The Top Changes and Challenges that May Affect Your Reimbursement NOVEMBER 7, 2017
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1 BILLING FOR BEHAVIORAL HEALTH IN 2018 The Top Changes and Challenges that May Affect Your Reimbursement NOVEMBER 7, 2017
2 BILLING FOR BEHAVIORAL HEALTH IN 2018 AGENDA 1 About Echo 2 Echo Expertise 3 The State of Behavioral Health Billing 4 The Changing Definition of Reimbursement 5 Tools of the Trade 6 Square Peg in a Round Hole 7 Controlling Your Own Destiny 8 Q & A
3 ABOUT ECHO Making our partners clinically effective and financially strong Privately owned since 1981 Partners in over 35 states Over 35 years of experience providing software and services Our partners, collectively, work with each of the MCOs and DMH With Echo, we ve developed a partnership that promotes flexibility, an adaptability to meet the electronic health record needs of an ever-changing mental healthcare environment.
4 ECHO EXPERTISE Billing for Behavioral Health in 2018 Suki Norris Senior Knowledge Engineer Suki joined The Echo Group in 1996 and has more than 35 years of experience in healthcare including healthcare law, managed care and behavioral health. Suki has extensive experience with Medicaid waivers, meaningful use, and the Excellence in Mental Health Act. She has worked extensively in data analysis, including analysis of big data in support of clients and ongoing research. Her knowledge of behavioral health law has been sought by customers across the country as they address specific needs such as managed care and Health Information Exchange implementation. Suki received her Bachelor's Degree in economics from Mills College and her Juris Doctor degree from Golden Gate University.
5 THE STATE OF BEHAVIORAL HEALTH BILLING What are the top billing challenges in 2018? Understanding the rules of today Anticipating the (your) rules for tomorrow Selecting, setting, and adapting your technology for today, tomorrow, and the day after, and the day after that, and the day after that, and the day after that Quality Assurance Measures Teaching to the test
6 THE CHANGING DEFINITION OF REIMBURSEMENT Understanding the rules of today Fee for Service The Triple Aim MACRA
7 THE CHANGING DEFINITION OF REIMBURSEMENT Anticipating the (your) rules for tomorrow The trek to Alternate Payment Models
8 THE CHANGING DEFINITION OF REIMBURSEMENT Category 1 Fee-for-Service Claim for each service provided Quality is based on internal processes
9 THE CHANGING DEFINITION OF REIMBURSEMENT Category 2 Fee for Service Link to Quality Foundational Payments for Infrastructure & Operations Pay For Reporting Rewards for Performance Rewards and Penalties for Performance
10 THE CHANGING DEFINITION OF REIMBURSEMENT Category 3 APMs Built on Fee for Service Alternative Payment Methods with Upside Gainsharing Alternative Payment Methods with Upside Gainsharing / Downside Risk
11 THE CHANGING DEFINITION OF REIMBURSEMENT Category 4 Population-Based Payment Condition-Specific Population-Based Payment Comprehensive Population-Based Payment
12 TOOLS OF THE TRADE Selecting, setting, and adapting your technology for today, tomorrow, and the day after The most important tool is you Know the answer before asking the question Having the right tools in your tool box Selecting the right technology (businesses) partner
13 SQUARE PEG IN A ROUND HOLE Teaching to the test Value = Better Care Quality vs. Quantity Quality care is evidenced based Clients and Providers are paramount
14 SQUARE PEG IN A ROUND HOLE Challenge with the test Based on quality Quality is represented by measures Measures are calculated using claims data or data from your Electronic Health Record About Measures 653 Endorsed Measures 55 (of the 653) address Behavioral Health Conditions Of the 55 only 9 are outcomes measures Of the 55 only 15 are related to Substance Use Disorder No outcomes addressing Social and Behavioral Determinants
15 CONTROLLING YOUR OWN DESTINY What you should be doing now Over 50% of states participate in delivery system including APM reimbursement Do you know what your states is doing? Follow your state activities Waivers submitted by the state Manage care contracts entered into by the state Volunteer a stakeholder when you have the chance Monitor the development of new quality measures Join the task force Provide comments
16 QUESTIONS
17 ARTICLES FOR FURTHER CONSIDERATION Quality and Parity: New Payment Models for Behavioral Health, The Kennedy Forum, September 8, 2017 Payment Reforms and Opportunities for Behavioral Health: Alternative Payment Model Examples, Scattergood, September 2017 Behavioral Health Draft Report for Comment, National Quality Forum, April 5, 2017 The Current State of Behavioral Health Quality Measures: Where Are the Gaps?, Psychiatric Services, August 2015 Fixing Behavioral Health Care in America, The Kennedy Forum, 2015 Value-Based Mental Health Care Delivery, Professor Michael E. Porter, February 29, 2012 The Quality of Care for Adults with Mental and Addiction Disorders: Issues in Performance Measures, Constance M. Horgan, Deborah W. Garnick, January 10, 2005
18 BILLING FOR BEHAVIORAL HEALTH IN 2018 The Top Changes and Challenges that May Affect Your Reimbursement NOVEMBER 7, 2017
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