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| 1/1/2021 @ 4:52:00 PM
Post 1 of 9
Contributor: brad.ashby@southmainky.com
Does anyone have experience adding behavioral health to the mix of an already operating RHC? We have added opioid addiction to our practice and have outsourced behavioral health. It would work so much better having this service in-house. I just don't know where to start to add this service. We are located in Kentucky so if anyone in Kentucky has experience it would be best, but I never shy away from any advice.
Thanks!
Brad 1/4/2021 @ 11:50:00 AM
Post 2 of 9
Contributor: Charles James, North American Healthcare Management Services
The best place to start with "in-house" behavioral health is with an LCSW providing counseling services. Kentucky Medicaid has an expanded provider list which includes addiction counselors. (Most Medicaid agencies do). Medicare covers LCSWs - not this expanded state list. It is certainly possible to start with one of the therapists listed below, but they would only be bill claims for non-Medicare patients.
The trick with addiction therapy in our RHC is we have to ensure that 51% of our total provider hours are primary care. We cannot be "primarily mental health centers". It is imperative that we treat the whole patient - not just their addiction. Document that all patients conditions have been treated - not just their behavioral health issues. Then get them engaged with the behavioral health providers. This is also a wonderful opportunity to provide care management services. Look at Option B for G0511 and Psychiatric Coordinate of Care G0512. Kentucky Approved RHC Providers Physician Licensed Clinical Social Worker Osteopathic Physician Psychologist Podiatrist Marriage And Family Therapist Optometrist Licensed Professional Clinical Counselor Advanced Practice Registered Nurse Licensed Psychological Practitioner Licensed Dentist/ Oral Surgeon Certified Psychologist With Autonomous Functioning Physician Assistant Charles A. James, Jr. President and CEO 888.968.0076 Office 314.560.0098 Cell www.northamericanhms.com [cid:image001.jpg@01D6E287.124BFB00] This transmission contains privileged, confidential, and proprietary information and is only for the use of the individuals listed above, and may not be copied, distributed, or disseminated without express written consent. If you receive this transmission in error, please immediately destroy it. 1/4/2021 @ 1:08:00 PM
Post 3 of 9
Contributor: corsonr@mvhealth.org
In our research, we have learned that LCSW have a Master's degree in social work, and in the State of Washington, also have 4000 hours or two years of supervised training under a LSW. Is it the case that only LSW can bill for provider mental health services? We were thinking of adding a social worker that may not have the 4000 hours of supervised training in order to serve as our behavioral health manager and bill out for CoCM services. Can we bill out for CoCM services with this licensure?
Becky Corson, MBA Mid-Valley Clinic Omak, WA 98841 509-861-2461 corsonr@mvhealth.org 1/4/2021 @ 2:24:00 PM
Post 4 of 9
Contributor: Charles James, North American Healthcare Management Services
For Medicare, LCSW and Clinical Psychologist (PhD) may bill behavioral health services in the RHC. Relative to the LSW who does not meet the state requirement billing for care management services, here is what the Care Management FAQ
For the CCM codes describing time spent per calendar month by "clinical staff," who qualifies as "clinical staff"? If the billing physician (or other billing practitioner) furnishes services directly, can their time count towards the clinical staff time required to bill ? Practitioners should consult the CPT definition of the term "clinical staff." In addition, time spent by clinical staff may only be counted if Medicare's applicable "incident to" rules are met such as supervision, applicable State law, licensure and scope of practice. Of course, other staff may help facilitate CCM services, but only time spent by clinical staff can be counted. If the billing practitioner performs CCM services themselves, the time of the billing practitioner may be counted as clinical staff time or, alternatively, applied towards reporting professional CCM (CPT code 99491). For the CCM codes describing time spent per calendar month by "clinical staff," do the times listed for the work of the billing practitioner mean that the billing practitioner must spend that amount of time each month, in addition to the clinical staff time in the code descriptors, in order to billCCM? No, for these codes, these times should be considered like the typical times for evaluation and management (E/M) office visits. They are assumed times, established through physician survey by the American Medical Association when the codes were created and valued, for how much time the billing practitioner spends himself or herself each month, but are not exact times. The billing practitioner's time could be spent in activities such as directing clinical staff; personally performing clinical staff activities; or in the case of complex CCM, performing moderate to high complexity medical decision making. In my view, under this definiton, the LSW who has not met state requirements could certainly bill incident to the billing provider. The LSW who has NOT met state requirements could not BE the billing provider. From the Care Management Services MLN Booklet Practitioner Eligibility: Physicians and the following non-physician practitioners may bill CCM services: Certified Nurse Midwives Clinical Nurse Specialists Nurse Practitioners Physician Assistants CAJ Note: RHCs bill G0511 or G0512. The following refer to the Fee-for-Service Care Management codes, but the descriptions apply: NOTE: CCM may be billed most frequently by primary care practitioners, although in certain circumstances specialty practitioners may provide and bill for CCM. The CCM service is not within the scope of practice of limited-license physicians and practitioners such as clinical psychologists, podiatrists, or dentists, although practitioners may refer or consult with such physicians and practitioners to coordinate and manage care. CPT code 99491 includes only time that is spent personally by the billing practitioner. Clinical staff time is not counted towards the required time threshold for reporting this code. CPT codes 99487, 99489, and 99490 - Time spent directly by the billing practitioner or clinical staff counts toward the threshold clinical staff time required to be spent during a given month. CCM services that are not provided personally by the billing practitioner are provided by clinical staff under the direction of the billing practitioner on an "incident to" basis (as an integral part of services provided by the billing practitioner), subject to applicable state law, licensure, and scope of practice. The clinical staff are either employees or working under contract to the billing practitioner whom Medicare directly pays for CCM. Charles A. James, Jr. President and CEO North American Healthcare Management Services 9245 Watson Industrial Park * St. Louis, Missouri 63126 888.968.0076 Office 314.560.0098 Cell www.northamericanhms.com 'Proper preparation prevents poor performance." Lt. Col. Tom Warner - paraphrased (USAF- Deceased) See our Stopwatch challenge! http://www.aprima.com/aprima-stopwatch-challenge [cid:image003.jpg@01D6E29C.9B71F280] This transmission contains privileged, confidential, and proprietary information and is only for the use of the individuals listed above, and may not be copied, distributed, or disseminated without express written consent. If you receive this transmission in error, please immediately destroy it. 1/4/2021 @ 2:30:00 PM
Post 5 of 9
Contributor: Beth O'Connor, Virginia Rural Health Association
Does any of that information change if the services are being provided via telehealth? (depending on the regulations of the specific state)
Beth O'Connor, M. Ed. Executive Director Virginia Rural Health Association 540-231-7923 1/4/2021 @ 4:01:00 PM
Post 6 of 9
Contributor: Charles James, North American Healthcare Management Services
Yes and no. Yes, the Public Health Emergency waivers allows ANY personnel appriopriately licensed in the state to provide telehealth services. In this instance, however, the LSW was NOT appropriately licensed in the state. So no, she could not provide telehealth services and bill G2025.
