Reducing Adolescent Substance Abuse Initiative (RASAI) Learning Community

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Reducing Adolescent Substance Abuse Initiative (RASAI) Learning Community"

Transcription

1 Howard Zucker, Acting Commissioner Arlene González-Sánchez, M.S., L.M.S.W. Commissioner Ann Marie T. Sullivan, M.D., Commissioner Reducing Adolescent Substance Abuse Initiative (RASAI) Learning Community Andrew M. Cuomo, Governor 1

2 Presenters Mark Tremblay, M.A., M.P.A. NYS Department of Health - Office of Health Insurance Programs Gwen Diamond NYS Office of Mental Health - Reimbursement Policy and Implementation Katherine Cusano, Broome County Deputy Commissioner of Mental Health Christopher Baron Lourdes Hospital - Executive Director Revenue Cycle Rita Guido Computer Sciences Corporation (CSC) - Outreach Supervisor 2

3 Provider Types Eligible to Bill for Office-based SBIRT Services Provider Type Physicians (services may be performed by another provider type under the supervision of the physician) Required OASAS Approved Training/Certification 4 hours, unless certified by the American Society of Addiction Medicine (ASAM), the American Board of Ambulatory Medicine (ABAM), the American Academy of Addiction Psychiatry (AAAP) or the American Academy Osteopathic Association (AOA) Nurse Practitioners 4 hours, unless qualified as a Certified Addictions Registered Nurse (CARN) Nurse Midwives Psychologists 4 hours 4 hours 3 NOTE: Article 31 clinics cannot submit practitioner claims for SBIRT. Only institutional claims can be submitted for SBIRT

4 Providers Eligible to Deliver SBIRT Services Under a Licensed Provider/Facility Physician Assistants Provider Type Required Training/ Certification 4 hours Registered Nurses Licensed Practical Nurses Licensed Master Social Worker (LMSW) or Licensed Clinical Social Worker (LCSW) Licensed Mental Health Counselors Licensed Marriage and Family Therapist Certified School Counselor Certified Rehabilitation Counselor 4 hours, unless qualified as a CARN 4 hours 4 hours 4 hours 4 hours 4 hours 4 hours OASAS-credentialed professionals including CASACs, (CPPs) and Credentialed Problem Gambling Counselors Health Educators and unlicensed individuals (may only provide SBIRT services under the supervision of a licensed health care professional, following consistent protocols) 4 hours 12 hours 4 NOTE: Article 31 clinics cannot submit practitioner claims for SBIRT. Only institutional claims can be submitted for SBIRT

5 SBIRT Billing Guidelines Practitioner Offices, Hospitals and Clinics 5

6 Insurance Codes and Types of Insurance The type of insurance the patient has, and the length of time spent in service delivery determines the codes used. This will also determine any fee billed to the insurance company.

7 SBIRT Billing Codes Payer Code Description Medicaid H0049 Alcohol and/or drug screening Medicaid H0050 Alcohol and/or drug service, brief intervention, per 15 min 7

8 Medicaid FFS Billing CPT H0049 (alcohol and/or drug screening) is used for substance use screening. Diagnosis code ICD-9 code V82.9 (unspecified condition) is REQUIRED on claims with this procedure code. CPT H0050 (alcohol and/or drug service, brief intervention) is used for substance abuse brief intervention services. Diagnosis code ICD-9 V65.42 (counseling and substance abuse) is REQUIRED on claims with this procedure code. When Medicaid is secondary Providers must code the correct HCPCS codes when submitting claims to Medicaid. If Medicare or third-party payors require a different code, it must be replaced with H0049 or H0050 before submitting to Medicaid. 8

9 Medicaid FFS Billing cont. Frequency Limits Medicaid will cover two screenings (H0049) and six brief interventions (H0050) per year NCCI Edits Some procedure code combinations will consolidate due to the Federal National Correct Coding Initiative. Article 31 clinics are exempt from NCCI edits For more information see: Coding-Initiative.html 9

10 Billing SBIRT in an Article 31 Clinic Providers will bill use the 837i claim form (do not submit a separate practitioner claim) SBIRT claims will use the appropriate OMH clinic rate code (e.g., 1504, 1516) and appropriate HCPCS code: H0049 and/or H0050. Both codes have an APG weight of.2803 SBIRT rates for OMH licensed clinics: Rate with QI Rate without QI Hospital Rate (Art.31 Clinic) Upstate Article 31 & DTCs Downstate Article 31 & DTCs County Article 31 Upstate Article 31 & DTCs Downstate Article 31 & DTCs County Article 31 Upstate Hospital Downstate Hospital $ $ $ $ $ $ $39.03 $

11 Billing SBIRT in Part & Clinics Pre-Admission Screen H0049 (Medicaid) Brief Intervention H0050 (Medicaid) Post Admission Brief Treatment H0004 A brief treatment may be billed on the same day as other categories, including, but not limited to individual or group counseling services Providers should code H0004 and NOT H0050 for postadmission Brief Treatment services 11

12 APG Payments for SBIRT in Part and Programs Medicaid APG Rate Per Service Upon Full Implementation of APG Payments Clinic Upstate Clinic Downstate Opioid Upstate Opioid Downstate Screening $41.37 $48.41 $38.13 $44.62 Brief Intervention/ Brief Treatment $41.37 $48.41 $38.13 $44.62 Screening is not intended to be provided to all patients or where it is known that the patient is appropriate for admission (e.g. a court order); has an assessment from another program; or presents with circumstances that indicate that a substance use disorder (SUD) problem may be present. Additionally, screening may not be provided in a group setting. 12

13 Medicaid Managed Care SBIRT services are covered benefits under Medicaid Managed Care and Family Health Plus (FHPlus) MCOs are required to pay government rate for at least 1 st 2 years Plans are required to cover the same frequency limits as FFS w/out prior authorization, but may permit additional screenings/brief intervention visits Reimbursement rates for plan members receiving SBIRT services from in network providers will be established in provider agreements. Out-of-network providers will be reimbursed at negotiated rates, except for out-of-network emergency departments which will be reimbursed according to the Medicaid FFS methodology FHPlus co-payments are not applicable to SBIRT. 13

14 Requirements for SBIRT Documentation Screening tool completed CRAFFT Score on the CRAFFT Copy of the completed screening tool must be retained in the record. Documentation must denote start/stop time or total face-to-face time with the patient, because the SBIRT codes are time-based codes Although the completed screenings may be in another section of the chart, there needs to be representation on the progress note that the screening still took place.

