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Medicaid/Medicare

Medicaid & Medicare

For many community behavioral health and health centers, Medicaid and Medicare are the payers most frequently billed for integrated clinical services.Therefore, an important first step is determining how to bill these sources and to obtain credentialing for providers who will deliver services.
Check out the eSolutions article: Footing the Bill for Integrated Care and learn more about  financing its role in integrating primary and behavioral healthcare services.



WEBINARS

Billing for Integrated Health Services
June 12, 2012
Presented by Kathleen Reynolds

Recording

Presentation

Transcript
 

Recordings (synched audio and slides) remain in our archive for one year. For webinar recordings more than one year old, contact us at Integration@TheNationalCouncil.org

Medicaid

Medicaid is America’s health ‘safety net’, serving as the primary payer of healthcare services for millions of people with chronic illnesses, including mental illnesses and addictions. To support the integration efforts of community health and behavioral health providers and practices, CIHS provides the tools needed to ensure appropriate care and optimum health for all, especially those served by public health systems, and promotes Medicaid billing solutions that can make integrated health programs financially viable.

General Resources

The Department of Health and Human Services - Centers for Medicare & Medicaid Services (CMS) released a telehealth services factsheet that provides the information about services furnished to eligible Medicare beneficiaries via a telecommunications system.  Beginning January 2015 CMS added psychotherapy to the list of services that can be furnished to Medicare beneficiaries under the telehealth benefit.
Please note:The information in this publication applies only to the Medicare Fee-For-Service Program (also known as Original Medicare).

Published by the American Society of Addiction Medicine, the Medicaid Benefits for the Treatment of Opioid Use Disorder Nationwide displays state's Medicaid fee-for-service benefit coverage for medications approved to treat opioid dependence.

The Centers for Medicare and Medicaid Services and states are partnering to transform health care systems by creating and testing new models of care delivery and payment. The State Innovation Models:  Early Experiences and Challenges of an Initiative to Advance Broad Health System Reform shares interviews with officials from states participating in the State Innovation Models (SIM) Initiative which reveals that the readiness of providers and payers to adopt innovations varies, requiring different starting points, goals, and strategies. 

SAMHSA's Medicaid Handbook: Interface with Behavioral Health Services reviews Medicaid and its role in financing services and treatment for mental health disorders and substance use disorders. It also discusses services included in state Medicaid plans, the role of the provider, reimbursement, and other factors related to Medicaid.

On June 6, 2012, the Centers for Medicare and Medicaid Services (CMS) approved Georgia as the first state to have Medicaid-recognized whole health and wellness peer support provided by certified peer specialists (CPSs). Georgia’s newly approved Medicaid service will be delivered by peer support whole health and wellness coaches certified in Whole Health Action Management (WHAM), a training developed by CIHS that promotes outcomes of integrated health self-management and preventive resiliency.

Prepared for Changes to Current Procedural Terminology (CPT) Code Sets for psychiatry services beginning January 1, 2013? Defined by the American Medical Association (AMA), the CPT code set describes procedures and services by physicians and other health care professionals. While changes to the code sets are made on an annual basis, decisions made this year will have a higher-than-usual impact on psychiatry. The extent of the changes is not yet fully known, but a new  National Council  new fact sheet to prepare provider agency for the changes.

National Study of "Barriers to Timely Primary Care and Emergency Department Utilization Among Medicaid Beneficiaries” conducted by the  University of Colorado School of Medicine and Oregon Health and Science University concludes: "Compared with individuals with private insurance, Medicaid beneficiaries were affected by more barriers to timely primary care and had higher associated emergency department utilization. Expansion of Medicaid eligibility alone may not be sufficient to improve health care access."

SAMHSA’s Reimbursement of Mental Health in Primary Care Settings incudes practical, achievable suggestions to improve access to timely and targeted mental health services in primary care settings. It reviews policy and service delivery change mechanisms to improve reimbursement of mental health services in primary care settings. By using knowledge from a variety of individuals and settings and combining empirical research with qualitative interviews and expert forum proceedings, this document identifies areas where federal agencies, states, provider organizations, and commissioner associations can clarify, collaborate, educate, and provide support to improve the reimbursement of and access to mental health services in primary care settings.

