FREQUENTLY ASKED QUESTIONS

 

 

What can a neurocognitive evaluation tell me?

 

A "neuropsychological," or neurocognitive evaluation, can be useful in many ways. Many patients are concerned about changes they have witnessed in a family member or perhaps they have detected changes in themselves and are worried that they are coming down with something. The evaluation is very helpful in clarifying whether changes are normal for a person's age. The evaluations are also state-of-art for other situations to including: 1) Documenting your cognitive strengths and weaknesses; 2) Determining whether a "real" impairment actually exists or whether cognitive changes are actually due to the interference effects of medications, or acute or chronic stress or emotional fluctuations.  The evaluation is of paramount importance for identifying specific conditions that may be present alone or in combination, like ADHD, a learning disability, depression, anxiety, Autism Spectrum characteristics or a cognitive disorder, taking into consideration factors such as age, sex, education, mood, sleep, pain, etc. 3)  If real, rarely occurring changes are detected, the evaluation can help determine etiology, or what is causing the cognitive disorder. For example, determining whether cognitive or behavioral changes are likely related to Alzheimer's disease, Dementia with Lewy Bodies, or another form of dementia, or whether the changes are related to known medical condition like stroke, concussion, TBI, Epilepsy, or other condition; 4) Providing a baseline against which subsequent evaluations can be compared. A baseline evaluation is used to monitor and track if cognitive changes are in fact taking place by comparing exam data across evaluations.  The baseline data is also very useful for measuring whether a person is responding to specific treatment (e.g. medications, cognitive training); 5) Determining whether you might benefit from certain cognitive or behavioral treatments or pharmacotherapy.

 

 

What will happen when I call to inquire about service?

 

First, a free 15-minute consultation is offered so that you can speak with Dr. Driscoll, get a sense for him, and see if evaluation services are what you really need.  Calls are returned within 1 business day when you leave a message.  If we agree that evaluation is the proper course, you will be asked to register as a new patient by completing a series of forms (sorry…). These include:

 

Demographics and contact information.

Consent for Treatment

Patient Rights to Privacy in Telehealth

Release of Information for Patients of Age who accept involvement of parent(s) or caregivers.

Permission to record sessions

Practice Policy and Procedures

 

 

What information/records do you need? 

 

After scheduling your appointment, you will be asked to complete an online intake questionnaire and provided with a link to upload relevant medical documents, such as results from any brain imaging (e.g., MRI, CT) or cognitive evaluations, if available.

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What is the Tiered Assessment Approach?

 

The Tiered assessment system enables us to perform the least amount of testing possible to obtain valid and reliable information, thereby reducing the stress on the patient and family and the cost of the evaluation.  In many practices, a standard battery is prescribed regardless of the referral question.  Many questions can be answered with fewer tests, less time, and expense.  Only if concerns arise about the quality or the depth of the Tier 1 data will additional testing be prescribed. For example, the Tier 1 data may be partially invalid because the patient may have been so uncomfortable with the telehealth format that their responses were inconsistent.  Or, the data may suggest the presence of a condition that requires deeper investigation and verification.  The testing that is conducted via telehealth has "built-in" validity indicators so that Dr. Driscoll can "see" if the data is trustworthy. If concerns about the data are found or if deeper investigation is needed, Dr. Driscoll will discuss these issues during your feedback session so that you understand fully why the additional testing is being recommended.    The Tiered approach to neurocognitive evaluation increases accessibility and reduces costs for patients by conducting only services that are necessary to answer the referral question. 

