[PC-BH-Integration] networking

Wed Feb 7 10:29:07 EST 2007

The Vermont RWJ DPC site tested the feasibility of using these codes - we had our "Care Partners" record activities that met the criteria, and subsequently allowed free standing and hospital-affiliated primary care practices to bill for them. Part of the reluctance practices had in using these codes was the perceived lack of clear instructions from Medicare on how to use them, and  the fact that the commercial insurers weren't reimbursing for them, either. In some cases, it wasn't worth the administrative hassle to  provide the service when Medicaid was the primary payer, especially when the practices payer mix was more heavily Medicare or commercial I  agree with Sandy that the FQHC  "encounter rate" eimbursement structure allows for more flexibility; also, if social work or psychology services are considered a "core" FQHC service, a separate encounter might be billable - but could vary by state. 

We also explored the mirror image of this scenario, and were funded tby RWJ through the Center for Health Care Strategies to place RN's in community mental health centers to do wellness assessments, preventive medicaine services and patient education for  SPMI consumers with significant physical health conditions such as diabetes, COPD, or CVD. As a result of that demonstration, Medicaid also pays for selected E&M and preventive medicine services when the provider  of record is a CMHC (usually the psychiatrist, with the RN working under the doc's supervision)  and the consumer carries a physical health diagnosis.  
________________________________

From: pc-bh-integration-bounces at lists101.his.com on behalf of Blount, Alexander
Sent: Tue 2/6/2007 8:38 AM
To: 'pc-bh-integration at lists101.his.com'
Subject: Re: [PC-BH-Integration] networking

Most Medicaid programs do not reimburse, though they are mandated to do so, at least in the Federally Qualified Health Centers of the state.  The mandate is from Health Resources and Services Administration under NIH.  This is an opportunity for advocacy, expecially because it is easy to make the case that the work that can be done under the codes is most needed by that population and most likely to save money in lower medical and emergency costs down the road.  For a copy of the mandate, go to www.IntegratedPrimaryCare.com and look for the paragraph on H&B codes.

Alexander Blount, EdD 
Professor of Clinical Family Medicine 
University of Massachusetts Medical School 
Chair 
Collaborative Family Healthcare Association 
55 Lake Avenue, North 
Worcester, Massachusetts 01655 
O. 508 856-2147   F. 508 856-1212 
blounta at ummhc.org 
http://www.umassmed.edu/fmch/faculty/Blount.cfm?start=0& 

	-----Original Message-----
	From: pc-bh-integration-bounces at lists101.his.com [mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of Wen, Frances K. (HSC)
	Sent: Monday, February 05, 2007 1:46 PM
	To: pc-bh-integration at lists101.his.com
	Subject: Re: [PC-BH-Integration] networking

	My billing dept has told me that our state's Medicaid authority won't reimburse for those codes, but Medicare will.

	Thanks,

	Fran

	Frances Wen, Ph.D.

	Assistant Professor

	Associate Director of Research

	Health Service Psychologist

	Department of Family Medicine

	The University of Oklahoma College of Medicine, Tulsa

	1111 S. St. Louis Ave.

	Tulsa, OK 74120

	(918) 619-4712

	CONFIDENTIALITY NOTICE:    This email, including any attachments, contains information from The University of Oklahoma College of Medicine-Tulsa, Department of Family Medicine, which may be confidential or privileged. The information is intended to be for the use of the individual or entity named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution or use of the contents of this information is prohibited. If you have received this email in error, please notify the sender immediately by "reply to sender only" message and destroy all electronic and hard copies of the communication, including attachments.

________________________________

	From: pc-bh-integration-bounces at lists101.his.com [mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of McGlathery, Michael
	Sent: Friday, February 02, 2007 4:14 PM
	To: pc-bh-integration at lists101.his.com
	Subject: Re: [PC-BH-Integration] networking

	We are struggling with the 96,000 codes. We are having a multi agency meeting the end of this month so please check with me after then. Michael McGlathery, PhD. Solano County, Fairfield, Ca

________________________________

	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 7:06 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

The information transmitted is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, transmission, re-transmission, dissemination or other use of, or taking of any action in reliance upon this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the material from any computer.

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