Transcript Scha-Mi Behavioral Health Webinar - School

Behavioral Health Provider
Update
Overview
Upcoming changes for providers:
 What’s new & Who it effects
 Coding/Billing Information
 Credentialing/Enrollment
What’s New
FOR BEHAVIORAL HEALTH PROVIDERS
Bulletin: MSA 15-44
Michigan Department of Health and Human Services
(MDHHS) has begun enrolling behavioral health
providers to the Medicaid program. “Fee-for-service
outpatient behavioral health visits will be increased
from 10 to a maximum of 20 combined visits in a 12month period, per beneficiary, by all providers of
behavioral health services.”
What’s new?
January 1st, 2016, Behavioral Health provider will be
able to bill Medicaid of Michigan for services.
Link to Bulletin MSA 15-44:
www.michigan.gov/documents/mdhhs/msa_15-44_504790_7.pdf
December 1st, 2015, provider enrollment began.
www.michigan.gov/medicaidproviders
Provider Support: 1-800-292-2550
**Enrollment as a provider is done through CHAMPS with MDHHS. You must set up
a user account before going forward with provider enrollment. Please use above link to
access CHAMPS**
Who is eligible?
 Psychologists (Master’s Limited or Doctoral Level)
 Social Workers (Master’s Level)
 Professional Counselors (Master’s or Doctoral
levels)
**Limited licensed psychologists, social
workers, professional counselors or student
interns must be overseen by enrolled, fullylicensed provider of the same profession**
Who Is Eligible?
 Student Interns
See Bulletin MSA 15-44
 Tribal Health Centers
See Bulletin MSA 15-44
Questions
WHO IS ELIGIBLE
Coding & Billing
PROCESS
Behavioral Health CPT Codes
CPT Code
90785
Code Description
Max Fee
Add-on code to be used in conjunction with codes for primary service:
$9.11
psychiatric diagnostic evaluation (90791); psychotherapy (90832, 90834,
90837); and group psychotherapy (90853)
90791
Psychiatric diagnostic evalaution
$72.31
90832
Psychotherapy, 30 minutes with patient and/or family member
30 minutes
$36.05
90834
Psychotherapy, 45 minutes with patient and/or family member
45 minutes
$47.35
90837
Psychotherapy, 60 minutes with patient and/or family member
60 minutes
$70.13
90839
Psychotherapy for crisis, first 60 minutes
60 minutes
$73.50
90840
Add on for each additional 30 minutes of psychotherapy for crisis, used
each additional
$35.26
in conjunction with code 90839
30 minutes
90847
Family psychotherapy, with patient present
$59.03
90853
Group psychotherapy
$14.26
Access full code list at: www.scha-mi.org/events
How to Use Codes
Actual length of session
Code As
Code Description
Max Fee
0-15 minutes
Not reported
16-37 minutes
90832
30 minutes (with patient and/or
family member)
$36.05
38-52 minutes
90834
45 minutes (with patient and/or
family member)
$47.35
53-89 minutes
90837
60 minutes (with patient and/or
family member)
$70.13
Group Psychotherapy
90853
$14.26
How to use Codes cont.
What is the difference between 90791 and 90792?
90791: psychiatric diagnostic evaluation without medical services, is an “integrated
biopsychosocial assessment, including history, mental status, and recommendations.
The evaluation may include communication with family or other sources and review and
ordering of diagnostic studies.” (CPT 2013 guidelines)
90792: psychiatric diagnostic evaluation with medical services is “an integrated
biopsychosocial and medical assessment, including history, mental status, other
physical examination elements as indicated, and recommendations. The evaluation may
include communication with family or other sources, prescription of medications, and
review and ordering of laboratory or other diagnostic studies.” (CPT 2013 guidelines)
What are the codes for crisis services?
90839: Psychotherapy for crisis; first 60 minutes
+90840: each additional 30 minutes (listed separately in addition to the code for primary
services)
*this is an add-on code
Does the CPT time rule apply to the codes for crisis services?
Yes. According to CPT guidelines, “90839 is used to report the first 30-74 minutes of
psychotherapy for crisis on a given dates… Psychotherapy for crisis of less than 30
minutes total duration on a given date should be reported with 90832 or 90833 (when
provided with evaluation and management services). Code 90840 is used to report
additional block(s) of time, of up to 30 minutes each beyond the first 74 minutes.”
Billing
 Electronically accepted
Professional format ASC X12N 837 5010
 CMS 1500 paper claims
See manual for specifics on submitting
Manual: www.michigan.gov/medicaidproviders
~Policy and Forms
~Medicaid Provider Manual
Questions
CODING & BILLING
Credentialing & Enrollment
PROCESS
Credentialing
 Credentialing & Enrollment
~Identification/verification of all required
documents and information
~Facility and/or group
~Practitioner
~Creation/update of practitioner’s Council for
Affordable Quality Healthcare [CAQH] file
~Identification of geographic area’s insurance
payers
~Registration & enrollment with identified payers
~Continued attestation of CAQH and payer
enrollments/credentialing
Enrollment
 Enrollment with Medicaid of Michigan
www.michigan.gov/medicaidproviders
~Scroll down under Hot Topics and click on
Champs icon
~Single Sign On (SSO)
Sign Up for user access
Access Information emailed
~Start enrollment process
MDHHS Provider Support: 1-800-292-2550
Questions
CREDENTIALING & ENROLLMENT
Review
 January 1st, 2016 start providing behavioral health
services
 December 1, 2015, enrollment began
 Credentialing/Enrollment
 Who is eligible:
Psychologists (Master’s Limited or Doctoral Level)
Social Workers (Master’s Level)
Professional Counselors (Master’s or Doctoral levels)
Useful Information
 www.michigan.gov/medicaidproviders
 www.michigan.gov/documents/mdhhs/msa_15-
44_504790_7.pdf
 MDHHS Provider Support: 1-800-292-2550
 www.scha-mi.org/events
Resources
 (2013, March 7th). National Council For Community
Behavioral Healthcare. Retrieved from
http://www.thenationalcouncil.org/wpcontent/uploads/2013/06/NC-CPT-FAQ-for-2013V3.pdf.
 MSA Bulletin. (2015, October 30). Retrieved from
www.michigan.gov/documents/mdhhs/msa_1544_504790_7.pdf.
Thank You
6035 Executive Drive Suite 103
Lansing, Michigan 48911
Phone: 517-908-0847
Fax: 517-908-0826
Website: www.scha-mi.org