Courtney Benjamin Wolk1,2, Carol L Alter3, Rachel Kishton4, Jeffrey Rado5,6, Jacob A Atlas5, Matthew J Press2,7, Neil Jordan8,9,10, Michael Grant11, Cecilia Livesey1, Lisa J Rosenthal5,6, Justin D Smith8,12,13,14. 1. Department of Psychiatry, Perelman School of Medicine. 2. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. 3. Department of Psychiatry, Baylor Scott & White, Temple, TX. 4. National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA. 5. Northwestern Medicine. 6. Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. 7. Primary Care Service Line, University of Pennsylvania Health System, Philadelphia, PA. 8. Departments of Psychiatry and Behavioral Sciences. 9. Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago. 10. Center of Innovation for Complex Chronic Healthcare, Hines, IL. 11. Department of Information Sciences (Population Health), Northwestern Medicine. 12. Preventive Medicine. 13. Medical Social Sciences. 14. Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.
Abstract
BACKGROUND: There is strong evidence supporting implementation of the Collaborative Care Model within primary care. Fee-for-service payment codes, published by Current Procedural Terminology in 2018, have made collaborative care separately reimbursable for the first time. These codes (ie, 99492-99494) reimburse for time spent per month by any member of the care team engaged in Collaborative Care, including behavioral care managers, primary care providers, and consulting psychiatrists. Time-based billing for these codes presents challenges for providers delivering Collaborative Care services. OBJECTIVES: Based on experience from multiple health care organizations, we reflect on these challenges and provide suggestions for implementation and future refinement of the codes. CONCLUSIONS: Further refinements to the codes are encouraged, including moving from a calendar month to a 30-day reimbursement cycle. In addition, we recommend payers adopt the new code proposed by the Centers for Medicare and Medicaid Services to account for smaller increments of time.
BACKGROUND: There is strong evidence supporting implementation of the Collaborative Care Model within primary care. Fee-for-service payment codes, published by Current Procedural Terminology in 2018, have made collaborative care separately reimbursable for the first time. These codes (ie, 99492-99494) reimburse for time spent per month by any member of the care team engaged in Collaborative Care, including behavioral care managers, primary care providers, and consulting psychiatrists. Time-based billing for these codes presents challenges for providers delivering Collaborative Care services. OBJECTIVES: Based on experience from multiple health care organizations, we reflect on these challenges and provide suggestions for implementation and future refinement of the codes. CONCLUSIONS: Further refinements to the codes are encouraged, including moving from a calendar month to a 30-day reimbursement cycle. In addition, we recommend payers adopt the new code proposed by the Centers for Medicare and Medicaid Services to account for smaller increments of time.
Authors: Justin D Smith; Emily Fu; Jeffrey Rado; Lisa J Rosenthal; Allison J Carroll; Jacob A Atlas; Andrew D Carlo; Inger Burnett-Zeigler; Neil Jordan; C Hendricks Brown; John Csernansky Journal: Contemp Clin Trials Commun Date: 2021-07-26
Authors: Emily Fu; Allison J Carroll; Lisa J Rosenthal; Jeffrey Rado; Inger Burnett-Zeigler; Neil Jordan; Andrew D Carlo; Adaora Ekwonu; Ariella Kust; C Hendricks Brown; John G Csernansky; Justin D Smith Journal: J Gen Intern Med Date: 2022-08-05 Impact factor: 6.473