MICHAEL GEROME RAILEY, Ph.D.
NPI 1124216346, individual, Tallahassee, FL, Psychologist
- Hours beyond a day in 4 months under one organization, which can be supervisory billing.
- Records needed.
Hours billed per day
Medicaid billing converted into hours of hands-on care per day. The lower bound counts one unit per claim line and needs no price; the other two divide dollars by a unit price, the conservative one at 1.5 times the price. The clinician on the claim may be a supervisor under state rules, so billing organizations are counted too.
| month | what was found | hours per day, lower bound | hours per day, at price | hours per day, conservative | per working day | patients | billing organizations | codes | paid |
|---|---|---|---|---|---|---|---|---|---|
| Mar 2024 | More hours than a day holds at a conservative unit price | 19.0 | 51.7 | 34.5 | 47.9 | 158 | 1 | 90832 90834 90837 90853 H2019 | $21K |
| Apr 2024 | More hours than a day holds at a conservative unit price | 19.3 | 82.1 | 54.8 | 70.7 | 140 | 1 | 90832 90837 90853 H2019 | $29K |
| May 2024 | More hours than a day holds at a conservative unit price | 13.3 | 69.6 | 46.4 | 58.9 | 124 | 1 | 90832 90837 90853 H2019 | $28K |
| Oct 2024 | More hours than a day holds at a conservative unit price | 11.7 | 42.7 | 28.5 | 32.7 | 219 | 1 | 90832 90853 H2010 H2019 | $27K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | MICHAEL GEROME RAILEY, Ph.D. |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | October 12, 2007, last updated August 23, 2024 |
| Practice location | 2236 CAPITAL CIR NE STE 203, Tallahassee, FL 32308-8304, 850-727-4757 |
| Specialties | Psychologist, Counseling (103TC1900X, license PY7835 FL) Counselor, Mental Health (101YM0800X, license PY7835 FL) Psychologist (103T00000X, primary, license PY7835 FL) |
Procedures billed
The specific codes behind the dollars. Medicaid figures come from T-MSIS (2018 to 2024) and are compared with every other provider billing the same code; Medicare figures come from the 2024 physician and supplier file and compare this provider's submitted charge with what Medicare allowed, against the usual ratio for that code.
| code | what it is | paid | share | per patient-month | typical | rank among providers | |
|---|---|---|---|---|---|---|---|
| H2019 | Therapeutic behavioral services per 15 min | $987K | 72% | $214 | $226 (top 5% from $1K) | 47th percentile | |
| 90832 | Psychotherapy, 30 minutes | $151K | 11% | $51 | $59 (top 5% from $239) | 42nd percentile | |
| H0032 | Medicaid service code | $76K | 6% | $92 | $98 (top 5% from $675) | 47th percentile | |
| H0031 | Medicaid service code | $54K | 4% | $60 | $100 (top 5% from $540) | 31st percentile | |
| 90853 | Group psychotherapyhistory of abuse | $34K | 2% | $113 | $60 (top 5% from $332) | 77th percentile | |
| 90837 | Psychotherapy, 1 hourhistory of abuse | $21K | 2% | $140 | $191 (top 5% from $442) | 27th percentile | |
| 90847 | Family psychotherapy with patient, 50 minutes | $16K | 1% | $174 | $130 (top 5% from $458) | too few months to rank | |
| 90791 | Psychiatric diagnostic evaluation | $10K | 1% | $76 | $105 (top 5% from $228) | 29th percentile |
| code | what it is | services | beneficiaries | paid | submitted per service | allowed per service | charge to allowed | usual for this code |
|---|---|---|---|---|---|---|---|---|
| 90832 | Psychotherapy, 30 minutes | 776 | 54 | $40K | $98 | $68 | 1.5x | 2.0x (90th percentile 3.5x) |
| 96133 | Evaluation of neuropsychological test, each additional hour | 50 | 14 | $4K | $200 | $95 | 2.1x | 2.9x (90th percentile 5.2x) |
| 90791 | Psychiatric diagnostic evaluation | 18 | 18 | $2K | $215 | $166 | 1.3x | 1.9x (90th percentile 3.6x) |
| 96137 | Administration of psychological or neuropsychological test, each additional 30 minutes | 66 | 11 | $2K | $100 | $36 | 2.8x | 3.2x (90th percentile 6.8x) |
| 90837 | Psychotherapy, 1 hour | 15 | 13 | $2K | $222 | $149 | 1.5x | 1.6x (90th percentile 2.9x) |
| 96132 | Evaluation of neuropsychological test, first hour | 14 | 14 | $1K | $200 | $125 | 1.6x | 2.3x (90th percentile 4.7x) |
| 96136 | Administration of psychological or neuropsychological test, first 30 minutes | 11 | 11 | $350 | $100 | $40 | 2.5x | 3.0x (90th percentile 6.1x) |
A submitted charge many times the allowed amount is common and lawful; it matters when it is far above what other providers submit for the same code.
In this area
2 providers in Leon County, FL carry an indicator in the public record, with $0 at stake between them. The most common is part of a provider network, on 2 of them.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | HEART N SOUL HOSPICE OF FLORIDA Tallahassee, FL, ranked 4844 | $0 |
|
| 3 | CENTERWELL HEALTH SERVICES (CERTIFIED), INC. Tallahassee, FL, ranked 6442 | $0 |
|
Recent enforcement in FL
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
Referral packet
The packet is a draft for a reviewer. It reads every public record behind this case, states what the records show with a citation for each finding, names the regulation each finding relates to, and lists the ordinary explanations to rule out first. It never asserts intent.