BH Redesign Billing Examples. NextGen Users Group. April 11, 2017
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1 BH Redesign Billing Examples NextGen Users Group April 11, 2017
2 Billing Example: Mental Health Day Treatment Hourly July 2 nd, 2017: 1 hour of MH Day treatment is provided by a bachelor s level social worker trainee July 5 th, 2017: 2 hours of MH Day treatment is provided by a LISW July 10 th, 2017: 2 hours of MH Day treatment is provided by a Master s level social worker trainee Optional/Not required Blank Agency NPI H U9, HN, and HQ H HK, HQ LISW NPI H U9, HO, and HQ
3 Billing Example: MH Day Treatment Per Diem July 2 nd, 2017: 3 hours of MH Day treatment is provided by a Bachelor s level social worker trainee July 5 th, 2017: 5 hours of MH Day treatment is provided by a LISW July 10 th, 2017: 4 hours of MH Day treatment is provided by a Master s level social worker assistant Optional/Not required Blank Agency NPI H U9, HN H HK LISW NPI H U8, HO
4 Billing Example: MH or SUD Crisis by Licensed Practitioners July 2 nd, 2017: 2 hours of MH or SUD crisis psychotherapy service is provided by a psychologist July 5 th, 2017: 1.5 hours of MH or SUD crisis psychotherapy service is provided by a LISW July 10 th, 2017: 1 hour of MH or SUD crisis psychotherapy service is provided by a licensed social worker - - Agency NPI PSY NPI PSY NPI LISW NPI LISW NPI U
5 Billing Example: MH or SUD Crisis Psychotherapy by Unlicensed Practitioners July 2 nd, 2017: 2 hours of MH or SUD crisis psychotherapy service is provided by a social worker trainee under direct supervision by supervisor #1 July 5 th, 2017: 1.5 hours of MH or SUD crisis psychotherapy service is provided by a marriage and family therapist trainee under direct supervision by supervisor #2 July 10 th, 2017: 1 hour of MH or SUD crisis psychotherapy service is provided by a social worker trainee under direct supervision by supervisor #1 Supervisor #1 NPI - Agency NPI U U UA - Supervisor #2 NPI UA - Supervisor #2 NPI U Note: rate paid will be supervisor rate, e.g., LISW. 5
6 Billing Example: MH or SUD Crisis Psychotherapy by Unlicensed Practitioners July 2 nd, 2017: 2 hours of MH or SUD crisis psychotherapy service is provided by a social worker trainee under general supervision by supervisor #1 July 5 th, 2017: 1.5 hours of MH or SUD crisis psychotherapy service is provided by a marriage and family therapist trainee under general supervision by supervisor #2 July 10 th, 2017: 1 hour of MH or SUD crisis psychotherapy service is provided by a social worker trainee under general supervision by supervisor #1 - - Agency NPI U U UA UA U Note: rate paid will be 85% of supervisor rate. Medical record must reflect supervision. 6
7 Billing Example: SUD Group Counseling July 2 nd, 2017: 2 hours of SUD group counseling were led by a licensed chemical dependency counselor II (LCDC II) and a chemical dependency counselor assistant (CDC-A) *When group services are provided by more than one practitioner for the entire duration, the highest level practitioner should be reported on the claim. Optional/Not required Blank Agency NPI H U3, HK
8 Billing Example: ASAM Level 1: Outpatient Services (5.5 Hours) July 2 nd, 2017: A chemical dependency counselor assistant (CDC-A) assesses a patient for one hour July 2 nd, 2017: A urine drug screen is performed by the CDC-A July 2 nd, 2017: 1.5 hours of individual counseling are provided by a CDC-A July 3 rd, 2017: Individual participates in 2 hours of group counseling led by a licensed independent chemical dependency counselor (LICDC) July 3 rd, 2017: A Master s level care management specialist provides 1 hour of SUD case management service - - Agency NPI H U H U H U H HK LICDC NPI H HO
9 Billing Example: ASAM Level 2: Intensive Outpatient (10.5 Hours) July 2 nd, 2017: One hour of assessment is provided by a chemical dependency counselor assistant (CDC-A) July 2 nd, 2017: A urine drug screen is performed by the CDC-A July 2 nd, 2017: 1.5 hours of individual counseling are provided by the CDC-A July 3 rd, 2017: Individual participates in 2 hours of group counseling led by a licensed independent chemical dependency counselor (LICDC) July 3 rd, 2017: A Master s level care management specialist provides 1 hour of SUD case management services July 3 rd, 2017: A registered nurse provides 1 hour of group education about medication management July 6 th. 2017: Individual participates in 4 hours of group counseling led by a licensed independent social worker - - Agency NPI H U H U H U H HK LICDC NPI H HO T HQ RN NPI - Ordering NPI H HK LISW NPI 9
10 Billing Example: IOP and Partial Hospitalization July 3 rd, 2017: Individual participates in 6 hours of group counseling led by an LSW July 5 th, 2017: Individual participates in 6 hours of group counseling led by an LSW July 7 th, 2017: agency receives prior authorization for Partial Hospitalization level of care; individual participates in 6 hours of PH group counseling led by an LISW, as well 1 hour of individual SUD counseling provided by a SWT Not required Not required Agency NPI H U4, HK H U4, HK H HK, TG LISW NPI - - PA# H U
11 Billing Example: CPT and Supervision July 2 nd, 2017: a social work trainee (SWT) provides a 30 minute individual psychotherapy service under direct supervision by an LISW (the LISW is immediately available and interruptible by the SWT). July 5 th, 2017: An LSW provides a 30 minute individual psychotherapy service under general supervision by an LISW (the LISW is available by phone for the LSW to consult with) LISW NPI Blank Agency NPI U9 - - (uses header) U
12 Billing Example: HCPCS and General Supervision July 2 nd, 2017: 30 minutes of TBS is provided by a Bachelor s level social worker trainee July 5 th, 2017: 30 minutes of CPST is provided by an LSW - Blank Agency NPI H U9, HN H U
13 13 ODM Preparation for Trading Partner Testing Rapid Response Team A May June Respond to trading partner-identified issues Communicate ODM-identified issues Communication BH-Enroll@medicaid.ohio.gov ODM has dedicated phone option for trading partners on Provider Hotline ODM has communicated with HPE Support Desk re BH testing
14 14 ODM Preparation for July Rapid Response Team B July - end date determined based on need Respond to provider-identified issues regarding claims processing Communication BH-Enroll@medicaid.ohio.gov ODM to provide dedicated phone option on Provider Hotline
15 15 Q & A Document Will continue to add questions as we receive them and provide responses.
16 Questions? 16
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