[PC-BH-Integration] networking-billing codes used

Carolyn Tjoland, LPCC ctjoland at whssf.org
Wed Feb 7 11:59:45 EST 2007


Lori and others,
 
I'm so delighted to see you ask this question and to see others' responses
to date - hopefully we can all learn from each others' experiences. New
Mexico does NOT recognize the 96150-156 codes, and NM has carved out BH
funding which is administered by ValuOptions. We are a nonprofit primary
care clinic (not funded as an FQHC but approx half our pts are uninsured or
underinsured) and have been offering integrated care for 2 1/2 yrs now with
great enthusiasm and acceptance by our patients and providers, but with
great difficulty financially. Our pt load is approx 6,000 pts per year; I am
the only BH provider. We had small grants the first 2 yrs which helped
offset 1/3 or less of the cost. An additional strategy has been to do "warm
handoffs" as much of possible, meaning that I as the BH Consultant am
summoned by the PCP and introduced to the pt in the exam room and offer
immediate services - these "extended visits" are then billed out under the
PCP's name with an internal mechanism to credit a portion of the
reimbursement for the visit to the BH program. My visits w/ pts are limited
to 30-minute sessions on a short term basis, and are more educational and
action/now oriented than longer term insight-oriented therapy. If pts need
more intensive longer term care, I see them temporarily while they are on
waiting lists to be seen at our CMHC or other programs that receive funding
to provide these type of services.  
 
Because it has been our priority to offer integrated care, we have had a
policy of only offering BH services to those who are already our pts or wish
to receive their primary care services here. Because of that, we have not
been accepted by BH payors on their panels because we might need to turn
away a pt who only wanted BH services. Additionally, many of the
requirements of BH payors, including Medicaid in NM, are contradictory to
integrated care; such as, separate BH treatments plans, administration of
the lengthy and time consuming ASI (Alcohol Severity Index) even when no
alcohol/drug use is indicated, etc. Even so, we are considering opening up
the BH services to anyone and jumping these administrative hoops, knowing
that it will most likely diminish what we have been able to offer as
"integrated care" just so the BH program can stay alive financially. We have
been advocating and trying to negotiate a special demonstration grant with
ValuOptions so that we could demonstrate to them and other potential payors
the cost effectiveness of integrated care w/ lessened administrative
hurdles, but its been an 18-month process to date and not "granted" yet!
 
I'll hope everyone will continue to share their dilemnas and strategies to
deal with this critical funding issue.
 
Thank you,
Carolyn Tjoland, LPCC
Women's Health Services
901 W Alameda, Suite 25
Santa Fe, NM  87501
(505) 955-9436 Direct Line
(505) 955-9437 Direct Fax
ctjoland at whssf.org
www.whssf.org



  _____  

From: pc-bh-integration-bounces at lists101.his.com
[mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of Lori Partee
Sent: Thursday, February 01, 2007 8:06 AM
To: pc-bh-integration at lists101.his.com
Subject: [PC-BH-Integration] networking


Greetings,
I am hoping to network with other Health Integration Specialists, providing
behavioral health services in a medical care setting.  I have been in this
setting for the past 4 years.  We started with 4 positions and once the MH
incentives stopped, and the Medical agency was required to pay for the
service, it was reduced to 1 position.  We  have been billing for the past 2
years the 96150-96151 codes.  We are looking for ways to improve the program
by checking with others who are doing similar work.  Some questions are: How
is your agency billing if at all?  Are they getting reimbursed for services?
Does anyone use the disease model for services?  Productivity measures--Do
you have specific expectations?  What were they when you started vs. now?
I believe in the value of the service provided and would like to strengthen
this program.  Please respond if you would like to share information about
your job and program.
Thanks,
Lori Partee, LMSW
Behavioral Health Clinician
InterCare Community Health Network
Benton Harbor, MI
269*927-2608 Ext 108
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