Charles A. James, Jr. President and CEO North American Healthcare Management Services 9245 Watson Industrial Park * St. Louis, Missouri 63126 888.968.0076 Office 314.560.0098 Cell www.northamericanhms.com 'Proper preparation prevents poor performance." Lt. Col. Tom Warner - paraphrased (USAF- Deceased) See our Stopwatch challenge! http://www.aprima.com/aprima-stopwatch-challenge [cid:image001.jpg@01D6E2AA.565E32E0] This transmission contains privileged, confidential, and proprietary information and is only for the use of the individuals listed above, and may not be copied, distributed, or disseminated without express written consent. If you receive this transmission in error, please immediately destroy it. 1/12/2021 @ 5:43:00 PM
Post 7 of 9
Contributor: Kim Keating, Nursery Street Family Care Clinic
We are a provider based RHC in Missouri. Our state has a Primary Care Healthcare Home Initiative that we were eligible for. It provides a PM/PM for each patient that is enrolled on the panel. The PM/PM offset some to the cost of bringing on required staff, inclusive of a BHC. Our first BHC was a part-time MSW and only served our PCHH patients, concentrating on high utilizers. The next BHC was an LCSW. Since the LCSW is a billable provider in a Missouri RHC, we were able to justify full time. The LCSW's FTE is split 20/80 between the PCHH Initiative and the RHC Cost Report. Increased PCHH panel size would warrant an increase in the PCHH portion of her FTE. I'd recommend checking into any Healthcare Home initiatives your state may offer.
Kimberly L. Keating, PCMH CCE Patient Centered Healthcare Home Director | Family Care Clinics Bates County Memorial Hospital 615 West Nursery St | PO Box 370 | Butler, MO 64730 kkeating@bcmhospital.com www.bcmhospital.com Office: 660-200-7000 ext 7020 Fax: 660-200-2304 [cid:1f07d6e8-d8f7-46fb-939e-e8d82bd3bde7] HIPAA Confidentiality Notice This e-mail communication and any attachments may contain confidential and privileged information for the use of the designated recipient names above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its contents is prohibited. If you have received this communication in error, please notify Bates County Memorial Hospital immediately by telephone at 660 -200 -7117 and destroy all copies of this communication and any attachments. 1/13/2021 @ 10:55:00 AM
Post 8 of 9
Contributor: Charles James, North American Healthcare Management Services
Kim - Thank you for this insight. Please - absolutely - as Kim says - check out these programs at the state level. These are excellent opportunities to start thinking about care management services as well. Many of us are struggling with how to make sure our patients needs are addressed. Much of this is now happening with phone contact instead of a face-to-face visit. There is a significang behavioral health component to G0511. I would LOVE to see some folks utilizing G0512, which is Psychiatric Coordination of Care. I believe these are both significantly underutilized relative to Behavioral Health.
Put it this way: It's a way to get paid for all of those phone calls. Thanks, Kim!! Charles A. James, Jr. President and CEO North American Healthcare Management Services 9245 Watson Industrial Park * St. Louis, Missouri 63126 888.968.0076 Office 314.560.0098 Cell www.northamericanhms.com 'Proper preparation prevents poor performance." Lt. Col. Tom Warner - paraphrased (USAF- Deceased) See our Stopwatch challenge! http://www.aprima.com/aprima-stopwatch-challenge [cid:image001.jpg@01D6E992.1D7963C0] This transmission contains privileged, confidential, and proprietary information and is only for the use of the individuals listed above, and may not be copied, distributed, or disseminated without express written consent. If you receive this transmission in error, please immediately destroy it. 3/2/2021 @ 4:52:00 PM
Post 9 of 9
Contributor: Lois Edwards, Care Now at New Start LLC
Where can I find which services are considered as a qualifying encounter by an LCSW? Such as 90832, 90791, etc. Are any group therapy services considered as a qualified encounter? The State Medicaid has several services on their Behavioral Health Fee schedule, but where do I find the services for an RHC? Thank you |
