Wednesday, April 09, 2008

petty vindications on the reimbursement side of my job...

OK, so this might be a bit arcane, but...

The managed care company that in charge of medicaid reimbursement in our area has this chart. Precisely who made this chart is not known, nor is the criterion by which they arrived at this decision. But, for example, they decided in this chart that psychological test A is worth 1/2 hour of reimbursement, while test B is only worth 15 minutes worth of reimbursement.

To understand why this is nonsensical, you have to understand that tests A & B are virtually identical in their complexity, cost to order, administration time, interpretation time, and in most other ways. The only difference is that test B is primarily used in the assessment of ADHD, whereas test A is used to screen for a broad assortment of emotional/behavioral problems.

So I'm guessing, a little, but the only thing I can figure out is that they looked at this from a financial perspective, freaked out about how common it is to screen for ADHD nowadays, and decided to cut the reimbursement rate for test B.

And now for that "petty vindications" bit. Recently, test B came up with a new version. And in this new version, there are forms for the teacher, parent, and child to fill out (the last version only had parent & teacher forms). So whereas in the past, I could only get reimbursed for 1/2 hour if I gave both forms, now I can claim a full hour's worth of reimbursement if I administer all 3 forms (because they the minimum unit of reimbursement is a half-hour, so they have to round it up if you can claim 45 minutes worth).

And don't even get me started on the logic behind reimbursing psychological testing at a lower rate than therapy services. Yeesh...

I have to say, after years of feeling nickeled and dimed on this particular managed care inanity, this feels pretty good.

1 comment:

more cows than people said...

wow. sounds ridiculous. glad you feel vindicated.