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

Fri Feb 9 12:40:18 EST 2007

Hi my name is Wendy Bradley, I am the Lead BHC at South Central
Foundation in Alaska. We have a practice of about 32 primary care
provider teams and seven BHCs in our clinic. We are also working on the
billing issue. In the meantime, we have been tracking utilization and
found that we have been able to reduce high utilization of frequent
patients by about 33%. Also, our BHCs work with the doctors and pts on
chronic conditions such as diabetes, obesity, and chronic pain which has
translated in an overall cost savings, inadvertently paying for our
positions. Employing a full time BHC is much cheaper than a full time
doctor. 

Aside from the medical, we see the typical mental health issues that
come into family practice that can really tie up the provider's time.
Our presence has allowed our PCP teams to become much more efficient and
effective in there work. Our interventions are around 20 minutes and
almost always follow the Doctors visit, unless it is a scheduled f/u. We
carry pagers and are always available. Our pts also have open access. I
do not know if this is helpful, but for now this is how we have
justified the program.

Thank you,

Wendy D. Bradley LPC

729-3378

________________________________

From: pc-bh-integration-bounces at lists101.his.com
[mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of Carolyn
Tjoland, LPCC
Sent: Wednesday, February 07, 2007 8:00 AM
To: pc-bh-integration at lists101.his.com
Subject: Re: [PC-BH-Integration] networking-billing codes used

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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