 

 

What will happen during my evaluation? (TIER 1) 

 

The first part of the evaluation will take place online during a video call. It will last approximately 2 hours. Dr. Driscoll will conduct a clinical interview to better understand your history, symptoms, and concerns.  Dr. Driscoll will take very careful notes and with your permission, the session will be recorded so that details are not missed.  As soon as the interview is converted to a written note, the audio recording is deleted.   Next, you will receive a series of forms to complete (I apologize in advance).  These are standardized assessments that address an array of issues related to attention, memory, and complex problem-solving. There is no right or wrong answer.  They inquire about your feelings and perceptions of yourself.  There will also be standardized forms for someone you chose to complete about you to obtain their point of view about your symptoms. Then, you will be scheduled for direct testing of your cognitive skills.  Depending on the Tier level of assessment recommended these will include computer administered instruments and/or tests Dr. Driscoll administers to you during a video session.  Dr. Driscoll will then conduct all scoring and interpretation of the data (2 hours) and will meet with you at a separate appointment (1 hour) to discuss the results in detail. Following this meeting a written report will be provided along with recommendations for treatment as needed (1 hour).

The total time invested on Dr. Driscoll’s part for a Tier 1 evaluation is approximately 5-6 hours.  The cost is $1800.

 

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What does a TIER 2 evaluation involve?

 

The TIER 2 exam validates and extends the inquiry of a TIER 1 exam.  An additional test administration session is scheduled in an online video appointment. This appointment will be 2-4 hours with breaks of course.  It involves more rigorous and comprehensive testing using tests that are more demanding.  Again, you cannot fail these tests.  You will not know how your are performing during the tests.  Your performance is compared to many, many other people your same age, to see if your performance shares similar qualities or if there are notable departures from normal characteristics. You cannot get all the items correct, no one can.  It is designed that way on purpose.  Just try to do your very best.

 

The TIER 2 exam consists of the additional test administration (2-4 hours), test scoring and data synthesis with TIER 1 data, interpretation, additional report writing, additional recommendations, and a new feedback session conducted via video conferencing.  The testing time and “behind the scenes” work is approximately 6 hours.  The cost is an additional $1200. So, the total cost for a TIER 1 plus Tier 2 evaluation is $3000.

 

 

What does a TIER 3 evaluation involve?

 

A TIER 3 evaluation requires in-person testing to obtain the most valid and reliable information possible. These examinations are reserved for younger children whose parents are concerned about possible learning disabilities, ADHD, Autism Spectrum Disorder or other conditions.  Some people are able to complete a Tier 3 evaluation virtually if we break into separate sessions.  These exams are usually known in advance, through the information obtained during initial consultation.  Evaluations that are requested to determine surgical candidacy, surgical planning, or post-surgical evaluations for planning rehabilitation services need to be conducted in-person.  The Tier 3 evaluation is particularly complex due to the need to investigate many conditions that have strong overlap.  For example, for an adult concerned about undiagnosed Autism Spectrum Disorder, conditions like social anxiety, different types of personality types disorders, Non-verbal Learning Disability, OCD, PTSD, depression and others need to be "ruled out" or identified in terms of to what degree their co-occurrence is contributing to the clinical picture, before confidently arriving at final diagnosis.  In total, these evaluations involve 12-15 hours of combined of testing, data analysis, extensive discussion with parents and family as needed and generation of written reports for distribution to the patient’s care team. The cost of this evaluation is an additional $1000 or a total cost of $4000.    

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Here is a more detailed breakdown of the procedures included for each evaluation Tier: 

 

TIER 1: 

 

This level of evaluation is designed for adults who are concerned about changes they have noticed in their cognition, who may have had experience with other family members who developed cognitive challenges as they grew older, and who want to “check themselves out” to make sure nothing concerning is actually taking place.  This evaluation involves the following:

- A clinical interview via telehealth

- An Adult History form sent to you by email for you to complete and send back.

- Completion of an online neuropsychological test battery that is administered via telehealth (a link to the test is sent to your email.  Just click on the link follow the steps.  It is designed for people who have little or no experience with computers.  The test takes about 45 minutes.  A family member can be with you to connect to the test if you would like.).

- Administration of 2 survey forms, one to you and one to someone who knows you very well.  It is a measure of your emotions.  There is no right or wrong answer.  It helps identify your state of reaction to any current stressors in your life that might be effecting your cognition.

- Finally, there is a 45 minute feedback session (via telehealth) with you about your test results.  You may certainly invite anyone else you wish to this session.

