Billing & Financing
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Behavioral Health Integration and Collaborative Care
As you plan for behavioral health integration, consider all of the benefits of providing effective, evidence-based behavioral health care. Please review the AIMS Center's guide to Broadly Defining Value for Your Model of Integrated Care. There are many critical factors that play a role in helping a practice develop a comprehensive sustainment plan. Finances are just one aspect to consider.
Along with increased focus on access to behavioral health services, the options for financing an integrated behavioral health program have expanded in recent years. Below we describe options for reimbursing integrated services in your practice and offer additional tools to help practices understand these options and estimate revenues.
➔ Psychotherapy Fee-For-Service
If your practice uses independently licensed mental health professionals, you have the option to bill a variety of CPT codes for behavioral health integration (BHI) activities. All activities may not be reimbursable, and reimbursement may vary by payer and provider license.
➔ Bundled Payments for BHI and CoCM
In 2017, CMS introduced codes for billing General Behavioral Health Integration (BHI) and Psychiatric Collaborative Care Model Services (CoCM). The codes are billed for services provided in a calendar month, and through the treating medical provider. They allow more flexibility in staffing a behavioral health integration program and also reimburse for a wider range of activities. These codes may be used to bill patients with any behavioral health condition being treated by the billing practitioner, including substance use disorders. Since 2018, designated FQHC/RHC practices may also bill Medicare for behavioral health integration and collaborative care services. In 2020, CMS introduced new codes for billing SUD services in an integrated, office-based medical setting, that are modeled after CoCM and other Care Management services. We are happy to provide the Quick Guides below for an introduction to all these services. Each Quick Guide contains links to source materials for more details.
Since their introduction by CMS for Medicare beneficiaries, a steadily increasing number of private payers and state Medicaid programs also recognize and reimburse for these codes, which are described in detail in current CPT and HCPCS manuals.
Tools
*New Financial Updates for 2022:
- Quick Guide on Bundled Payments for Behavioral Health Integration Service
- Quick Guide on Payments for Behavioral Health Integration Services for FQHCs & RHCs
- Quick Guide on Medicare Payments for Office-Based Substance Use Disorder Services
Please note that patient consent is required for billing BH Integration codes and office-based SUD codes. This guide may help you navigate this requirement:
Further Reading
- Medicaid and Collaborative Care for Substance Use Disorder
Shatterproof & The Path Forward, 2020
➔ Collaborative Care Billing Case Studies
The first resource below illustrates how a practice might consider billing psychotherapy and/or collaborative care codes during a full episode of care for a patient. The scenario shows how to count time and what options for billing are available each month depending on staffing, practice setting, and what elements of patient care happened each month. The next link is a published case study outlining a large healthcare system's successful efforts to change their billing workflows under CoCM. You can find the Collaborative Care Billing Case Study here.
Tools
Further Reading
- Billing Newly Available CoCM CPT Codes in an Academic Primary Care System
Psychiatric Services, 2020
➔ Frequently Asked Questions for Billing Collaborative Care
Since hosting monthly finance office hours, the AIMS Center has compiled the most commonly asked questions and their answers. Questions address a variety of billing and financing topics including, reimbursement, the CoCM team, general BHI code, patient cost, registry options, telehealth, time tracking and more.
Tools
➔ APA Financing Resources
The American Psychiatric Association provides several resources, including toolkits and webinars, to help clinics navigate reimbursement and funding opportunities for Collaborative Care.
➔ Financial Modeling Workbook
In collaboration with the Institute for Family Health and the American Psychiatric Association, the AIMS Center has recently updated the Financial Modeling Workbook. The updated workbook allows practices to create scenarios according to their clinic type, staffing model, work activities, billing preferences and visit volume in order to more accurately estimate revenue and expenses for providing integrated behavioral health care.
Tools
- To download one or more of the available versions please see our Financial Modeling Workbooks page.