Financing Strategies for Behavioral Health Integration and Collaborative Care Management
As you plan for behavioral health integration, consider all of the benefits of providing effective, evidence-based behavioral health care. Please review the AIMS Center's guide to Broadly Defining Value for Your Model of Integrated Care. There are many critical factors that play a role in helping a practice develop a comprehensive sustainment plan. Finances are just one aspect to consider.
Along with increased focus on access to behavioral health services, the options for financing an integrated behavioral health program have expanded in recent years. Below we describe options for reimbursing integrated services in your practice and offer additional tools to help practices understand these options and estimate revenues.
If your practice uses independently licensed mental health professionals, you have the option to bill a variety of CPT codes for behavioral health integration (BHI) activities. All activities may not be reimbursable, and reimbursement may vary by payer and provider license. You can find more information about billing codes in the Basic Coding for Integrated Behavioral Health resource.
Bundled Payments for General Behavioral Health Integration (BHI) and Psychiatric Collaborative Care Model Services (CoCM)
In 2017, CMS introduced codes for billing General BHI and CoCM. The codes are billed for services provided in a calendar month, and through the treating medical provider. They allow more flexibility in staffing a behavioral health integration program and also reimburse for a wider range of activities. These codes may be used to bill patients with any behavioral health condition being treated by the billing practitioner, including substance use disorders. To learn more about the codes for behavioral health integration services, download the AIMS Center Summary Sheet on Bundled Payments for Behavioral Health Integration Services.
Since 2018, designated FQHC/RHC practices may also bill Medicare for behavioral health integration and collaborative care services. To learn more about the FQHC/RHC G-codes, download the AIMS Center Summary Sheet on Payments for Behavioral Health Integration Services for FQHCs & RHCs.
Since their introduction by CMS for Medicare beneficiaries, a steadily increasing number of private payers and state Medicaid programs also recognize and reimburse for these codes, which are described in detail in current CPT and HCPCS manuals.
Collaborative Care Billing Case Study
The following scenario illustrates how a practice might consider billing psychotherapy and/or collaborative care codes during a full episode of care for a patient. The scenario shows how to count time and what options for billing are available each month depending on staffing, practice setting, and what elements of patient care happened each month. You can find the Collaborative Care Billing Case Study here.
Link to APA Financing Resources
Financial Modeling Workbook
In collaboration with the Institute for Family Health and the American Psychiatric Association, the AIMS Center has recently updated the Financial Modeling Workbook. The updated workbook allows practices to create scenarios according to their clinic type, staffing model, work activities, billing preferences and visit volume in order to more accurately estimate revenue and expenses for providing integrated behavioral health care.
To download one or more of the available versions please see our Financial Modeling Workbooks page.