Effective Billing and Collecting

2017 ◽  
pp. 250-264
Author(s):  
Thomas M. Kozak ◽  
Andrea Kozak Miller
Keyword(s):  
Real World ◽  
Insurance Coverage ◽  
Health Maintenance Organizations ◽  
Psychological Services ◽  
Insurance Companies ◽  
Fee For Service ◽  
Patient Centered ◽  
Health Maintenance ◽  
Medical Homes ◽  
Testing Patient

This chapter examines billing for psychological services through an ethical and procedural lens. Types of billing are reviewed, including fee-for-service and various types of insurance. The usual and customary rate for billing as compared to the amount paid by various types of insurance companies is explored, as is the insurance coverage related to psychological testing. Patient-centered medical homes are discussed, including their relationship to managed care and health maintenance organizations. Capitated systems are reviewed, including how to plan for services and ethical concerns in this model. Other types of billing, including Medicare and Medicaid, are discussed as is the use of a sliding fee scale and collection agencies. This chapter offers a general overview of billing and collecting for psychological services while exploring ethical and real-world considerations.

"DR UNNECESSARY"

PEDIATRICS ◽  
1996 ◽  
Vol 97 (2) ◽  
pp. A30-A30
Author(s):  
J. F. L.
Keyword(s):  
Managed Care ◽  
Private Practice ◽  
Psychiatric Treatment ◽  
Health Maintenance Organizations ◽  
Case Managers ◽  
Fee For Service ◽  
Health Maintenance ◽  
Insurance Costs ◽  
Treatment Plans

The old reality for many psychiatrists was a private practice filled with long-term patients who paid $100 or more for 50 minutes of talk. The new reality? Managing medication for up to 30 new patients a week for half the hourly fee—and answering to case managers who aren't even doctors. No wonder the number of U.S. medical school graduates in psychiatric residencies dropped nearly 12%—to 3909 from 4447—between 1988 and 1994. The blame—or the credit—goes to managed care, the catchall term for the revolution that has swept through both the medical and mental health care fields in recent years. Desperate to cut runaway health insurance costs, most companies have axed longstanding fee-for-service plans and instead steer employees seeking psychiatric treatment to health maintenance organizations or specialized managed-care firms. These organizations decide the type and amount of care patients receive. Psychiatrists have to get with the program—and agree to its treatment plans and fee schedules—or watch the bulk of their practices disappear. Only the rare psychiatrist can attract private patients wealthy enough to pay for traditional psychotherapy without the benefit of insurance.

Open Source Approach for Mitigating Misinformation Risk in Complementary and Alternative Medicine Practices

2014 ◽  
Vol 3 (1) ◽  
pp. 1-11
Author(s):  
Venugopal Gopalakrishna-Remani ◽  
Mary Helen Fagan
Keyword(s):  
Alternative Medicine ◽  
Open Source ◽  
Health Maintenance Organizations ◽  
Insurance Companies ◽  
Health Maintenance ◽  
Medical Practitioners ◽  
Alternative Medicines ◽  
Development Framework ◽  
Health Insurance Companies ◽  
Proper Diagnosis

Patients and health maintenance organizations are spending approximately $47 billion annually on innovative alternative medical techniques such as aromatherapy, biofeedback, chiropractic manipulation, homeopathy and others. Health insurance companies, drug regulation agencies, medical practitioners and educated patients are demanding more reliable information concerning these alternative medicines and complementary processes. While these approaches have been successful, the community of stakeholders is demanding scientifically proven, evidence-based validation of the materials and practices. Validation is essential to formalize the use of alternative medicines and complementary treatments. However there are very few peer reviewed journal articles and a lack of approval methodologies in this field, which may be related symptoms. Another key problem is the lack of accurate knowledge about the proper diagnosis-treatment match. This may result in negligence risk for practitioners or opportunity lost risk for patients who miss access to a potential remedy. The open source approach evolved in the information technology field out of the free public software movement, which has been effective for knowledge creation, collaboration and sharing across disciplines and cultures. For example, the authors all have free Internet browsers and utility software. Therefore, the authors investigated applying the 'open source' ideology as a potential methodology for solving these problems. They developed an alternative medicine knowledge development framework to facilitate creating, collaborating on, and sharing innovations in the field.

scholarly journals Total Cost of Care Lower among Medicare Fee-for-Service Beneficiaries Receiving Care from Patient-Centered Medical Homes

2014 ◽  
Vol 50 (1) ◽  
pp. 253-272 ◽  
Author(s):  
Martijn van Hasselt ◽  
Nancy McCall ◽  
Vince Keyes ◽  
Suzanne G. Wensky ◽  
Kevin W. Smith
Keyword(s):  
Cost Of Care ◽  
Fee For Service ◽  
Patient Centered ◽  
Total Cost ◽  
Patient Centered Medical Homes ◽  
Medical Homes

HMOs AND THE NEW HEALERS

PEDIATRICS ◽  
1995 ◽  
Vol 96 (1) ◽  
pp. 137-137
Author(s):  
J. F. L.
Keyword(s):  
Health Plan ◽  
Health Maintenance Organizations ◽  
Insurance Companies ◽  
Health Maintenance ◽  
Brigham Young University ◽  
Medical Establishment

The illness: a pulled muscle. The health plan's recommendations: A massage and a potion of healing herbs, including minced palmetto berries and chopped valerian root. The patient's reaction: "Taking valerian root was a lot easier than some heavy prescription which might have knocked me on my tail," says Skip Dane, a professor at Brigham Young University in Provo, Utah, whose recent injury came about when he was lifting weights. Clearly, this isn't your parents' health plan ... ... Treatments once scorned by the medical establishment (and still viewed warily by many doctors) are gaining coverage from health-maintenance organizations, insurance companies, and health alliances.

HEALTH MAINTENANCE ORGANIZATIONS VERSUS FEE FOR SERVICE: PATIENT SATISFACTION WITH COST AND QUALITY.

1992 ◽  
Vol 1992 (1) ◽  
pp. 91-95
Author(s):  
Chris Girard ◽  
Rockwell Schulz ◽  
James O'Leary ◽  
James Greenley ◽  
William Scheckler
Keyword(s):  
Patient Satisfaction ◽  
Health Maintenance Organizations ◽  
Fee For Service ◽  
Health Maintenance

The Internal Economics of HMOs: A Research Agenda

1996 ◽  
Vol 53 (1_suppl) ◽  
pp. 44-64 ◽  
Author(s):  
Thomas Rice ◽  
Jon Gabel
Keyword(s):  
Cost Sharing ◽  
Service Sector ◽  
Health Maintenance Organizations ◽  
Economic Incentives ◽  
Fee For Service ◽  
Natural Experiments ◽  
Physician Payment ◽  
Health Maintenance ◽  
The Relationship

As health maintenance organizations (HMOs) emerge as the dominant delivery system, the value of research on the fee-for-service sector will diminish. Health services researchers, purchasers, and HMOs will turn their attention to what makes some HMOs more effective than others. To understand this, researchers should take advantage of natural experiments that occur within an individual HMO. This strategy capitalizes on the diversity within an HMO; a single HMO offers different benefit packages, uses different methods for paying providers, and uses different utilization management programs with different employer groups. The authors reviewed the relatively few studies that take advantage of natural experiments. Findings indicate that patients and physicians respond to economic incentives, but no study has examined the relationship between changes in cost sharing or physician payment and quality of care. To achieve external validity, the authors recommend that funding organizations support consortia that replicate similar natural experiments at different HMOs.

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