One of the most frequent questions we get from practitioners is: what is the allowed amount for my services? 

The answer is:  it depends.  It can vary quite a bit, even across plans from the same in

Suppose Suzie spends $200 to see a therapist who does not take her health insurance (which is a PPO plan she obtains through her employer). Depending on the treatment she receives and the type of insurance plan, her insurance company might say the amount she paid exceeds the “allowed amount”. For out-of-network services, the patient is usually responsible for paying the difference. In this example, the allowed amount is $160. The allowed amount is what gets applied to her benefits policy. Most

  By Vatsal G. Thakkar, M.D. Founder, Reimbursify A few years ago, a patient left me an urgent message.  Her insurance company was demanding that I complete a W-9 before they would reimburse her for out-of-network expenses.  I know, this makes no sense whatsoever.  I was out-of-network, would not be receiving funds directly from the insurance company, and there was no tax reporting requirement by the insurance company.  So why was this necessary? A W-9 is a standardized legal document used to

The biggest change to CPT coding in psychiatry happened in 2013 I got precisely 30 seconds of CPT coding guidance as a resident in psychiatry at Vanderbilt University Medical Center. A senior resident taught me 3 codes — the one for a new patient (90801), the one for a 50 minute follow-up (90807), and the one to use for a 30 minute follow-up visit (90805). That’s it. Reimbursement issues were the last of my concerns — no one goes into medicine to learn how to code office

Elon Musk, perhaps the most ambitious tech CEO today, is promising self-driving Teslas as soon as next year. A friend of mine who owns a Tesla model X SUV reports to me that though he loves the car, “autopilot is not safe in the city, it panics at intersections and doesn’t start slowing down until it’s too late for red lights.” He goes on to say, “there are too many variables it doesn’t read. It does really well on the highway but

Coding Best Practices for Ketamine Clinics Most outpatient out-of-network services like a visit to a doctor or therapist utilize fairly simple medical coding–there’s usually just one (or maybe two) service codes (also known as CPT, or Current Procedural Terminology codes). But as new treatments go out-of-network, like ketamine infusions for depression, medical coding needs to adapt. The Basics: Inpatient vs. Outpatient coding Inpatient vs. outpatient coding can be miles apart. This major difference has been caused by the tortuous history of hospital

Insiders don’t know or share the prices in health care, which is one of the reasons costs get so inflated. As Reimbursify’s cofounder, Vatsal Thakkar, MD, writes about in the New York Times, the third-party payer system is broken. The lack of pricing transparency is a big part of this. Vatsal’s family member recently had some blood tests that cost $1,196.85. The negotiated rate by insurance was $34.59. Does he have amazing insurance? No. Does the third-party payer system create prices that