[PC-BH-Integration] Behavioral Healthcare Clinician Consultationtime

[Bill Rosenfeld]

Great question.

 

We have attached the IBH warm hand-off to the initial co-pay that a
patient paid to see the doc.  We essentially write the visit off for all
patients, but our Medicaid patients are billed for the service if there
is a medical diagnostic and an intervention is done.  96152 is the code
most frequently used.  96150 is used when the clinician has deployed a
psychometric tool.  In Arizona, the State Medicaid plans pay for this
service and it is considered in our "PPS" or "HRSA wrap" fee arrangement
and is paid out at the same rate as a physician visit....  We have all
diabetics, CVD, Asthmatics, and obesity patients referred to our
Behaviorists on the same day as the visit.  Because we are in a carved
out system with a RBHA, we can only bill the medical diagnostics.  We
can have a secondary DSM-IV diagnostic, but it is not necessary.  We
inform the self-pay patient that the return visit will be billed unless
on the same day as the doc visit (which would be included in the co-pay
for the physician.  Visiting with the BH provider only is a $25.00 fee
for most of our patients who are below federal poverty level and
uninsured.  

 

Our program sustains itself and has proven viability under this system.
The difficulty is having all around you understand the quarterly
payments on our PPS system and to make sure that the "powers that be"
understand how the program impacts the bottom line.  I would be happy to
provide more information if it could be of help.  I do know that Arizona
Medicaid has had a favorable view on the reimbursement end that other
states might not be getting the benefit from...

 

-Bill

________________________________

From: pc-bh-integration-bounces at lists101.his.com
[mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of Susan
Markley
Sent: Monday, May 14, 2007 2:09 PM
To: pc-bh-integration at lists101.his.com; pc-bh-integration at nccbh.net
Subject: [PC-BH-Integration] Behavioral Healthcare Clinician
Consultationtime

 

Hello,

 

We are having some issues around financial viability for the integration
model.  One issue is that our Behavioral healthcare Clinician sees
clients that are referred by the Primary Care physician or APN as soon
as the referral is made while the patient is in the office.  This is a
brief consultation usually lasting about 15-20 minutes.  At that point,
the clinician decides on a recommendation for intake/ assessment.  This
initial consult has not been viewed as a billable service as it is a
brief contact that some prospective clients might not be willing to pay
for (for those who are self pay).     Does anyone else do something
different and if so, how do you negotiate the billing issue?  Are others
billing a third party for this consultation?

 

Thank you for your time,

 

Susan Markley







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