eSolutions: Financing and Billing, June 2012
eSolutions, June 2012: Financing and Billing
eSolutions is a monthly e-newsletter bringing you practical solutions and resources on primary and behavioral healthcare integration from across the United States.
In This Issue:
By Kathleen Reynolds, Senior Consultant for the SAMHSA-HRSA Center for Integrated Health Solutions
Financing is a key to integrating primary and behavioral healthcare services. However, it is not the first issue of consideration. The first is discovering the best clinical model for your program. Only upon making this critical determination should you consider the financing supports you need. This may seem contrary to the common myth that financing imposes formidable barriers that must be considered when selecting a clinical model. The truth is financing is not an insurmountable obstacle to integrated care. There are nearly always means of reimbursement for the clinical model that best meets the needs of your agency, your partner, and your community.
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.
One frequently posed question is whether two services can be billed on the same day (“same day billing”). The federal government — whether through Medicaid or Medicare — does not prohibit this. Medicare covers physical health and behavioral health visits in the same day or by the same provider according to CFR Title 42 Volume 2, Part 405. Section 405.2463.
Instead, Medicaid reimbursement varies from state to state (i.e., where one state may be able to bill for two services in one day, another may not). Currently, 28 state Medicaid programs allow reimbursement for two services by one provider organization. In addition, in a contractual business model between a health center and behavioral health center, both entities can bill for services provided on the same day using their respective provider numbers.
Health and Behavioral Assessment/Intervention (HBAI) Codes are also important codes that allow behavioral health specialists to bill on the same day a person sees a physician for services secondary to a primary care diagnosis such as diabetes, chronic obstructive pulmonary disease, or chronic pain. There are Current Procedural Terminology (CPT) codes approved by Medicare; some states use these for Medicaid, as well. Some other states need to “turn on the codes” for use. See if your state has “turned on the codes.”
Billing may seem complicated, but when you learn the ropes, you can bill accurately and eliminate missed opportunities. A reimbursable bill must have three things for payment: the correct CPT code, the correct diagnostic code, and the service must be provided by the appropriately credentialed staff person. To provide integrated health providers with billing solutions, the SAMHSA-HRSA Center for Integrated Health Solutions developed customized Billing and Financial Worksheets for each state to help identify existing billing opportunities for services provided in integrated healthcare settings. In states where the identified codes are not currently reimbursable, these worksheets identify areas where you can engage your state agencies on reimbursement for integrated services that are meeting the community’s needs.
In addition to downloading your state’s billing worksheet, you can also listen to a recent billing and financing webinar and accessing additional financing information on the CIHS website. Also, contact CIHS directly for technical assistance.
Care Plus NJ: In It to Win It
As community health centers and behavioral health centers across the nation integrate services, they must develop a financing infrastructure to bill for those services. With support from the SAMHSA Primary and Behavioral Health Care Integration program, Care Plus NJ is working toward a sustainable infrastructure to financially sustaining its integration efforts — for the long haul.
The community behavioral health center is persevering to expand behavioral health services to include integrated primary care services. Care Plus NJ maximizes its billing opportunities by ensuring the following:
- Finance staff is trained to bill accurately for primary care services
- Accurate codes in the billing system
- Proper credentialing for prescribers under Medicaid, Medicare, and insurance panels
- Prescribing clinicians have Medicaid and Medicare numbers (to qualify for meaningful use payments in New Jersey, each prescribing clinician must have a Medicaid number rather than use the agency’s Medicaid number)
- Clinical workflow analysis links to billing and reimbursement
- State agencies are educated on billing issues
- Accurate billing and payments for primary care services
Future business plans prepare for expected developments and health reforms
Recently, Care Plus NJ successfully processed its first Medicare claim. And their efforts continue as they work toward using Health and Behavior Assessment/Intervention (HBAI) codes for depression screening by their primary care providers.
Billing for integrated services can pose some challenges. The below tips will help your billing process run smoother.
1. Make sure your CPT codes, diagnostic codes, and clinician credentialing match. Knowing what can be billed and who can bill for services will greatly improve your ability to bill.
2. Know the name and number of someone working at every payor you bill. Build a relationship with that person.
3. Know your state Medicaid rules and regulations. Stay abreast of any changes.
4. Be open with your integration partner. Trust is essential and it is built upon open lines of communication.
5. Never give up. If a service is not billable now, work toward getting it billable (see #2).
For more financing solutions and tips, visit www.integration.samhsa.gov.
