[PC-BH-Integration] Registris for Behavioral Health

[MARIE Susan]

This is a bit complex-
We provide fully integrated mental health care within a primary care clinic.  We (the physical health Medicaid insurer and our organization) developed an operational definition of "primary care behavioral health" that would be covered. (How we got there requires more than an email).    SO, they pay 99212 or 99213 regardless whether a psych NP or regular primary care provider provides the visit.  We also agreed it was discriminatory to limit it to some diagnoses- so someone with bipolar disorder who is appropriately treated with this level of services is covered as well as someone with anxiety or depression or  medical problem.  The insurer saves money in eliminating some billing screens and not having to work the denials.
The key concepts are:
Services are provided directly in the clinic alongside PCPs in one clinical record as part of the team.
Services are in a "primary care template"- briefer, more patients per day than traditional mental health.  (that's why we didn't include the longer 992xx codes).  All our medication management visits are covered with this. 
Hope this helps- I'm happy to provide more info if you'd like. 
 Susan Marie, Portland, OR

________________________________

From: pc-bh-integration-bounces at lists101.his.com on behalf of Meg Backas
Sent: Tue 3/3/2009 11:49 AM
To: pc-bh-integration at nccbh.net
Subject: [PC-BH-Integration] Registris for Behavioral Health



Are you saying that you can use the 992xx series without a mh diagnosis, or does the diagnosis not require a diagnostic assessment?

 

Meg Backas, LICSW

Director of Social Services 

mbackas at maryscenter.org <mailto:mbackas at maryscenter.org> 

Mary's Center for Maternal and Child Care, Inc.

2333 Ontario Rd, NW

Washington, DC 20009

202-420-7122 (direct)

202-797-2628 (fax)

www.maryscenter.org <http://www.maryscenter.org/> 

 

 

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