Behavioral Health Integration and Collaborative Care
As you plan for behavioral health integration, consider all the benefits of providing effective, evidence-based behavioral health 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 are two presentations that can help with billing.
This AIMS Center Webinar Series video highlights the experiences of three large health systems who implemented the Collaborative Care Model (CoCM) billing codes. The practices describe in detail why they chose that strategy and how they operationalize it.
Anna Ratzliff, MD, PhD Co-Director of the AIMS Center, and others, give a general overview of CoCM financing. They describe how the codes work, options for financing, important aspects of operationalizing the model, and other strategies to consider when implementing a CoCM program in your clinical site.
Psychotherapy Fee-for-Service
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.
Bundled Payments for BHI and COCM
In 2017, CMS introduced codes for billing General Behavioral Health Integration (BHI) and Collaborative Care Model Services (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 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. Since 2018, designated FQHC/RHC practices may also bill Medicare for behavioral health integration and collaborative care services. In 2020, CMS introduced new codes for billing substance use services in an integrated, office-based medical setting, which are modeled after CoCM and other Care Management services. We are happy to provide the Quick Guides below for an introduction to all these services. Each Quick Guide contains links to source materials for more details.
Tools
New Financial Updates for 2023:
- Quick Guide on Bundled Payments for Behavioral Health Integration Service
- Quick Guide on Payments for Behavioral Health Integration Services for FQHCs & RHCs
- Quick Guide on Medicare Payments for Office-Based Substance Use Disorder Services
Please note that patient consent is required for billing BH Integration codes and office-based substance use codes. This guide may help you navigate this requirement:
Further Reading
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 Studies
The first resource below 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. The next link is a published case study outlining a large healthcare system’s successful efforts to change their billing workflows under CoCM. You can find the Collaborative Care Billing Case Study here.
Frequently Asked Questions for Billing Collaborative Care
Since hosting monthly finance office hours, the AIMS Center has compiled the most commonly asked questions and their answers. Questions address a variety of billing and financing topics including, reimbursement, the CoCM team, general BHI code, patient cost, registry options, telehealth, time tracking and more.
Tools
APA Financing Resources
The American Psychiatric Association provides several resources, including toolkits and webinars, to help clinics navigate reimbursement and funding opportunities for Collaborative Care.
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 to estimate revenue and expenses more accurately for providing integrated behavioral health care.