The National Council’s assessment tool, Behavioral Health/Primary Care Integration: Environmental Assessment Tool, State Level Policy and Financing helps organizations review their state level policy and financing environment and the extent to which it supports effective collaboration among behavioral health and primary care providers, especially regarding Medicaid and “safety net” populations.

The National Association of Community Health Centers and SAMHSA developed a Paying for Behavioral Health Visits on Same Day as Medical Visit that provides information on which states allow for same day billing of a behavioral health and a primary care visit.

Center for Medicaid and Medicare Services(CMS)Resources
CMS issued a memo on Medicaid reimbursement for behavioral health services provided in Federally Qualified Health Centers and Rural Health Clinics.

CMS issued a memo on Medicaid reimbursement for services provided in FQHCs and RHCs by clinical psychologists, clinical social workers and nurse practitioners.

Billing Resources

The SBIRT reimbursement map is an interactive tool designed to help determine whether billing codes are listed on a state’s fee schedule, and, if listed, whether or not they are open for reimbursement (i.e. a billing amount has been assigned to the codes).

National Study of "Barriers to Timely Primary Care and Emergency Department Utilization Among Medicaid Beneficiaries” conducted by the University of Colorado School of Medicine and Oregon Health and Science University concludes: "Compared with individuals with private insurance, Medicaid beneficiaries were affected by more barriers to timely primary care and had higher associated emergency department utilization. Expansion of Medicaid eligibility alone may not be sufficient to improve health care access."

CMS introduced a new series of mental and behavioral health codes in 2010, giving behavioral health providers a more accurate, refined way of billing for services provided to patients with a physical health diagnosis. Medicaid’s Health and Behavior Assessment and Intervention Codes (HBAI) 96150-96155 CPT Series are currently available in many states.

Medicare & Medicare rESOURCES

Medicare can be an important financier of integrated behavioral health and primary care services, especially in its role in preventative, older adult, and chronic care. CIHS aims to provide the latest information and resources related to publicly financed integrated care, including those provided by Medicare.

Call Our Helpline: 202-268-7457

Medicaid & Medicare

For many community behavioral health and health centers, Medicaid and Medicare are the payers most frequently billed for integrated clinical services.Therefore, an important first step is determining how to bill these sources and to obtain credentialing for providers who will deliver services.
Check out the eSolutions article: Footing the Bill for Integrated Care and learn more about  financing its role in integrating primary and behavioral healthcare services.



WEBINARS

Billing for Integrated Health Services
June 12, 2012
Presented by Kathleen Reynolds

Recording

Presentation

Transcript
 

Recordings (synched audio and slides) remain in our archive for one year. For webinar recordings more than one year old, contact us at Integration@TheNationalCouncil.org

Medicaid

Medicaid is America’s health ‘safety net’, serving as the primary payer of healthcare services for millions of people with chronic illnesses, including mental illnesses and addictions. To support the integration efforts of community health and behavioral health providers and practices, CIHS provides the tools needed to ensure appropriate care and optimum health for all, especially those served by public health systems, and promotes Medicaid billing solutions that can make integrated health programs financially viable.

General Resources

The Department of Health and Human Services - Centers for Medicare & Medicaid Services (CMS) released a telehealth services factsheet that provides the information about services furnished to eligible Medicare beneficiaries via a telecommunications system.  Beginning January 2015 CMS added psychotherapy to the list of services that can be furnished to Medicare beneficiaries under the telehealth benefit.
Please note:The information in this publication applies only to the Medicare Fee-For-Service Program (also known as Original Medicare).

Published by the American Society of Addiction Medicine, the Medicaid Benefits for the Treatment of Opioid Use Disorder Nationwide displays state's Medicaid fee-for-service benefit coverage for medications approved to treat opioid dependence.

The Centers for Medicare and Medicaid Services and states are partnering to transform health care systems by creating and testing new models of care delivery and payment. The State Innovation Models:  Early Experiences and Challenges of an Initiative to Advance Broad Health System Reform shares interviews with officials from states participating in the State Innovation Models (SIM) Initiative which reveals that the readiness of providers and payers to adopt innovations varies, requiring different starting points, goals, and strategies. 