15 Modifiers Used with Diagnostic Codes: Two digit, two character or alphanumeric characters, appended to the end of a Current Procedural Technology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code Modifies the code description without changing the core meaning of the Current Procedural Technology and/or Healthcare Common Procedure Coding System description Provides additional information regarding the services or procedures provided Tells the clinical story more completely Integral part of the Current Procedural Technology and Healthcare Common Procedure Coding System coding system Are designed to provide payers with additional information needed to process or adjudicate a claim

16 Modifiers cont. When two separate and distinct patient encounters are provided by a single provider on the same day, a modifier (e.g., 25 Significant, Separately Identifiable Evaluation and Management Service or 59 Distinct Procedure Service) should be appended to the additional procedure/service to indicate that the second code is separate and/or distinct. This is especially important when billing for mental hygiene type services. For instance, NCCI prohibits billing both (family psychotherapy) and SBIRT (i.e., H0049 or H0050) for the same session, but will allow payment for both codes if modifier 59 is appended to the second procedure (applicable in Article 31 hospital). However, please note that modifiers may only be appended to HCPCS/CPT codes if clinical circumstances justify use of a modifier. A modifier should not be appended to a HCPCS/CPT code solely to bypass an NCCI edit if the clinical circumstances do not justify its use. 16

17 Real Life Experiences with SBIRT Billing Chris Baron - Lourdes Hospital Katherine Cusano - Broome County Mental Health 17

18 Computer Sciences Corporation (CSC) Responsibilities Processing Medicaid claims Provider Manuals Remittance statements and checks Electronic Fund Transfer Billing inquiries & guidelines Provider training Medicaid Eligibility Verification System (MEVS) Issues paper claim forms (excluding UB-04) Electronic Transmitter Identification Numbers (ETIN) epaces (Electronic Provider Assisted Claim Entry System) Provider Enrollment Maintenance (Fee-for-Service) Contact CSC / emedny Call Center (800) Website 18

19 Computer Sciences Corporation (CSC) emedny Call Center Support units for Practitioners, Institutions, Professional, Pharmacy, MOAS, PTAR and MEIPASS Provides assistance with questions regarding: - claims - billing - electronic and paper remittance - form orders - prior approval - new enrollment into the New York State Medicaid program - epaces enrollment - Electronic Funds Transfer (EFT) - ETIN applications - provider maintenance forms - Explanation of eligibility responses Hours of Operation: non-pharmacy billing or claims, or provider enrollment: Monday through Friday: 7:30 a.m. - 6:00 p.m., Eastern Time (excluding holidays) eligibility, DVS, and pharmacy claims: Monday through Friday: 7:00 a.m. - 10:00 p.m., Eastern Time (excluding holidays) Weekends and Holidays: 8:30 a.m. - 5:30 p.m., Eastern Time 19

20 Computer Sciences Corporation (CSC) Provider Outreach Regional Representatives located in 8 regions Capital District, North Country/Mohawk Valley, South/Central NY, Finger Lakes, Western NY, Hudson Valley, NYC and Long Island CSC Regional Representatives are available to offer provider billing training on a variety of topics through numerous methods including: Individual meetings with providers to train and troubleshoot issues Group training seminars and webinars Request a meeting with a regional representative at or register to attend a seminar or webinar on the emedny website Training page at 20

21 Medicaid Billing Questions CSC Billing/Claiming Questions: NYS DOH - Medicaid Policy Questions: APG Mailbox NYS OMH Article 31s Billing Questions NYS OASAS - Billing Questions (518) or 21

22 Questions? 22

Ambulatory Patient Groups (APG) Policy and Medicaid Billing Guidance OASAS Certified Outpatient Chemical Dependence Programs

Ambulatory Patient Groups (APG) Policy and Medicaid Billing Guidance OASAS Certified Outpatient Chemical Dependence Programs Ambulatory Patient Groups (APG) Policy and Medicaid Billing Guidance OASAS Certified Outpatient Chemical Dependence Programs www.oasas.ny.gov TABLE OF CONTENTS SECTION: PAGE 1. Background and Introduction

More information

Behavioral Health Management of Substance Use Disorder Services

Behavioral Health Management of Substance Use Disorder Services Behavioral Health Management of Substance Use Disorder Services Arlene González-Sánchez, Commissioner Robert Kent, General Counsel SAMSHA: New York State should remain consistent with SAMSHA policy philosophy

More information

Managed Care Readiness Training Series: Revenue Cycle Management 2nd Learning Community Charge Capture and Coding

Managed Care Readiness Training Series: Revenue Cycle Management 2nd Learning Community Charge Capture and Coding Managed Care Readiness Training Series: Revenue Cycle Management 2nd Learning Community Charge Capture and Coding Charge Capture and Coding Presenter: David Wawrzynek MS, MBA Managed Care Technical Assistance

More information

Financing integrated Healthcare in Washington

Financing integrated Healthcare in Washington Financing integrated Healthcare in Washington as of: April 23. 2012 E & M Codes CPT Code 99201-99205 99211-99215 Est. Pt Diagnostic Code May be used only with physical Federally Qualified Health Centers

More information

New Substance Abuse Screening and Intervention Benefit Covered by BadgerCare Plus and Medicaid

