Financing Strategies for Collaborative Care
There are innovative ways to finance a collaborative care program in your organization. Below are opportunities and examples of financing a collaborative care program.
Payment for Medicare Beneficiaries
The Centers for Medicare & Medicaid Services announced final rules in the Physician Fee Schedule 2018 for Medicare payments for patients participating in a collaborative care program or receiving other behavioral health integration services. The interim G-codes for behavioral health integration services will be replaced by CPT® codes effective January 2018. The payment structure may be used to treat patients with any behavioral health condition that is being treated by the billing practitioner, including substance use disorders. To learn more about the 2018 codes for behavioral health integration services, download the AIMS Center Cheat Sheet on Medicare Payments for Behavioral Health Integration Services.
At this time, FQHC- and RHC-designated practices may not bill the CPT® codes. However, CMS has finalized billing G-codes for FQHCs and RHCs to be implemented in January 2018. To learn more about the FQHC/RHC G-codes, download the AIMS Center's CMS Behavioral Health Integration Payment Cheat Sheet for FQHCs & RHCs.
Accountable Care and Value-Based Purchasing Strategies
Many large healthcare purchasers such as the Boeing Company already include clinical outcomes measures for depression in their shared savings and at risk contracts with Accountable Care Organizations (ACO). As a result, ACOs are learning to be outcomes-focused and learning to deliver on quality and value, not quantity of services. The new 2017 HEDIS depression remission and response measures are of particular interest to payers and purchasers as they continue to define and refine behavioral health outcome metrics for value-based purchasing.
If your practice uses clinical social workers and other licensed mental health professionals, you may be able to bill a variety of CPT codes for behavioral health integration (BHI) activities. While increasing numbers of payers are willing to pay case rates, bundled service rates, and value-based payments, most practices may still need to utilize traditional fee-for-service psychotherapy codes to pay for their BHI efforts. You can find more information about BHI billing codes in the Basic Coding for Integrated Behavioral Health resource.
Financial Modeling Workbook
The AIMS Center and the American Psychiatric Association, in collaboration with the Institute for Family Health, have created a Financial Modeling Workbook designed to help practices look at their staffing model, visit volume, and both fee-for-service and case rate payments to be able to more accurately estimate revenue and expenses for providing integrated behavioral health care.