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Paying for Primary Care and Behavioral Health Services Provided in Integrated Care Settings



Interim State-based Billing and Financial Worksheets

CIHS provides tools and resources to primary and behavioral healthcare organizations to help them successfully implement bidirectional integrated healthcare. A key success factor is the financial viability and sustainability of programs’ integration efforts, including appropriate and accurate billing for services. CIHS has developed customized Interim Billing and Financial Worksheets for each state that identify existing billing opportunities for services provided in integrated settings. In states where the identified codes are not currently reimbursable, these worksheets identify areas of potential state policy work. Special thanks to Mary Jean Mork from MaineHealth for her pioneering work in this financing area. The format of these Interim Billing Worksheets was adapted from early work at MaineHealth to identify billing solutions for providers in Maine.

While Medicare billing processes and procedures are consistent nationwide, Medicaid benefits, coding, and payment requirements vary across states, territories, and the District of Columbia. To effectively bill for Medicaid reimbursable services, organizations must submit a claim form that contains specific CPT (Current Procedural Terminology) codes that link to relevant billable diagnostic codes and are provided by appropriately licensed professionals. CPT and diagnostic codes are consistent across the country; however, state Medicaid programs determine the types of services, codes, and individuals credentialed to provide services, resulting in unique billing rules and regulations in each state.

Financing is often perceived as one the three biggest barriers to sustainable integration activities. By not billing at all, or billing incorrectly, providers risk denied or delayed claims payments, wasted time and resources, and missed reimbursement opportunities for services provided. These Interim Billing Worksheets will assist Primary and Behavioral Health Care Integration (PBHCI) grantees and others bill correctly by informing providers on available CPT codes that can be used to bill for services and the discipline and credential required by the public funding source (i.e., Medicare, Medicaid) to bill for the CPT code.   

The services provided as part of bidirectional integration are often more easily billable in partnerships between Federally Qualified Health Centers (FQHCs) and community behavioral health organizations. These Billing and Financial Worksheets identify the core set of CPT codes used to bill for specific bidirectional health and wellness services provided by FQHCs and/or community behavioral health organizations. The Worksheets link CTP codes with the state-specific diagnostic codes and associated professional credentials needed to submit a successful, payable claim. 

Private insurance companies can also use the CPT codes in these Worksheets for billing and reimbursement. However, commercial insurance programs are individualized and more varied than Medicaid. Contact commercial insurance companies directly to determine what services are covered. 

Each of the Interim CIHS Billing and Financial Worksheets have been reviewed by the specific state’s Medicaid office. With continuing changes in healthcare financing, states continually review and update their Medicaid state plans and programs. It is important to understand that these CIHS Worksheets provide a “point in time” and information may change as states change their Medicaid programs. Please communicate changes affecting your state’s billing guidelines to CIHS; CIHS will update these Worksheets regularly.


Billing tools & resources

The medical billing and coding certification homepage features 65 short, instructional videos, all vetted by professionals in the healthcare field, which cover a wide range of billing and coding topics.

WEBINARS

Billing for Integrated Health Services
Financing integrated healthcare is one of the key challenges encountered by organizations during implementation of services. This webinar featured the state based Interim Billing and Financial Worksheets developed by CIHS. The webinar addresses the core aspects of billing for integrated health services and assist participants in successfully using the worksheets to maximize billing opportunities for integrated health services.

June 12, 2012
Presented by Kathleen Reynolds


June 12, 2012
Presented by Kathleen Reynolds

Recording

Presentation

Transcript

Call Our Helpline: 202-268-7457

Paying for Primary Care and Behavioral Health Services Provided in Integrated Care Settings



Interim State-based Billing and Financial Worksheets

CIHS provides tools and resources to primary and behavioral healthcare organizations to help them successfully implement bidirectional integrated healthcare. A key success factor is the financial viability and sustainability of programs’ integration efforts, including appropriate and accurate billing for services. CIHS has developed customized Interim Billing and Financial Worksheets for each state that identify existing billing opportunities for services provided in integrated settings. In states where the identified codes are not currently reimbursable, these worksheets identify areas of potential state policy work. Special thanks to Mary Jean Mork from MaineHealth for her pioneering work in this financing area. The format of these Interim Billing Worksheets was adapted from early work at MaineHealth to identify billing solutions for providers in Maine.

While Medicare billing processes and procedures are consistent nationwide, Medicaid benefits, coding, and payment requirements vary across states, territories, and the District of Columbia. To effectively bill for Medicaid reimbursable services, organizations must submit a claim form that contains specific CPT (Current Procedural Terminology) codes that link to relevant billable diagnostic codes and are provided by appropriately licensed professionals. CPT and diagnostic codes are consistent across the country; however, state Medicaid programs determine the types of services, codes, and individuals credentialed to provide services, resulting in unique billing rules and regulations in each state.

Financing is often perceived as one the three biggest barriers to sustainable integration activities. By not billing at all, or billing incorrectly, providers risk denied or delayed claims payments, wasted time and resources, and missed reimbursement opportunities for services provided. These Interim Billing Worksheets will assist Primary and Behavioral Health Care Integration (PBHCI) grantees and others bill correctly by informing providers on available CPT codes that can be used to bill for services and the discipline and credential required by the public funding source (i.e., Medicare, Medicaid) to bill for the CPT code.   

The services provided as part of bidirectional integration are often more easily billable in partnerships between Federally Qualified Health Centers (FQHCs) and community behavioral health organizations. These Billing and Financial Worksheets identify the core set of CPT codes used to bill for specific bidirectional health and wellness services provided by FQHCs and/or community behavioral health organizations. The Worksheets link CTP codes with the state-specific diagnostic codes and associated professional credentials needed to submit a successful, payable claim. 

Private insurance companies can also use the CPT codes in these Worksheets for billing and reimbursement. However, commercial insurance programs are individualized and more varied than Medicaid. Contact commercial insurance companies directly to determine what services are covered. 

Each of the Interim CIHS Billing and Financial Worksheets have been reviewed by the specific state’s Medicaid office. With continuing changes in healthcare financing, states continually review and update their Medicaid state plans and programs. It is important to understand that these CIHS Worksheets provide a “point in time” and information may change as states change their Medicaid programs. Please communicate changes affecting your state’s billing guidelines to CIHS; CIHS will update these Worksheets regularly.


Billing tools & resources

The medical billing and coding certification homepage features 65 short, instructional videos, all vetted by professionals in the healthcare field, which cover a wide range of billing and coding topics.

WEBINARS

Billing for Integrated Health Services
Financing integrated healthcare is one of the key challenges encountered by organizations during implementation of services. This webinar featured the state based Interim Billing and Financial Worksheets developed by CIHS. The webinar addresses the core aspects of billing for integrated health services and assist participants in successfully using the worksheets to maximize billing opportunities for integrated health services.

June 12, 2012
Presented by Kathleen Reynolds


June 12, 2012
Presented by Kathleen Reynolds

Recording

Presentation

Transcript

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Phone: 202-684-7457