New Substance Abuse Screening and Intervention Benefit Covered by BadgerCare Plus and Medicaid Update December 2009 No. 2009-96 Affected Programs: BadgerCare Plus, Medicaid To: All Providers, HMOs and Other Managed Care Programs New Substance Abuse Screening and Intervention Benefit Covered by BadgerCare

More information

OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE

OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE Brief Coverage Statement Outpatient Substance Use Disorder (SUD) Fee-For-Service (FFS) Treatment Services are available for the treatment of substance

More information

HARP HOME AND COMMUNITY BASED SERVICES (HCBS)

HARP HOME AND COMMUNITY BASED SERVICES (HCBS) New York State HARP Mainstream BH Billing and Coding Manual For Individuals Enrolled in Mainstream Medicaid Managed Care Plans And Health and Recovery Plans (HARPs) March 18, 2015 - DRAFT CONTENTS Managed

More information

2013 CPT CODE CHANGES for NYS OMH Licensed Clinics. New York State Office of Mental Health December 13, 2012

2013 CPT CODE CHANGES for NYS OMH Licensed Clinics. New York State Office of Mental Health December 13, 2012 2013 CPT CODE CHANGES for NYS OMH Licensed Clinics New York State Office of Mental Health December 13, 2012 Background New Psychiatric CPT codes published by AMA Compliance mandatory under federal law

More information

Questions asked on SBIRT TA Webinar

Questions asked on SBIRT TA Webinar Questions asked on SBIRT TA Webinar Housekeeping Could you send out the link to download the updated SBIRT guidance document? The updated SBIRT guidance document is available online here: http://www.oregon.gov/oha/pages/cco-baseline-data.aspx

More information

OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE

OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE OUTPATIENT SUBSTANCE USE DISORDER SERVICES FEE-FOR-SERVICE BRIEF COVERAGE STATEMENT This benefit coverage standard describes outpatient Substance Use Disorder services (known as SUD Fee-For-Service (FFS)

More information

Collaborative Care Tips for Sustainability. Virna Little, PsyD, LCSW r, SAP The Institute for Family Health NYS Collaborative Care Initiative

Collaborative Care Tips for Sustainability. Virna Little, PsyD, LCSW r, SAP The Institute for Family Health NYS Collaborative Care Initiative Collaborative Care Tips for Sustainability Virna Little, PsyD, LCSW r, SAP The Institute for Family Health NYS Collaborative Care Initiative Teamwork Applies to Billing Too!!! Combine with other initiatives

More information

The Collaborative Models of Mental Health Care for Older Iowans. Model Administration. Collaborative Models of Mental Health Care for Older Iowans 97

The Collaborative Models of Mental Health Care for Older Iowans. Model Administration. Collaborative Models of Mental Health Care for Older Iowans 97 6 The Collaborative Models of Mental Health Care for Older Iowans Model Administration Collaborative Models of Mental Health Care for Older Iowans 97 Collaborative Models of Mental Health Care for Older

More information

Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals

Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals IOWA PLAN F BEHAVIAL HEALTH RE: Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals The purpose of this document is to clarify who can provide which outpatient services

More information

NEW YORK STATE MEDICAID PROGRAM INFORMATION FOR ALL PROVIDERS

NEW YORK STATE MEDICAID PROGRAM INFORMATION FOR ALL PROVIDERS NEW YORK STATE MEDICAID PROGRAM INFORMATION FOR ALL PROVIDERS INTRODUCTION Table of Contents PREFACE... 2 FOREWORD... 3 MEDICAID MANAGEMENT INFORMATION SYSTEM... 4 KEY FEATURES... 4 Version 2011-1 June

More information

Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals

Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals Professional Criteria and Medicaid Reimbursable Outpatient Services by Professionals The purpose of this document is to clarify who can provide which outpatient services to Iowa Plan Medicaid members.

More information

4758-6-01 Scope of practice for chemical dependency counselor assistants (CDCA).

4758-6-01 Scope of practice for chemical dependency counselor assistants (CDCA). 4758-6-01 Scope of practice for chemical dependency counselor assistants (CDCA). (A) An individual holding a valid chemical dependency counselor assistant certificate may do both of the following in addition

More information

Keep Your Mind and Body Healthy: Understanding Mental Health Providers, Care and Coverage

Keep Your Mind and Body Healthy: Understanding Mental Health Providers, Care and Coverage Keep Your Mind and Body Healthy: Understanding Mental Health Providers, Care and Coverage Our mental health is a vital part of our overall well-being. It affects how we think, how we feel, and how we act.

More information

Screening, Brief Intervention and Referral to Treatment SBIRT Coding, Billing and Reimbursement Manual

Screening, Brief Intervention and Referral to Treatment SBIRT Coding, Billing and Reimbursement Manual Screening, Brief Intervention and Referral to Treatment SBIRT Coding, Billing and Reimbursement Manual Prepared For: Wisconsin Initiative to Promote Healthy Lifestyles (WIPHL) January 2010 Table of Contents

More information

Update January 2008. BadgerCare Plus Information for Providers. BadgerCare Plus Overview. Definition of the New Benefit. No.