- You will receive a written report of your results along with recommendations as needed.

- Total time for interview, completion of forms, testing, feedback and report writing is approximately 3-4 hours.

 

TIER 2:

 

All of the services provided in Tier 1, plus ...

Online administration of comprehensive neuropsychological battery suitable for virtual administration that more fully measures attention and concentration, speech and language functions, academic achievement levels, memory, visuospatial processing, executive functions including comprehensive IQ testing, social-emotional evaluation, and adaptive functioning skills.

There will be a subsequent appointment for feedback or discussion of the results and further recommendations.

There will be an addendum report that incorporates all information gained form the additional assessment.

Dr. Driscoll is willing to consult with a child's school or child study team to participate in the 504 planning process or the development of an Individualized Educational Plan.  In fact, interaction with a child's school is invaluable in helping to identify the need for and develop accommodations.

Total time for interview, completion of forms, testing, feedback and report writing is approximately 6 - 8 hours.

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TIER 3

 

Includes all services from the Tier 1 and Tier 2 evaluations, plus

Administration of a test battery in a traditional, in-person manner.  Note, that neuropsychological testing is via telehealth is still a new endeavor. Most all test instruments were developed before COVID 19, when all testing was conducted in person.  And so, administering tests via telehealth is not the way the test instruments were originally designed to be given.  These same tests are being adapted at a rapid rate for virtual administration but the "norms" of these tests, that is, the scores of healthy children and adults to whom your child or loved on is being compared, may be less accurate because taking the tests via video conference may introduce a factor that weakens the accuracy of the scores. There are many studies that now compare how the "traditional administration" and telehealth administration of each instrument equates.  There is a growing body of literature that endorses use of the traditional tests via telehealth, that the administration methods are essentially equivalent but there are still some tests that do not translate well.  Dr. Driscoll only uses tests that have an evidence base indicating that testing in-person and testing via telehealth are reasonably equivalent.  If there is concern that a particular testing session is not producing comparable data, then the test session is discarded and another approach is designed. For testing that is particularly complex due to the patient's young age or diagnostic concerns, attention problems, behavioral or emotional concerns, or if the test session was interrupted by technical malfunction, or a disturbance in the room where the patient is taking the test, adjustments will be made to obtain the best data possible. For cases where the data is being used to plan a surgery, i.e. Epilepsy surgery, or deep brain stimulation treatment in Parkinson's or essential tremor or other movement disorders, the testing must be done in person.  Arrangements can be made for such situations on a case by case basis.

 Total time for interview, completion of forms, testing, feedback and report writing is approximately 10 -15 hours.

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Is the evaluation covered by insurance?

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Dr. Driscoll does not participate with insurance companies at this time.  There are several reasons for this.  First, insurance companies require access to your notes as a condition of payment.  This is over-reaching.  Second, the process of applying to become a provider on an insurance panel takes 6 to 12 months to complete and the insurance company may conclude that they do not need any more providers with Dr. Driscoll's specialty at he end of their process.  Third, insurance companies require that doctors sign a contract which states that the insurance company can change their policy about pre-authorizing treatments, about the rules for submission of records, and their fee schedule at their discretion.  Increasingly, providers in psychology and neuropsychology are opting out of participation with insurance. In many cases, insurance companies do not approve neuropsychological assessment as part of their coverage, regardless.   Typically, patients can expect to pay out-of-network costs for a cognitive evaluation, even when using in-network insurance. Most private clinics, like MHI & Neurobehavioral Associates, require payment up front and will help as much as possible by coaching patients on how to request reimbursement from their insurance company after services are completed if they have PPO insurance. While patients may be able to find a clinic that is in-network with their insurance, most of these clinics also have very long wait-times, as much as three to nine months and you will likely still incur out-of-pocket costs. MHI & Neurobehavioral Associates' Tiered assessment process was developed to shorten evaluation length, thereby increasing access and reducing costs for patients, while guaranteeing absolute privacy in the evaluation process.

