psychologist billing under MD Psychiatrist

[finalpsychyear]

Does anyone know how this works? Can I as an Psychiatrist hire a clinical counselor and/or masters level psychologist and have them bill through me or does this always require them to have their own license even if i hire them as part of my private practice?

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[hamstergang]

I looked this up a year ago or so relating to LPCs and LCSWs billing through me, but I think the same applies to psychologists. You should look at "incident to" billing. Best I could tell, such billing required the MD to see the patient first to determine the treatmemt, then someone else could actually carry out the treatment plan. The MD would need to periodically see the patient to check in, and whatever MD the bill goes under that day (could be different than the original MD if part of a group) would have to be physically in the building at the time to provide help if needed.

I was later told such strict requirements didn't apply when doing incident to billing as a facility/hospital.

I think the therapist needs their own license regardless. Billing for the work done is different than being licensed to do the work.

 

[finalpsychyear]

I looked this up a year ago or so relating to LPCs and LCSWs billing through me, but I think the same applies to psychologists. You should look at "incident to" billing. Best I could tell, such billing required the MD to see the patient first to determine the treatmemt, then someone else could actually carry out the treatment plan. The MD would need to periodically see the patient to check in, and whatever MD the bill goes under that day (could be different than the original MD if part of a group) would have to be physically in the building at the time to provide help if needed.

I was later told such strict requirements didn't apply when doing incident to billing as a facility/hospital.

I think the therapist needs their own license regardless. Billing for the work done is different than being licensed to do the work.

Ok i remember as residents for an attending in residency he would have several med students doing therapy in a few rooms at a time and the attending would stop in for a few min in each one then bill them as incident to billing. This was done in an academic facility. If i remember correctly incident billing can be done through any type of "support" staff if they are being directly supervised by the MD who also is in for part of the session as well? This of course would be using the NPI and billing throught he supervising doctor. If i'm way off base here please let me know.

 

[hamstergang]

If i remember correctly incident billing can be done through any type of "support" staff if they are being directly supervised by the MD who also is in for part of the session as well?

I have no idea what the rules are for residents, but for others the MD does not need to physically enter the room or see the patient.

 

[finalpsychyear]

I have no idea what the rules are for residents, but for others the MD does not need to physically enter the room or see the patient.

Ok now if i have ancillary staff like a nurse,secretary, or a student in general psych but not a clincal psychologist and it is my private practice where I am present at and also see the patient for a portion of the "therapy" with the above. I am legally able to bill for this service correct since i am actually a part of the session?

 

[hamstergang]

Ok now if i have ancillary staff like a nurse,secretary, or a student in general psych but not a clincal psychologist and it is my private practice where I am present at and also see the patient for a portion of the "therapy" with the above. I am legally able to bill for this service correct since i am actually a part of the session?

I don't think you can have unlicensed people doing billable work. You can bill for the time you actually spend with the patient. Having unlicensed people do clinical work sounds like a terrible liability anyway.

 

[WisNeuro]

I don't think you can have unlicensed people doing billable work. You can bill for the time you actually spend with the patient. Having unlicensed people do clinical work sounds like a terrible liability anyway.

You can if they are a clinical trainee. We do it for practicum, interns, and fellows all of the time, with some exceptions. They are under our license. I don't know about doing this with unlicensed individuals who are not there as part of their training, though. Also, this usually requires heavy amounts of supervision, which is unbillable. So, I can't imagine doing this in private practice without running afoul of some things.

 

[finalpsychyear]

You can if they are a clinical trainee. We do it for practicum, interns, and fellows all of the time, with some exceptions. They are under our license. I don't know about doing this with unlicensed individuals who are not there as part of their training, though. Also, this usually requires heavy amounts of supervision, which is unbillable. So, I can't imagine doing this in private practice without running afoul of some things.

What qualifies as a clinical trainee? Would someone with a masters in gen psych looking to learn psychotherapy be able to be supervised in my private practice and it be billable if they didn't have a license? Supervised as in sharing the video provided patient consents and having it reviewed for the hour of therapy done level of supervision. I know there is clinical psych tracks and then general psych so i'm not sure if either could in theory do this or just the former at least in the context of my PP.

 

[calvnandhobbs68]

Ok now if i have ancillary staff like a nurse,secretary, or a student in general psych but not a clincal psychologist and it is my private practice where I am present at and also see the patient for a portion of the "therapy" with the above. I am legally able to bill for this service correct since i am actually a part of the session?

lol you’re gonna have your secretary do psychotherapy? Wtf?

 

[finalpsychyear]

lol you’re gonna have your secretary do psychotherapy? Wtf?

lol no. I just want to know what is actually allowed per the law in a PP setting.

 

[cbrons]

What is a "masters-level" psychologist?

 

[clausewitz2]

What is a "masters-level" psychologist?

Often someone with a master's degree in counseling psychology. Depending on the state they can end up certified as marriage-family therapists or licensed professional counselors. It is a thing.

 

[WisNeuro]

What qualifies as a clinical trainee? Would someone with a masters in gen psych looking to learn psychotherapy be able to be supervised in my private practice and it be billable if they didn't have a license? Supervised as in sharing the video provided patient consents and having it reviewed for the hour of therapy done level of supervision. I know there is clinical psych tracks and then general psych so i'm not sure if either could in theory do this or just the former at least in the context of my PP.

May vary by state. If they already have their terminal degree, they still technically can under someone else's license(e.g., fellows). As a master's degreed, they probably could as well, may need some sort of provisional thing, though. Best to check with state guidelines.

Also, a gen psych masters has 0 training in clinical work. This sounds like a huge liability that I would forgo taking. I can imagine that in the rare instance of a board action, you would get roasted for having a non-clinical degree doing clinical work for you.

 

[clausewitz2]

May vary by state. If they already have their terminal degree, they still technically can under someone else's license(e.g., fellows). As a master's degreed, they probably could as well, may need some sort of provisional thing, though. Best to check with state guidelines.

Also, a gen psych masters has 0 training in clinical work. This sounds like a huge liability that I would forgo taking. I can imagine that in the rare instance of a board action, you would get roasted for having a non-clinical degree doing clinical work for you.

Yeah having lots of classmates in most of my doctoral classes who were in non-clinical psychology programs of various descriptions I would not actually rank their ability to do clinical work at that time above mine as a linguist. It's like attempting to do a CABG because you study the biochemistry of atherosclerosis.

 

[WisNeuro]

Yeah having lots of classmates in most of my doctoral classes who were in non-clinical psychology programs of various descriptions I would not actually rank their ability to do clinical work at that time above mine as a linguist. It's like attempting to do a CABG because you study the biochemistry of atherosclerosis.

I mean, it's essentially just sewing, right?

 

[clausewitz2]

I mean, it's essentially just sewing, right?

I use knives when I'm cooking all the time, what's the big deal?