Update January 2008. BadgerCare Plus Information for Providers. BadgerCare Plus Overview. Definition of the New Benefit. No. Update January 2008 No. 2008-04 BadgerCare Plus Information for Providers To: All Providers, HMOs and Other Managed Care Programs Mental Health and Substance Abuse Screening, Preventive Mental Health Counseling,

More information

FAQs on Billing for Health and Behavior Services

FAQs on Billing for Health and Behavior Services FAQs on Billing for Health and Behavior Services by Government Relations Staff January 29, 2009 Practicing psychologists are eligible to bill for applicable services and receive reimbursement from Medicare

More information

Behavioral Health Services. Provider Manual

Behavioral Health Services. Provider Manual Behavioral Health Provider Manual Provider Behavioral Health 1 May 1, 2014 TABLE OF CONTENTS Chapter I. General Program Policies Chapter II. Member Eligibility Chapter IV. Billing Iowa Medicaid Appendix

More information

OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN

OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN ISSUE DATE: May 23, 2014 EFFECTIVE DATE: May 26, 2014 NUMBER: OMHSAS-14-02 SUBJECT: Enrollment and Payment of Licensed Providers that Provide

More information

Maryland Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland

Maryland Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland As of July 2003, 638,662 people were covered under Maryland's Medicaid/SCHIP programs. There were 525,080 enrolled in the Medicaid

More information

Behavioral Health Providers Frequently Asked Questions

Behavioral Health Providers Frequently Asked Questions Behavioral Health Providers Frequently Asked Questions Q. What has changed as far as Behavioral Health services? A1. Effective April 1, 2012, the professional and outpatient facility charges for Licensed

More information

Payment Policy. Evaluation and Management

Payment Policy. Evaluation and Management Purpose Payment Policy Evaluation and Management The purpose of this payment policy is to define how Health New England (HNE) reimburses for Evaluation and Management Services. Applicable Plans Definitions

More information

Division of Behavioral Health. Requirements for Program Staff

Division of Behavioral Health. Requirements for Program Staff Division of Behavioral Health Requirements for Program Staff Integrated BH Regulations Training 1 Program Staff Program Staff are professionals who render behavioral health services directly to a recipient.

More information

NEW YORK STATE OFFICE OF MENTAL HEALTH 14 NYCRR Part 599 Clinic Treatment Programs Interpretive/Implementation Guidance 8-17-2010

NEW YORK STATE OFFICE OF MENTAL HEALTH 14 NYCRR Part 599 Clinic Treatment Programs Interpretive/Implementation Guidance 8-17-2010 NEW YORK STATE OFFICE OF MENTAL HEALTH 14 NYCRR Part 599 Clinic Treatment Programs Interpretive/Implementation Guidance 8-17-2010 This document is intended to provide interpretive/implementation guidance

More information

ATTENTION: ALTERNATIVE BILLING CONCEPTS (ABC) CODES FOR BEHAVIORAL HEALTH SERVICES TO END AS OF 12/31/2009

ATTENTION: ALTERNATIVE BILLING CONCEPTS (ABC) CODES FOR BEHAVIORAL HEALTH SERVICES TO END AS OF 12/31/2009 ATTENTION: ALTERNATIVE BILLING CONCEPTS (ABC) CODES FOR BEHAVIORAL HEALTH SERVICES TO END AS OF 12/31/2009 Alaska Medical Assistance will transition from use of Alternative Billing Concepts (ABC) procedure

More information

Billing Frequently Asked Questions

Billing Frequently Asked Questions Billing Frequently Asked Questions What are the general conditions which must be met in order to bill for a service? All billed services except assessment must be medically necessary for the treatment

More information

NEW YORK STATE OFFICE OF MENTAL HEALTH 14 NYCRR Part 599 Clinic Treatment Programs Interpretive/Implementation Guidance 01-04-2012

NEW YORK STATE OFFICE OF MENTAL HEALTH 14 NYCRR Part 599 Clinic Treatment Programs Interpretive/Implementation Guidance 01-04-2012 NEW YORK STATE OFFICE OF MENTAL HEALTH 14 NYCRR Part 599 Clinic Treatment Programs Interpretive/Implementation Guidance 01-04-2012 This document is intended to provide interpretive/implementation guidance

More information

Financing integrated Healthcare in California

Financing integrated Healthcare in California Financing integrated Healthcare in California as of October 12, 2012 E & M Codes CPT Code 99201-99205 ew Pt 99211-99215 Est. Pt Diagnostic Code May be used only with physical Federally Qualified Health

More information

Psychotherapy Professional Services

Psychotherapy Professional Services Status Active Reimbursement Policy Section: Behavioral Health Section Policy Number: RP - Behavioral Health - 001 Psychotherapy Professional Services Effective Date: June 1, 2015 Psychotherapy Professional

More information

Behavioral Health Quality Standards for Providers

Behavioral Health Quality Standards for Providers Behavioral Health Quality Standards for Providers TABLE OF CONTENTS I. Behavioral Health Quality Standards Access Standards A. Access Standards B. After-Hours C. Continuity and Coordination of Care 1.

More information

Outpatient Behavioral Health

Outpatient Behavioral Health Outpatient Behavioral Health 29 Chapter 29 29.1 Enrollment..................................................................... 29-2 29.1.1 Provisionally Licensed Psychologist (PLP)..................................

More information

BEHAVIORAL MEDICINE CODING AND BILLING GUIDE DEVELOPED: FEBRUARY 2005

BEHAVIORAL MEDICINE CODING AND BILLING GUIDE DEVELOPED: FEBRUARY 2005 BEHAVIORAL MEDICINE CODING AND BILLING GUIDE DEVELOPED: FEBRUARY 2005 This is a matrix of basic coding and billing information, arranged by payer, for coding and billing guidance. It should be used in

More information

Managed Care Technical Assistance Center Kick-Off Forum FAQs Updated 1.23.2015

Managed Care Technical Assistance Center Kick-Off Forum FAQs Updated 1.23.2015 1. Billing When will providers receive billing codes? A draft manual will be sent out shortly. All Plans and providers will use the same coding construct, which will crosswalk procedure code and modifier

More information

Coding for Tobacco Use and Cessation Counseling

Coding for Tobacco Use and Cessation Counseling Coding for Tobacco Use and Cessation Counseling Diagnosis Coding The International Statistical Classification of Diseases and Related Health Problems (ICD) codes support the medical necessity for performing

More information

Medicaid Behavioral Health Clinic Rehabilitation Services Manual

Medicaid Behavioral Health Clinic Rehabilitation Services Manual Medicaid Behavioral Health Clinic Rehabilitation Services Manual WV DHHR BUREAU FOR MEDICAL SERVICES JUNE 16, 2014 Charleston, WV Clinic/Rehab Collaboration Over the past year, BMS, BHHF, behavioral health

