid and speaking of the low reimbursments she said, "take care of the poor, and you'll end up poor". That being said she seemed very happy in her practice. There is something to be said about serving low income patients, who often need the medical care more the the affluent. It seems very rewarding. And remember, doctors don't go hungry. Life's not all about personal economic advancement.

Thank you, that's the kind of pep-talk I needed.... and thank you everyone else too for your advice!

A

 

[michaelrack]

And remember, doctors don't go hungry.

And I guess as long as social security is around, retired docs won't go hungry either