SAMHSA's Medicaid Handbook: Interface with Behavioral Health Services reviews Medicaid and its role in financing services and treatment for mental health disorders and substance use disorders. It also discusses services included in state Medicaid plans, the role of the provider, reimbursement, and other factors related to Medicaid.

On June 6, 2012, the Centers for Medicare and Medicaid Services (CMS) approved Georgia as the first state to have Medicaid-recognized whole health and wellness peer support provided by certified peer specialists (CPSs). Georgia’s newly approved Medicaid service will be delivered by peer support whole health and wellness coaches certified in Whole Health Action Management (WHAM), a training developed by CIHS that promotes outcomes of integrated health self-management and preventive resiliency.

Prepared for Changes to Current Procedural Terminology (CPT) Code Sets for psychiatry services beginning January 1, 2013? Defined by the American Medical Association (AMA), the CPT code set describes procedures and services by physicians and other health care professionals. While changes to the code sets are made on an annual basis, decisions made this year will have a higher-than-usual impact on psychiatry. The extent of the changes is not yet fully known, but a new  National Council  new fact sheet to prepare provider agency for the changes.

National Study of "Barriers to Timely Primary Care and Emergency Department Utilization Among Medicaid Beneficiaries” conducted by the  University of Colorado School of Medicine and Oregon Health and Science University concludes: "Compared with individuals with private insurance, Medicaid beneficiaries were affected by more barriers to timely primary care and had higher associated emergency department utilization. Expansion of Medicaid eligibility alone may not be sufficient to improve health care access."

SAMHSA’s Reimbursement of Mental Health in Primary Care Settings incudes practical, achievable suggestions to improve access to timely and targeted mental health services in primary care settings. It reviews policy and service delivery change mechanisms to improve reimbursement of mental health services in primary care settings. By using knowledge from a variety of individuals and settings and combining empirical research with qualitative interviews and expert forum proceedings, this document identifies areas where federal agencies, states, provider organizations, and commissioner associations can clarify, collaborate, educate, and provide support to improve the reimbursement of and access to mental health services in primary care settings.

The National Council’s assessment tool, Behavioral Health/Primary Care Integration: Environmental Assessment Tool, State Level Policy and Financing helps organizations review their state level policy and financing environment and the extent to which it supports effective collaboration among behavioral health and primary care providers, especially regarding Medicaid and “safety net” populations.

The National Association of Community Health Centers and SAMHSA developed a Paying for Behavioral Health Visits on Same Day as Medical Visit that provides information on which states allow for same day billing of a behavioral health and a primary care visit.

Center for Medicaid and Medicare Services(CMS)Resources
CMS issued a memo on Medicaid reimbursement for behavioral health services provided in Federally Qualified Health Centers and Rural Health Clinics.

CMS issued a memo on Medicaid reimbursement for services provided in FQHCs and RHCs by clinical psychologists, clinical social workers and nurse practitioners.

Billing Resources

The SBIRT reimbursement map is an interactive tool designed to help determine whether billing codes are listed on a state’s fee schedule, and, if listed, whether or not they are open for reimbursement (i.e. a billing amount has been assigned to the codes).

National Study of "Barriers to Timely Primary Care and Emergency Department Utilization Among Medicaid Beneficiaries” conducted by the University of Colorado School of Medicine and Oregon Health and Science University concludes: "Compared with individuals with private insurance, Medicaid beneficiaries were affected by more barriers to timely primary care and had higher associated emergency department utilization. Expansion of Medicaid eligibility alone may not be sufficient to improve health care access."

CMS introduced a new series of mental and behavioral health codes in 2010, giving behavioral health providers a more accurate, refined way of billing for services provided to patients with a physical health diagnosis. Medicaid’s Health and Behavior Assessment and Intervention Codes (HBAI) 96150-96155 CPT Series are currently available in many states.

Medicare & Medicare rESOURCES

Medicare can be an important financier of integrated behavioral health and primary care services, especially in its role in preventative, older adult, and chronic care. CIHS aims to provide the latest information and resources related to publicly financed integrated care, including those provided by Medicare.

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Email: integration@thenationalcouncil.org

Phone: 202-684-7457