More information

NYS Chemical Dependence Services and Detoxification Reform

NYS Chemical Dependence Services and Detoxification Reform NYS Chemical Dependence Services and Detoxification Reform Presentation to the Commission on Health Care Facilities in the 21 st Century Shari Noonan, Acting Commissioner, NYS OASAS July 20, 2006 Chemical

More information

HEAL 22 Questions & Answers

HEAL 22 Questions & Answers HEAL 22 Questions & Answers Q1: What is HEAL 22? A1: The New York State Office of the Health and Information Technology Transformation (OHITT) has contracted with Regional Extension Centers (RECs) to expand

More information

This file contains the following documents in the order listed:

This file contains the following documents in the order listed: Table of Contents State/Territory Name: Colorado State Plan Amendment (SPA) #: 13-059 This file contains the following documents in the order listed: 1) Approval Letter 2) CMS 179 3) Approved SPA Pages

More information

Compensation and Claims Processing

Compensation and Claims Processing Compensation and Claims Processing Compensation The network rate for eligible outpatient visits is reimbursed to you at the lesser of (1) your customary charge, less any applicable co-payments, coinsurance

More information

TN No: 09-024 Supersedes Approval Date:01-27-10 Effective Date: 10/01/09 TN No: 08-011

TN No: 09-024 Supersedes Approval Date:01-27-10 Effective Date: 10/01/09 TN No: 08-011 Page 15a.2 (iii) Community Support - (adults) (CS) North Carolina is revising the State Plan to facilitate phase out of the Community Support - Adults service, which will end effective July 1, 2010. Beginning

More information

NEW YORK STATE MEDICAID PROGRAM OFFICE OF MENTAL HEALTH REHABILITATION IN COMMUNITY RESIDENCES

NEW YORK STATE MEDICAID PROGRAM OFFICE OF MENTAL HEALTH REHABILITATION IN COMMUNITY RESIDENCES NEW YORK STATE MEDICAID PROGRAM OFFICE OF MENTAL HEALTH REHABILITATION IN COMMUNITY RESIDENCES POLICY GUIDELINES Table of Contents SECTION I - REQUIREMENTS FOR PARTICIPATION IN MEDICAID ------------------------------------------2

More information

Alcohol and Drug Rehabilitation Providers

Alcohol and Drug Rehabilitation Providers June 2009 Provider Bulletin Number 942 Alcohol and Drug Rehabilitation Providers New Modifier and s for Substance Abuse Services Effective with dates of service on and after July 1, 2009, eligible substance

More information

Quality Management. Substance Abuse Outpatient Care Services Service Delivery Model. Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA)

Quality Management. Substance Abuse Outpatient Care Services Service Delivery Model. Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA) Quality Management Substance Abuse Outpatient Care Services Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA) The creation of this public document is fully funded by a federal Ryan White

More information

DEPARTMENT OF PSYCHIATRY. 1153 Centre Street Boston, MA 02130

DEPARTMENT OF PSYCHIATRY. 1153 Centre Street Boston, MA 02130 DEPARTMENT OF PSYCHIATRY 1153 Centre Street Boston, MA 02130 Who We Are Brigham and Women s Faulkner Hospital (BWFH) Department of Psychiatry is the largest clinical psychiatry site in the Brigham / Faulkner

More information

NY Medicaid EHR Incentive Program. Eligible Professionals Step 3: Practitioner Enrollment Form www.emedny.org/meipass

NY Medicaid EHR Incentive Program. Eligible Professionals Step 3: Practitioner Enrollment Form www.emedny.org/meipass Eligible Professionals Step 3: Practitioner Enrollment Form www.emedny.org/meipass July 2015 2 NY Medicaid Enrollment Form Presentation and Enrollment Form Overview Locating the Practitioner Enrollment

More information

Health Homes of Upstate New York (HHUNY) Navigating the Waters of Billing

Health Homes of Upstate New York (HHUNY) Navigating the Waters of Billing Health Homes of Upstate New York (HHUNY) Navigating the Waters of Billing Agenda Payment Overview Overview of the two channels of agencies and what it means for billing Billing Flow Important Information

More information

Innerview Reimbursement in the Physician Office Setting * 2014

Innerview Reimbursement in the Physician Office Setting * 2014 OVERVIEW This Guide is intended to assist with the process of billing and coding for Innerview, a Mental Health Clinical Decision Support System used in the primary care setting. Billing, coding and payment

More information

COMPREHENSIVE MEDICAID CASE MANAGEMENT (CMCM) [Type text] [Type text] [Type text] Version 2011-02

COMPREHENSIVE MEDICAID CASE MANAGEMENT (CMCM) [Type text] [Type text] [Type text] Version 2011-02 New York State UB-04 Billing Guidelines COMPREHENSIVE MEDICAID CASE MANAGEMENT (CMCM) [Type text] [Type text] [Type text] Version 2011-02 6/1/2011 EMEDNY INFORMATION emedny is the name of the electronic

More information

NEW YORK STATE MEDICAID PROGRAM MANAGED CARE MANUAL: STOP-LOSS POLICY AND PROCEDURE

NEW YORK STATE MEDICAID PROGRAM MANAGED CARE MANUAL: STOP-LOSS POLICY AND PROCEDURE NEW YORK STATE MEDICAID PROGRAM MANAGED CARE MANUAL: STOP-LOSS POLICY AND PROCEDURE Version 2011 1 (01/31/11) Page 1 of 23 TABLE OF CONTENTS Section I Purpose Statement... 3 Section II Stop-loss Policy

More information

NEW HAMPSHIRE CODE OF ADMINISTRATIVE RULES. PART He-W 513 SUBSTANCE USE DISORDER (SUD) TREATMENT AND RECOVERY SUPPORT SERVICES

