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Evolution of an Inpatient Pediatric Psychology Consultation Service: Issues Related to Reimbursement and the Use of Health and Behavior Codes

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Abstract

The purpose of this study was to evaluate an inpatient pediatric psychology consultation service, with particular focus on issues related to financial reimbursement for services. Information was gathered over a four year period (2001–2005) regarding number of consults, referral source and referral question, type of insurance, and reimbursement rates for health and behavior codes versus mental health codes. The financial impact of hiring an insurance verification specialist was also explored. Results indicated that reimbursement rates for health and behavior codes were higher than reimbursement rates for mental health codes. Health and behavior codes were rejected in 31% of cases that they were billed; the primary reason for rejection was that these codes were not a covered service by Medicaid. Hiring an insurance verification specialist was found to be a cost-effective method for improving the financial “bottom-line” for psychology services. Implications for practice are discussed.

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Authors and Affiliations

  1. Medical College of Wisconsin, Department of Pediatrics, 9000 W. Wisconsin Avenue, P.O. Box 1997, MS 744, Milwaukee, WI, 53226, USA

    Cheryl L. Brosig & Dawn M. Zahrt

Authors
  1. Cheryl L. Brosig
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  2. Dawn M. Zahrt
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Correspondence to Cheryl L. Brosig.

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Brosig, C.L., Zahrt, D.M. Evolution of an Inpatient Pediatric Psychology Consultation Service: Issues Related to Reimbursement and the Use of Health and Behavior Codes. J Clin Psychol Med Settings 13, 420–424 (2006). https://doi.org/10.1007/s10880-006-9047-2

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  • DOI: https://doi.org/10.1007/s10880-006-9047-2

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