SAMHSA Announces New Grant Opportunity: Project LAUNCH
Up to $45.8 million in Project LAUNCH Grants are available to create a shared vision for the wellness of children that drives the development of federal, state, and local coordinated networks. Applications are due on July 3.
AHRQ Releases New Brief on Patient-Centered Medical Homes
A new brief from the Agency for Healthcare Research and Quality offers programmatic and policy changes that can help agencies — especially smaller ones — better deliver services to all patients, including those with the most complex health needs, through patient-centered medical homes.
CDC Launches Powerful Anti-Smoking Campaign
The Centers for Disease Control and Prevention (CDC) launched an unprecedented 12-week campaign to prevent smoking and encourage smokers to quit. The campaign, called Tips from Former Smokers, uses powerful ads based on the experiences of former smokers suffering from illnesses caused by smoking.
ONC Issues New Guide on Health Information, Privacy and Security, and Meaningful Use
The Office of the National Coordinator’s Office of the Chief Privacy Officer released Guide to Privacy and Security of Health Information, an instructional guide designed to help healthcare practitioners, staff, and other professionals better understand the important role privacy and security play in the use of electronic health records and meaningful use. The guide is a comprehensive and easy-to-understand tool to help providers and professionals integrate privacy and security into their clinical practice.
New Resource Identifies Ways to Reduce Racial and Ethnic Disparities in Integrated Healthcare
Enhancing the Delivery of Health Care: Eliminating Health Disparities through a Culturally & Linguistically Centered Integrated Health Care Approach identifies key components and considerations to reduce racial and ethnic disparities in integrated health care and specialty care settings. It is based on research conducted by Hogg Foundation for Mental Health and proceedings from the national consensus meeting held in 2011, funded by the U.S. Department of Health and Human Services, Office of Minority Health.
CIHS Releases New SBIRT Issue Brief
SBIRT: Opportunities for Implementation and Points to Consider provides an overview of SBIRT’s benefits and core components, opportunities for implementation in healthcare settings that have become available through the Affordable Care Act, and potential obstacles to implementation.
CIHS Release new Paper on Behavioral Health Homes
CIHS’s new paper, Behavioral Health Homes for People with Mental Health & Substance Use Conditions: The Core Clinical Features, prepares behavioral health provider organizations to become health homes by outlining the essential clinical features. In addition, the paper introduces several real-world examples of how behavioral health provider organizations are successfully implementing the clinical features of a health homes around the country.
In Case You Missed Them
Check out all of CIHS webinars and check for upcoming webinars at www.integration.samhsa.gov.
Billing for Integrated Health Services Webinar
On June 12, Kathleen Reynolds, Senior Consultant for CIHS, presented on the financial viability and sustainability of integration efforts through appropriate and accurate billing for services. The webinar also featured the state-based Interim Billing and Financial Worksheets developed by CIHS. The slides and recording from the webinar are now available.
Preparing for Bidirectional Integration: Lessons from the Field
On June 14, CIHS hosted a webinar to highlight the valuable lessons learned from its recently completed Integrated Health Provider Learning Collaborative program. Speakers shared poignant issues related to bidirectional integration, including readiness assessment, anticipated challenges and outcomes, and necessary changes to delivery models, administrative processes, and culture. The slides and recording are now available.
To receive this newsletter and other CIHS e-mail updates, click here to enter your e-mail address and select “News from the SAMHSA-HRSA Center for Integrated Health Solutions” from the options listed.
Our free technical assistance services can help primary and behavioral healthcare providers find integrated health solutions that work. To contact CIHS, visit www.integration.samhsa.gov, e-mail Integration@thenationalcouncil.org, or call 202.684.7457.
SAMHSA–HRSA Center for Integrated Health Solutions
Director: Laura Galbreath; Deputy Director: Larry Fricks; eSolutions Editor: Heather Cobb
The SAMHSA-HRSA Center for Integrated Health Solutions, operated by the National Council for Community Behavioral Healthcare under a cooperative agreement from the U.S. Department of Health and Human Services, is funded jointly by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration. The CIHS promotes the development of integrated primary and behavioral healthcare services to better address the needs of people with mental health and substance use conditions, whether seen in specialty behavioral health or primary care setting.