NEW HAMPSHIRE CODE OF ADMINISTRATIVE RULES. PART He-W 513 SUBSTANCE USE DISORDER (SUD) TREATMENT AND RECOVERY SUPPORT SERVICES CHAPTER He-W 500 MEDICAL ASSISTANCE PART He-W 513 SUBSTANCE USE DISORDER (SUD) TREATMENT AND RECOVERY SUPPORT SERVICES He-W 513.01 Purpose. The purpose of this part is to establish the procedures and requirements

More information

The Utilization Threshold Program

The Utilization Threshold Program The Utilization Threshold Program In order to contain costs while continuing to provide medically necessary care and services, the Utilization Threshold (UT) program places limits on the number of services

More information

New York State Office of Mental Health 14 NYCRR Part 599 Clinic Treatment Programs Interpretive/Implementation Guidance 06-12-2015

New York State Office of Mental Health 14 NYCRR Part 599 Clinic Treatment Programs Interpretive/Implementation Guidance 06-12-2015 New York State Office of Mental Health 14 NYCRR Part 599 Clinic Treatment Programs Interpretive/Implementation Guidance 06-12-2015 This document is intended to provide interpretive/implementation guidance

More information

Session 14. Act Now-Review of the 2015 Telemedicine Law. 2016 Minnesota e-health Summit June 7, 2016, 2:15 PM

Session 14. Act Now-Review of the 2015 Telemedicine Law. 2016 Minnesota e-health Summit June 7, 2016, 2:15 PM Session 14 Act Now-Review of the 2015 Telemedicine Law 2016 Minnesota e-health Summit June 7, 2016, 2:15 PM 1 Speakers Moderator: Mark Sonneborn Presenter: Maureen Ideker RN, BSN, MBA, Great Plains Telehealth

More information

Clinic Frequently Asked Questions Updated February 27, 2012

Clinic Frequently Asked Questions Updated February 27, 2012 Clinic Frequently Asked Questions Updated February 27, 2012 Table of Contents Clinic Services... 1 Clinic Services Modifiers... 4 Coding... 5 Interim Claiming...11 COPS-Only- Interim Claiming...12 emedny

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Mental Health Services

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Mental Health Services DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Mental Health Services ICN 903195 September 2013 This booklet was current at the time it was published or uploaded onto

More information

New York State Health and Recovery Plan (HARP) / Mainstream Behavioral Health Billing and Coding Manual For Individuals Enrolled in Mainstream

New York State Health and Recovery Plan (HARP) / Mainstream Behavioral Health Billing and Coding Manual For Individuals Enrolled in Mainstream New York State Health and Recovery Plan (HARP) / Mainstream Behavioral Health Billing and Coding Manual For Individuals Enrolled in Mainstream Medicaid Managed Care Plans And HARPS Contents Managed Care

More information

Behavioral Health Coding, Contracting and Billing, Part 1 Presented by

Behavioral Health Coding, Contracting and Billing, Part 1 Presented by Disclosures Behavioral Health Coding, Contracting and Billing, Part 1 Presented by Mimi Reed, BHSA, CPC A, MCP, MTA, Consultant, SCHA MI Mimi Reed, BHSA, CPC A, MCP, MTA, Consultant, SCHA MI Amy Valimont,

More information

Basic Rural Health Clinic Billing

Basic Rural Health Clinic Billing Basic Rural Health Clinic Billing Charles A. James, Jr. President and CEO North American Healthcare Management Services Overview This presentation will discuss the basic elements of RHC billing. The following

More information

Telemedicine and Telehealth Services

Telemedicine and Telehealth Services Telemedicine and Telehealth Services Chapter.1 Enrollment..................................................................... -2.2 Benefits, Limitations, and Authorization Requirements...........................

More information

Medicaid Services for Substance Abuse

Medicaid Services for Substance Abuse Medicaid Services for Substance Abuse Community Behavioral Health Services Coverage and Limitations Handbook 2007 FADAA Annual Conference-Orlando Making Medicaid Work for Substance Abuse Agenda Overview

More information

JK: Provider Enrollment 855I and 855R 1532_0214

JK: Provider Enrollment 855I and 855R 1532_0214 JK: Provider Enrollment 855I and 855R 1532_0214 Presenters Carleen Parker Provider Outreach & Education Donna Pisani Provider Outreach & Education 2 National Government Services, Inc. Disclaimer National

More information

IMPORTANT INFORMATION ABOUT THE IRS 1099 FORM

IMPORTANT INFORMATION ABOUT THE IRS 1099 FORM New York State DECEMBER 2010 visit us online: www.nyhealth.gov THE OFFICIAL NEWSLETTER OF THE NEW YORK MEDICAID PROGRAM IMPORTANT INFORMATION ABOUT THE IRS 1099 FORM DECEMBER 2010 MEDICAID UPDATE Volume

More information

Understanding Coding & Reimbursement for SBI. Presented By: Jen Cohrs CPC, CPMA, CGIC Director of Educational Strategies Wisconsin Medical Society

Understanding Coding & Reimbursement for SBI. Presented By: Jen Cohrs CPC, CPMA, CGIC Director of Educational Strategies Wisconsin Medical Society Understanding Coding & Reimbursement for SBI Presented By: Jen Cohrs CPC, CPMA, CGIC Director of Educational Strategies Wisconsin Medical Society CPT codes, descriptions and material only are Copyright

More information

Announcing New York Medicaid s Statewide Patient-Centered Medical Home Incentive Program

Announcing New York Medicaid s Statewide Patient-Centered Medical Home Incentive Program DECEMBER 2009 SPECIAL EDITION Volume 25, Number 16, DAVID A. PATERSON GOVERNOR State of New York RICHARD F. DAINES, M.D. COMMISSIONER New York State DOH New York State DECEMBER 2009 SPECIAL EDITION NEW

More information

AHCCCS Billing Manual for IHS/Tribal Providers April, 2004 Behavioral Health Services Chapter: 12 Page: 12-1

