BH Redesign Billing Examples NextGen Users Group April 11, 2017
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 1 7-2-17 H2012 1 U9, HN, and HQ - - - - 2 7-5-17 H2012 2 HK, HQ LISW NPI - - - 3 7-10-17 H2012 2 U9, HO, and HQ - - - - 2
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 1 7-2-17 H2020 1 U9, HN - - - - 2 7-5-17 H2020 1 HK LISW NPI - - - 3 7-10-17 H2020 1 U8, HO - - - - 3
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 1 7-2-17 90839 1 - PSY NPI - - - 2 7-2-17 90840 2 - PSY NPI - - - 3 7-5-17 90839 1 - LISW NPI - - - 4 7-5-17 90840 1 - LISW NPI - - - 5 7-10-17 90839 1 U4 - - - - 4
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 1 7-2-17 90839 1 U9 - - - - 2 7-2-17 90840 2 U9 - - - - 3 7-5-17 90839 1 UA - Supervisor #2 NPI 4 7-5-17 90840 1 UA - Supervisor #2 NPI - - - - 5 7-10-17 90839 1 U9 - - - - Note: rate paid will be supervisor rate, e.g., LISW. 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 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 1 7-2-17 90839 1 U9 - - - - 2 7-2-17 90840 2 U9 - - - - 3 7-5-17 90839 1 UA - - - - 4 7-5-17 90840 1 UA - - - - 5 7-10-17 90839 1 U9 - - - - Note: rate paid will be 85% of supervisor rate. Medical record must reflect supervision. 6
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 1 7-2-17 H0005 8 U3, HK - - - - 7
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 1 7-2-17 H0001 1 U6 - - - - 2 7-2-17 H0048 1 U6 - - - - 3 7-2-17 H0004 6 U6 - - - - 4 7-3-17 H0005 8 HK LICDC NPI - - - 5 7-3-17 H0006 4 HO - - - - 8
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 1 7-2-17 H0001 1 U6 - - - - 2 7-2-17 H0048 1 U6 - - - - 3 7-2-17 H0004 6 U6 - - - - 4 7-3-17 H0005 8 HK LICDC NPI - - - 5 7-3-17 H0006 4 HO - - - - 6 7-3-17 T1002 4 HQ RN NPI - Ordering NPI - 7 7-6-17 H0015 1 HK LISW NPI 9
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 1 7-3-17 H0015 1 U4, HK - - - - 2 7-5-17 H0015 1 U4, HK - - - - 3 7-7-17 H0015 1 HK, TG LISW NPI - - PA# 45678 5 7-7-17 H0004 4 U9 - - - 10
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 1 7-2-17 90832 1 U9 - - (uses header) - - 2 7-5-17 90832 1 U4 - - - - 11
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 1 7-2-17 H2019 2 U9, HN - - - - 2 7-5-17 H0036 2 U4 - - - - 12
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 800-686-1516 ODM has communicated with HPE Support Desk re BH testing http://medicaid.ohio.gov/providers/billing/tradingpartners.aspx
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 800-686-1516 http://medicaid.ohio.gov/providers/billing/tradingpartners.aspx
15 Q & A Document Will continue to add questions as we receive them and provide responses.
Questions? 16