Psychometrist Supervision

Per Medicare Rules:
In psychology, psychometrists are often used to administer tests to patient, score them and play a role in organizing the testing situations and paperwork. These folks are called technicians by Medicare and Medicaid rules, and act as “physician extenders” in the professions. At Limbic Resources, we have three levels of pay for psychometrists; let’s start with the thinking behind this: i.e., $20 to shadow and while learning test administration/scoring; $25 to independently administer tests and score them; and $30 to think about the results to enhance personal learning and advance professionally. Many of our psychometrists are in school or go back for advanced training and degrees.

Philosophy: The ideas behind $30/hr for advanced learning came from having predoctoral interns, to encourage them to “learn” diagnosing, and develop thoughtful recommendations and know more about what to interview for.  Another idea behind this was that while initially more work for a supervisor (the psychologist) to train, the payoff was that s/he could spend less time on report writing once the psychometrist got pretty good at generating drafts.  For example, getting a supervisee to learn how to use percentages and compare results test-by-test to a prior evaluation saves A LOT of time for the psychologist on a repeat testing case.  This is why Limbic Resources (LR) does not pay more to a psychologist for training a psychometrist, instead there is a big payoff in time saved down the road, if the psychometrist is teachable and willing to learn.

It’s symbiotic as this helps both the psychometrist and psychologist.  Of course, every now and then when a psychologist sit down with a trainee to offer general supervision, LT doesn’t mind paying for that.  However, LR can’t afford to pay the psychologist for such training, as LR only makes an $80 profit for each evaluation done by a psychometrist.*  LR does better on the psychologist as Medicare allows $100 per hour-long unit (3 hrs = $300 LR grosses) and then the supervisor makes $150 as does LR on each evaluation.

When a Psychometrist is Ready to Move Forward…
A recent psychometrist (at the $20 rate) has typically been billing 10 half-hour units (1 base unit + 9 add-on units) per case.  That is the maximum we feel comfortable charging to Medicare for psychometry for our work. While time billed to Medicare in Panorama is often similar to time paid to a psychometrist, this is not a one-to-one relationship as explained below. Four hours billed to insurances is more typical for a fast moving person.  Still, some psychometrists who are slower charge us for six hours per case.  Regardless of what we pay a technician, we cap billing to Medicare at five hours (10 units).  Now for specific answers to questions about Jane, a psychometrist, from a supervising psychologist, Robert, see the brown highlighted answers below:

After doing 40+ test administrations Jane appears ready to move to the next step, meaning taking a stab at writing up the summary and entering the diagnoses and recommendations. I have the following questions:

I would continue to enter the billing. Jane would enter her own billing, which you check, at the top of the last page of the protocol, while you enter your own supervisory billing at the bottom. Note there is a “Check Billing” button for each of to use to scan for missing data or conflicts.

Who would enter the letters, the psychometrist or me?  Definitely have the psychometrist enter the inside address and start all letters, to save you much time.  It’s your call, but having her practice summarizing results to the doctor, sometimes the patient/family, etc. would be good practice in analytical and feedback skills.  Please start the letters with something like, “Jane saw Mr. Brown at our Buzzard’s Bay office…” to distinguish who actually saw the patient to the letter recipient.  Review letters carefully, as they are your work product in the end.

And how does that change her rate of pay and/or the time she can bill Limbic for? Jane moves to our max. of $30/hr (40% of our gross income, or much more if she charges for more hours then we bill*) to recognize her efforts.  Of course, she should not be practicing psychology without a license, so anything in the report, letters, etc. is always your work product.  As a “technician” she can’t bill for content – only for test set up, administration and scoring, helping the pt fill out questionnaires, setting up files, etc.  BTW, we don’t bill Medicare for any writing she does for the background section, which you might accept, delete or alter.  Hence nothing changes in her billing time, it does not increase with her new efforts to contribute to the Summary as we do not bill insurances for that, but her pay increases.

Note there is no documentation for Jane to check off in her documentation (green box, below) for report writing, result interpretation, diagnosing, etc. and non face-to-face time is billed only for entering the data and scoring (orange arrows).  A psychometrist’s time need not equal what is billed; e.g., she could bill insurances via Panorama a total of four hours (8 units), but still charge Limbic for five hours of pay for writing up he thoughts for your use.  Again, we don’t bill Medicare for her efforts to learn to write interpretive content, as that would be practicing psychology.