AHCCCS Billing Manual for IHS/Tribal Providers April, 2004 Behavioral Health Services Chapter: 12 Page: 12-1 Chapter: 12 Page: 12-1 GENERAL INFORMATION NOTE: Coverage and reimbursement for both Title XIX (Medicaid-AHCCCS) and Title XXI (KidsCare) services are explained in this chapter. The covered services, limitations,

More information

Affordable Care Act: Health Coverage for Criminal Justice Populations. Colorado Center on Law and Policy Colorado Criminal Justice Reform Coalition

Affordable Care Act: Health Coverage for Criminal Justice Populations. Colorado Center on Law and Policy Colorado Criminal Justice Reform Coalition Affordable Care Act: Health Coverage for Criminal Justice Populations Colorado Center on Law and Policy Colorado Criminal Justice Reform Coalition Who we are CCJRC and CCLP have partnered to help Colorado

More information

CPT Code Changes for 2013 Frequently Asked Questions Last Updated 3/7/2013

CPT Code Changes for 2013 Frequently Asked Questions Last Updated 3/7/2013 CPT Code Changes for 2013 Frequently Asked Questions Last Updated 3/7/2013 Contents Background... 1 Reporting Deviations from CPT Guidelines... 3 Psychotherapy Services... 3 Pharmacologic Management...

More information

SUBSTANCE ABUSE FACILITY GENERAL INFORMATION

SUBSTANCE ABUSE FACILITY GENERAL INFORMATION SUBSTANCE ABUSE FACILITY GENERAL INFORMATION I. BCBSM s Substance Abuse Facility Programs Traditional The Traditional BCBSM Substance Abuse Program provides benefits for the treatment of substancerelated

More information

Professional Treatment Services in Facility-Based Crisis Program Children and Adolescents

Professional Treatment Services in Facility-Based Crisis Program Children and Adolescents Professional Treatment Services in Facility-Based Crisis Program Children and Adolescents Medicaid and North Carolina Health Choice (NCHC) Billable Service WORKING DRAFT Revision Date: September 11, 2014

More information

Outpatient and Intensive Outpatient Narrative

Outpatient and Intensive Outpatient Narrative Los Angeles County Department of Public Health Substance Abuse Prevention and Control (SAPC) will implement an initial benefit package of Substance Use Disorder (SUD) services within the initial twelve

More information

Substance Use Disorder Services to be a Benefit of Texas Medicaid

Substance Use Disorder Services to be a Benefit of Texas Medicaid Substance Use Disorder Services to be a Benefit of Texas Medicaid Information Posted on August 13, 2010 Effective for dates of service on or after September 1, 2010, the following substance use disorder

More information

State of New York Department of Health

State of New York Department of Health Health Homes Provider Manual Billing Policy and Guidance State of New York Department of Health The purpose of this Manual is to provide Medicaid policy and billing guidance to providers participating

More information

Billing and Claim Billing and Claim Submission Boot Camp Submission Boot Camp Beverly Remm Beverly Remm

Billing and Claim Billing and Claim Submission Boot Camp Submission Boot Camp Beverly Remm Beverly Remm Billing and Claim Submission Boot Camp Presented by: Beverly Remm Orion Healthcare Technology Billing and Claim Submission Boot Camp Presented by: Beverly Remm Orion Healthcare Technology The presentation

More information

SUD Treatment & Prevention Staff Certification and Qualifications Requirements. All Treatment & Prevention Providers

SUD Treatment & Prevention Staff Certification and Qualifications Requirements. All Treatment & Prevention Providers Page 1 of 8 1. POLICY This policy is to ensure appropriately qualified, credentialed, and professionally licensed staff are providing substance use disorder (SUD) treatment and prevention services to Mid-South

More information

ValueOptions 2013 Current Procedural Terminology (CPT ) Code Changes 2012-2013

ValueOptions 2013 Current Procedural Terminology (CPT ) Code Changes 2012-2013 ValueOptions 2013 Current Procedural Terminology (CPT ) Code Changes 2012-2013 Topics Background What is Changing? What is Staying the Same? CPT Code Crosswalk Utilization Management Provider Frequently

More information

TELEMEDICINE POLICY. Page

TELEMEDICINE POLICY. Page TELEMEDICINE POLICY REIMBURSEMENT POLICY Policy Number: ADMINISTRATIVE 4.8 T0 Effective Date: May, 203 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS.. APPLICATION... OVERVIEW... REIMBURSEMENT

More information

Attachment C Behavioral Health Services New York Medicaid Billing Codes

Attachment C Behavioral Health Services New York Medicaid Billing Codes Attachment C Behavioral Health s New York Medicaid Billing Codes Listed below are the New York Medicaid program DRGs, procedure, fee, and rate codes for the Behavioral Health s that are not in the Medicaid

More information

Public Act No. 15-226

Public Act No. 15-226 Public Act No. 15-226 AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR MENTAL OR NERVOUS CONDITIONS. Be it enacted by the Senate and House of Representatives in General Assembly convened: Section 1. Section

More information

KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. Non-PIHP Alcohol and Substance Abuse Community Based Services

KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. Non-PIHP Alcohol and Substance Abuse Community Based Services KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL Non-PIHP Alcohol and Substance Abuse Community Based Services Introduction Section 7000 7010 8100 8200 8300 8400 Appendix Forms PART II BILLING INSTRUCTIONS

More information

Substance Use Disorder Treatment Coverage Requirements

Substance Use Disorder Treatment Coverage Requirements To: From: Clients and Friends Manatt, Phelps & Phillips, LLP Date: Subject: Substance Use Disorder Treatment Coverage Requirements In the final days of the 2014 legislative session, the State Legislature

More information

Insurance 101. Infant and Toddler Coordinators Association. July 28, 2012 Capital City Hyatt. Laura Pizza Plum Plum Healthcare Consulting