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If you have PPO insurance, MHI & Neurobehavioral Associates is an out-of-network provider. Therefore, many services may be eligible for reimbursement. Generally patients with PPO insurance can expect their insurance to reimburse most costs associated with completing Tier 1 of the evaluation. However, our fees are due up front before the first visit and we cannot communicate with your insurance provider. Your insurance company should be able to tell you how many hours of each procedure  (CPT) code you can expect reimbursement for and at what rate. After completing the evaluation, patients will be provided with a SuperBill that includes all of the appropriate CPT codes that were used and that you will need to submit if seeking reimbursement from your insurance company. It is strongly recommended that you contact your insurance company before booking your appointment to learn about the specific restrictions your insurance company may have for our services. Below are the codes you can use to inquire about your out-of-network insurance coverage.

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When calling your insurance company to inquire if you have coverage for out of network reimbursement, these are the codes you should give them.  These codes specify in insurance language what services will be provided in your evaluation. 

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Probable diagnostic code used to request neuropsychological evaluation based:

294.9 (F09) Cognitive Problems‍

 

Tier 1 Evaluation Codes (needed for all patients):

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90791 - Psychiatric Diagnostic Interview (1 unit per evaluation)

96136 –Psychological/neuropsychological test administration/scoring by QHP (30 min) (1 unit of 30 minutes)

96137 –Each additional 30 minutes (30 min) (1 unit of 30 minutes)

96132 - Neuropsych testing by psych/phys first hour (1 unit hour)

96133 - Neuropsych testing by psych/phys addtl hr (1 unit hour)

 

Tier 2 Evaluation Codes (*needed for minority of patients):

 

90791 - Psychiatric Diagnostic Interview (1 unit per evaluation)

96136 –Psychological/neuropsychological test administration/scoring by QHP (30 min) (1 unit of 30 minutes)

96137 –Each additional 30 minutes (30 min) (6 units of 30 minutes)

96132 - Neuropsych testing by psych/phys first hour (1 unit hour)

96133 - Neuropsych testing by psych/phys addtl hr (2 - 3 unit hours)

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Tier 3 Evaluation Codes (*needed for minority of patients):

90791 - Psychiatric Diagnostic Interview (1 unit per evaluation)

96136 –Psychological/neuropsychological test administration/scoring by QHP (30 min) (1 unit of 30 minutes)

96137 –Each additional 30 minutes (30 min) (6 units of 30 minutes)

96132 - Neuropsych testing by psych/phys first hour (1 unit hour)

96133 - Neuropsych testing by psych/phys addtl hr (4 unit hours)

96132 –Neuropsychological Testing Evaluation Services (1 hour)

96133 –Each additional hour (3-4 hours)

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How should I prepare for my evaluation? 

 

After you book your appointment, you will be sent a set of instructions for preparing for the cognitive evaluation, including how to access the Zoom platform, which will be used for the appointment. You may also be sent some testing materials by mail. Generally, patients should wear their glasses or hearing aids, if applicable, and take all medication as prescribed on the day of testing. We recommend using over-the-ear headphones that plug directly into your electronic device during the assessment, unless you frequently use Zoom and do not have any trouble hearing from your electronic device. Regarding other technical preparations, we have created a document to help you get your electronic devices ready for the online appointment. We can also call you before your appointment for a "Tech Check" to make sure everything is ready to go.

 

Do I need a computer for the appointment?

 

Yes, but you do NOT need to be a technology wiz to use MHI & Neurobehavioral Associates services. For cognitive evaluation appointments, you will need a computer or tablet with a screen that is at least 10 inches wide. This is the screen that you will see your neuropsychologist on.  Setting up your devices should only take a few minutes. We  email you simple written instructions on how set up access to Zoom. If needed, MHI & Neurobehavioral Associates will call you before your appointment to help you with any technical issues. For treatment appointments and feedback sessions, you only need one device (e.g., phone, tablet, computer), though we recommend using a screen at least 10 inches wide.

