Play 12

Billing and Reimbursement

OVERVIEW

Reimbursement is critical to sustainability. As such, exploring billing and reimbursement opportunities for S·BI·RT components is crucial to long-term implementation and sustainability. Billing and coding should be considered throughout the process of determining flow and EHR documentation (See Play 9 and Play 10). Further, sites with integrated Behavioral Health will find that reimbursement may allow them the option to integrate on-site Brief Treatment from those providers.


Purpose of Play 12 To develop billing and reimbursement for S·BI·RT (components parts) in
support of long-term sustainability.
Definitions Reimbursement from private insurers and NH Medicaid is available for S·BI·RT in NH. Optimized billing will differ from site to site with negotiated contracts, federally qualified health center (FQHC) status, and other reimbursement factors.
Team members Include financial, billing and coding staff.
Measure(s) Reimbursement for S·BI·RT components in the first six months of implementation contributing to the sustainability of the process.

 


Recommended Approach

  • Review current knowledge and included materials about billing and reimbursement for S•BI•RT components and related activities (behavioral health counseling).
  • Review the coding guidance (Appendix S) and seek consultation as necessary.
  • Determine what codes, for which service, provided by whom, for what time period is reimbursed by which insurer.
  • Finalize site-specific billing plan.

Keep In Mind

  • The NH landscape for billing and reimbursement for substance misuse has changed over the last year and continues to move in a positive direction.
  • The NH State budget signed in September 2015 by Governor Hassan includes substance use disorder services, including S·BI·RT, for all Medicaid beneficiaries in NH through private insurance plans.
  • Medicaid Early Periodic Screening Diagnosis and Treatment (EPSDT) for beneficiaries applies to substance use disorder diagnosis and treatment from a positive evidence-based screen (See Appendix T).
  • Advocates across the state have worked for years to increase access to substance use disorders through increasing access to reimbursement.
  • ANY ON-GOING DIFFICULTIES WITH BILLING AND REIMBURSEMENT SHOULD BE SHARED WITH THE CENTER, NEW FUTURES, AND/OR NH DHHS BUREAU OF DRUG AND ALCOHOL SERVICES so that systemic problems can be identified and ameliorated as soon as possible.

Corresponding Appendix Section(s)

Appendix S – NH S•BI•RT Billing & Coding
Appendix T – New Futures Medicaid EPSDT Overview