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

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

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

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.

CMS’ HBAI Codes Assessment Map to identify states where the codes have been ‘turned on’.
The American Psychological Association’s online tool supports primary and behavioral healthcare providers’ use of HBAI Codes.
Maine Health details how to use 96100 HBAI Codes in primary care settings.

Medicare

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.

Resources

Mental Health Services, a document of the Centers for Medicare and Medicaid Services, details Medicare-reimbursable mental health services and provides guidance to providers for revenue planning by offering a comprehensive overview of outpatient and inpatient mental health services. It is a handy guide on minimum qualifications for service providers, coverage, and payment criteria.

Medicare Billing Guidance – Screening for Depression in Adults

The Affordable Care Act provides added opportunities for Medicare patients to receive preventive services. The American Medical Association “Medicaid Preventive Services” brochure highlights the preventive services and patients covered by Medicare. In Addition, the AMA developed a document on How to Bill Medicare’s Annual Wellness Visit.

The Medicare Learning Network’s Mental Health Services booklet is an educational resource that discusses mental health services in the context of Medicare. The booklet covers Medicare-covered mental health services, mental health services that are not covered, mental health professionals, outpatient psychiatric hospital services, and inpatient psychiatric hospital services.

CMS launched the Comprehensive Primary Care initiative, a demonstration project in 5-7 markets, in which Medicare will work with commercial and state health insurance plans to offer additional support to primary care doctors in order to improve care coordination for patients.