Patients keep cancelling outpt visit due to being in IOP/PHP

[liquidshadow22]

Can anyone explain this as I havent seen it before.

Several patients are in IOP/PHP and give last second cancellation notice saying that they will be charged i guess extra for services at the IOP if they conduct an outpatient visit with an outpatient psychiatrist while they are in IOP.

For those who take insurance in outpatient, how do you navigate this?

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[SmallBird]

Can anyone explain this as I havent seen it before.

Several patients are in IOP/PHP and give last second cancellation notice saying that they will be charged i guess extra for services at the IOP if they conduct an outpatient visit with an outpatient psychiatrist while they are in IOP.

For those who take insurance in outpatient, how do you navigate this?

They can be seen in IOP and you can still bill for professional services, unless they are seeing a provider in IOP who is billing for professional services. I've worked in IOPs where we take over psychiatric management and do fairly frequent visits so patients usually can't see their outpatient psychiatrist. I've also had situations where the patient prefers to continue to see their outpatient psychiatrist and have supported that by only doing a visit at the time of intake and then not seeing them or billing any professional services after. Interestingly the day rate for an IOP can range from low $100s to mid/$400s from what I've seen, so it can be important for the viability of an IOP to be able to bill for professional services.

 

[Psyche0248]

No patient at our PHP/IOP in residency saw their outpatient psychiatrist again until they had completed the program. It could have caused confusion if multiple doctors were managing the same medications.

 

[Merovinge]

Insurance will not cover the PHP/IOP psychiatrist visit and the OP psychiatrist visit simultaneously. We always reach out to OP team to let them know they are in our program and that we will send a DC summary back with final meds and/or call/email for more complex cases. We are required to have a f/u apt listed prior to graduation from our services to OP care.

As above, IOPs can function without psychiatry and in that case you could certainly still see the patient. AFAIK in my area PHPs all require psychiatric visits every week for the insurance to fund the PHP stay. It's highly variable in my region if the PHP psychiatrist stays on during transition to IOP.

 

[Celexa]

Yes I thought this was standard--that patients can't see their outpatient psychiatrist while in PHP/IOP if the program includes psychiatry services.

 

[wolfvgang22]

I see all the IOP patients because there is no one else...

 

[comp1]

This seems like a patient reminder issue? Are they forgetting to cancel their appointments? Would a text or call reminder help? They will be charged cash I'm assuming at their IOP if they also see you the same day, but that doesn't justify a last minute cancellation. They should have cancelled when they enrolled in the IOP.

 

[whopper]

No show fees are what create the most compliance . With each first meeting with a patient I tell them upfront you will pay a no show fee if you don't show up. Otherwise get another doctor and I do allow exceptions in objectively provable emergencies.

Hospitalization-it's so rare that I never felt the desire to upfront warn patients that their insurance won't pay for the visit if they're in the hospital. This type of thing only happens about once every 6-12 months. So if that happens and the patient is a reliable person I usually just let them go, tell them to reschedule and not charge them the no show fee. If I know ahead of time they're going to the hospital I then tell the patient insurance won't pay if they do a telemedicine while in the hospital.

 

[SmallBird]

Yes I thought this was standard--that patients can't see their outpatient psychiatrist while in PHP/IOP if the program includes psychiatry services.

Common enough and reasonable but not 'standard' in the sense that it's not a requirement and many IOPs don't have medical services.

 

[liquidshadow22]

Both circumstances, patietns were planning on keeping their appointmnets with me despite being in partial and state they were told they cant see me by the PHP last minute and hence why they are cancelling the day before or day of the appointment. I actually didnt charge the no show fee because I felt this could be an issue that the patient was not aware of and didnt want to penalize them for it.

 

[claypigeon]

Both circumstances, patietns were planning on keeping their appointmnets with me despite being in partial and state they were told they cant see me by the PHP last minute and hence why they are cancelling the day before or day of the appointment. I actually didnt charge the no show fee because I felt this could be an issue that the patient was not aware of and didnt want to penalize them for it.

It might be worth reaching out to this and/or other local PHPs. The local PHP psychiatrist is usually happy to defer med management to the outpatient doc

I tell my outpatients when they’re in PHP, and tell my PHP patients when I’m working PHP, only one psychiatrist is managing the meds while they’re in PHP. Too many cooks in the kitchen leads to way too much polypharmacy.

They can still see me for supportive therapy and the like but usually the PHP doc is the better one to manage meds as they see the patient more often / weekly.

You can see the patient and bill per usual but insurance might only cover one of the same billing codes per day or might try to claw back the rare E/M code if they see two psychiatrists on the same day. I’ve never had coverage issues if it’s a different date of service.