What can a cognitive evaluation tell me?

 

When do I need to pay and are fees refundable?  

 

Payment is required at the time of booking (reserving the evaluation session time).  You can book your appointment over the phone or on the self-serve calendar located on this website.  Click the button that says "Book Your Own Appointment."  Then, follow the steps to submit your payment on this secure site. 
 

All fees are refundable within 24 hours of purchase, minus any credit card processing fees that may have applied. All appointments can be rescheduled at no additional cost if done at least 72 hours in advance. If you reschedule with less than 72 hours notice, you will be charged a $199 rescheduling fee.

 

Can a family member or friend attend the evaluation? 

 

For Tier 1, close friends or family members can be present during the first part of the appointment (interview portion). In fact, the neuropsychologist will likely have questions for your loved one, such as asking whether they have noticed any changes in your thinking or behavior. However, once cognitive testing begins, friends and family can no longer be present. Tier 2 testing must be completed independently with the examiner.

 

Why don't you offer in-person appointments exclusively? 

 

We created MHI & Neurobehavioral Associates to increase accessibility of neuropsychological services and expertise to patients. We are best able to accomplish this by providing our services online. Our online portal allows patients to access services from the comfort of their own home instead of having to travel long distances. Providing services virtually also allows us to offer services at lower rates because it removes the cost of maintaining office space. There are however, some circumstances where an in-person testing is essential to obtain valid and reliable data and in-person testing can be discussed and arranged on a case by case basis.  If Dr. Driscoll deems in-person testing is required and you are not able to travel to an office, Dr. Driscoll will try to help you find a provider in your area. 

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Are there certain situations where neurocognitive evaluations are not as helpful?

 

We do not recommend cognitive evaluations for individuals who are already dependent on others for basic activities of daily living  (e.g. showering, bathing, feeding, toileting) due to a well-documented cognitive disorder (e.g., late stage Alzheimer's disease). These patients, who we already know have a cognitive disorder, would likely perform so poorly on our cognitive tests that their scores would not be informative. However, testing may be helpful for those who are dependent on others for daily living but have not been diagnosed with a cognitive disorder yet or for family and caregivers to develop refined care plans and strategies. We don't recommend cognitive evaluations for those who are currently abusing alcohol or drugs or those with untreated severe psychiatric conditions (e.g., schizophrenia).

 

When will I receive results?  What can I do with them? 

 

Most patients will receive feedback from Tier 1 testing within 1-2 business days via a separate telehealth appointment. At the end of your appointment, the neuropsychologist will provide results, diagnoses, and recommendations. You will also be provided with a written  report to share with your referring provider, if you wish. For those patients who are recommended for additional testing (Tier 2 or 3), you will receive feedback within 7 days of completing testing. This will include a comprehensive written report.

You can save your written report for your own record and/or send it to your medical providers. MHI & Neurobehavioral Associates will also keep your results on file so that we can track cognitive changes over time through our annual repeat testing program. You will also be given recommendations for improving your cognitive and brain health. Some of the recommendations will be for services through MHI & Neurobehavioral Associates and others will be for services with other providers. We are beginning to build our network of quality providers who can help in delivering needed services.

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What are evaluation and management services?

 

Dr. Driscoll has found that many people need support not only to find services but to help navigate the medical and community services systems so that recommendations 1) actually get started and 2) that progress is monitored and tracked.  There needs to be a service where people who are recommended for certain kinds of help, can discuss the quality of the treatment they are receiving and try to measure their real-life response to such treatment. After all, if a treatment is not working, it needs to be investigated as to why.  If therapeutic effectiveness cannot be increased, it needs to be altered or changed.  For other people and families coping with chronic neurologic conditions, access and opportunity to discuss the status of their situation can be very helpful.  Dr. Driscoll refers to these consultations as "evaluation and management" sessions.  They can be scheduled as a separate service on a 1 x per month basis, or on another schedule depending on patient needs. The fee for these consultations is $175 per hour.  These sessions are well suited for telehealth.