Financing Strategies for Collaborative Care

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There are innovative ways to finance a collaborative care program in your organization. Below are opportunities and examples of financing a collaborative care program.

2017 CMS G Codes for Medicare Beneficiaries

The Centers for Medicare & Medicaid Services announced final rules for Medicare payments for services provided by primary care providers for patients participating in a collaborative care program or receiving other integrated behavioral health services. 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.

At this time, FQHC- and RHC-designated practices may not bill these codes. However, CMS has proposed billing codes for FQHCs and RHCs to be implemented in January 2018. To learn more about the proposed codes, download the AIMS Center's 2017 Proposed CMS Behavioral Health Integration Payment Cheat Sheet. Final rules will be published in Fall 2017.

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.

Psychotherapy Fee-For-Service

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.