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

Fri Feb 9 16:26:49 EST 2007

Hi Wendy,
It is great to hear about your program.  Wow, what a large clinic.  I also have been assisting with those chronic conditions or newly diagnosed conditions to help with the PCP load. There are 7 PCP's here, but the referrals are inconsistent and low, although they really believe in the program and appreciate the service/support.  My average is 3-4 most days with a few high days of 7-9.   What would you estimate is the average daily face to face contacts for you/other BHC?  Our clients are mostly poor, inner city, that are very crisis oriented.  Med compliance is an ongoing issue.  I also schedule for follow-up visits, in these cases in particular.  Despite the high needs of this community it has been difficult keeping the numbers up of direct service.

Thanks,
Lori Partee
Behavioral Health Clinician
269*927-2608 Ext 108

________________________________

From: pc-bh-integration-bounces at lists101.his.com on behalf of Bradley, Wendy D
Sent: Fri 2/9/2007 12:40 PM
To: pc-bh-integration at lists101.his.com
Subject: Re: [PC-BH-Integration] networking-billing codes used

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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