Insurance 101. Infant and Toddler Coordinators Association. July 28, 2012 Capital City Hyatt. Laura Pizza Plum Plum Healthcare Consulting Insurance 101 Infant and Toddler Coordinators Association July 28, 2012 Capital City Hyatt Laura Pizza Plum 1 Agenda Basics of Health Insurance Frequently Asked Questions Early Intervention and working

More information

Provider Handbooks. Telecommunication Services Handbook

Provider Handbooks. Telecommunication Services Handbook Provider Handbooks January 2016 Telecommunication Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health

More information

MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT RESOURCE GUIDE

MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT RESOURCE GUIDE MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT RESOURCE GUIDE May 2014 THE UNIVERSITY OF MARYLAND CAREY SCHOOL OF LAW DRUG POLICY AND PUBLIC HEALTH STRATEGIES CLINIC 2 PARITY ACT RESOURCE GUIDE TABLE OF

More information

A. CPT Coding System B. CPT Categories, Subcategories, and Headings

A. CPT Coding System B. CPT Categories, Subcategories, and Headings OST 148 MEDICAL CODING, BILLING AND INSURANCE COURSE DESCRIPTION: Prerequisites: None Corequisites: None This course introduces CPT and ICD coding as they apply to medical insurance and billing. Emphasis

More information

Examples of States Billing Codes for Mental Health Services, Publicly Funded

Examples of States Billing Codes for Mental Health Services, Publicly Funded Examples of States Billing Codes for Mental Health Services, Publicly Funded Written by Shelagh Smith, MPH, CHES, SAMHSA s Center for Mental Health Services Complied by Eileen Charneco, SAMHSA Intern December

More information

ILLINOIS: Frequently Asked Questions About the Autism Insurance Reform Law

ILLINOIS: Frequently Asked Questions About the Autism Insurance Reform Law ILLINOIS: Frequently Asked Questions About the Autism Insurance Reform Law What does Public Act 95 do? Broadly speaking, the Act does two main things: 1. It requires many private insurers to begin covering

More information

Palliative Care Billing, Coding and Reimbursement

Palliative Care Billing, Coding and Reimbursement Palliative Care Billing, Coding and Reimbursement Anne Monroe, MHA Physician Practice Manager Hospice of the Bluegrass and Palliative Care Center of the Bluegrass Kentucky 1 Objectives Review coding and

More information

NJ FamilyCare Expansion and Provider Enrollment FAQs

NJ FamilyCare Expansion and Provider Enrollment FAQs NJ FamilyCare Expansion and Provider Enrollment FAQs Roxanne Kennedy MSW, LCSW Project Officer, Managed Behavioral Health Division of Medical Assistance and Health Service January 17, 2014 1 Expansion

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Mental Health Services

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Mental Health Services DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Mental Health Services ICN 903195 January 2015 This booklet was current at the time it was published or uploaded onto the

More information

Policy and Billing Guidance Ambulatory Patient Groups (APGs)

Policy and Billing Guidance Ambulatory Patient Groups (APGs) Policy and Billing Guidance Ambulatory Patient Groups (APGs) P R O V I D E R M A N U A L REVISION 2.1 August 2012 Please Note: Red text indicates new policy clarifications and additions to the manual since

More information

Comparison of Executive, Senate and Assembly One House Budget Proposals Health/Mental Hygiene

Comparison of Executive, Senate and Assembly One House Budget Proposals Health/Mental Hygiene Comparison of Executive, Senate and Assembly One House Budget Proposals Health/Mental Hygiene Executive Budget Senate One House Assembly One House MULTI SECTOR/ HOSPITAL Increase in Minimum Wage from $9

More information

Important Update Regarding Behavioral Health CPT Codes and Pre-Certification Rules

Important Update Regarding Behavioral Health CPT Codes and Pre-Certification Rules Important Update Regarding Behavioral Health CPT Codes and Pre-Certification Rules Summary of change: Effective for dates of service on and after 1/1/2014, Amerigroup is updating the Amerigroup Georgia

More information

Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE FINAL Maryland Register Issue Date: November 1, 2013 Volume 40 Issue 22 Page 1878 Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 58 BOARD OF PROFESSIONAL COUNSELORS AND THERAPISTS 10.58.14 Supervision

More information

Medicaid Substance Abuse Treatment Self-Referral Protocols Substance Abuse Improvement Initiative (SAII) January 1, 2010

Medicaid Substance Abuse Treatment Self-Referral Protocols Substance Abuse Improvement Initiative (SAII) January 1, 2010 Medicaid Substance Abuse Treatment Self-Referral Protocols Substance Abuse Improvement Initiative (SAII) January 1, 2010 The Substance Abuse Improvement Initiative (SAII) allows Medicaid enrollees to select

More information

Facility/Organizational Providers Approval Signatures: Available Upon Request

Facility/Organizational Providers Approval Signatures: Available Upon Request 12/04/2006, 7/2/2007, Page 1 of 20 I. Purpose: A. To ensure facility/organizational provider applicants meet ValueOptions of California (VOC) credentialing criteria. B. This policy replaces ValueOptions,

More information

May 21, 2015 Joint Committee on Finance Paper #352

May 21, 2015 Joint Committee on Finance Paper #352 Legislative Fiscal Bureau One East Main, Suite 301 Madison, WI 53703 (608) 266-3847 Fax: (608) 267-6873 Email: fiscal.bureau@legis.wisconsin.gov Website: http://legis.wisconsin.gov/lfb May 21, 2015 Joint

More information

Frequently Asked Questions (FAQs) from December 2013 Behavioral Health Utilization Management Webinars

Frequently Asked Questions (FAQs) from December 2013 Behavioral Health Utilization Management Webinars Frequently Asked Questions (FAQs) from December 2013 Behavioral Health Utilization Management Webinars 1. In the past we did precertifications for Residential Treatment Centers (RTC). Will this change

More information