CCBHC Demonstration Service Procedure Code Billing Cycle

CCBHC Demonstration Service Procedure Code Billing Cycle

One of the key factors to becoming a successful Certified Community Behavioral Health Clinic (CCBHC) will be to have an efficient and effective Medicaid CCBHC demonstration service code billing cycle. If billings are not accurate or timely, cash flow will squeeze quickly. To have an effective billing cycle you must have accurate and timely encounter chart notes, an experienced billing team, proper oversight and self-audit procedures, and a billing system that is user-friendly with a robust reporting mechanism. High Quality Chart Notes The quality of a CCBHC billing cycle will only be as good as the provider chart notes documented for each encounter. Chart notes initiate the whole process and if you’re off track on step one, you’re already setup for failure. Chart notes can often be under-documented or overly-wordy. Providers, operations management, and key billing staff should corroborate to find the balance that best works for your CCBHC and meets Medicaid demonstration program service billing standards. Focus on the main service areas that act as trigger words for billing. For assistance with this, Oregon Health Authority (OHA) has provided a helpful demonstration service key. Quality chart notes will directly lead to quality billings. This means less rebilling, better capacity for providers and billing staff, and reliable program cash flows.   Self-Audit and Reporting Metrics An essential part of a self-sustaining billing cycle is adequate oversight. There should be personnel available within the organization that have the accountability and capacity to spot check billings before submission to Medicaid. This team member can also look at encounter data and compare it against collections to identify any weak areas. The answers...
Prospective Payment System (PPS) Critical to Oregon CCBHCs

Prospective Payment System (PPS) Critical to Oregon CCBHCs

Why is the PPS critical to CCBHCs? It’s how the CCBHC drives its mission. CCBHCs are paid through a PPS similar to that used by Federally Qualified Health Centers and other types of providers. States may select from two options for their PPS: a daily rate or a monthly rate. Oregon has selected to use the daily rate (PPS-1). Based on this selection, Oregon CCBHCs will be paid a single daily rate for each Medicaid patient who receives services at the clinic (or Designated Collaborating Organization) during that day. The same rate is paid regardless of the services provided to the patient. PPS rates are specific to each CCBHC. In establishing PPS rates, CCBHCs must create a cost report, including the cost of providing all services to all patients, in order to establish the per-day cost of serving Medicaid patients in your CCBHC. The PPS rate is applicable to Medicaid patients only. The cost report will likely include estimated costs related to new services and/or new costs to be provided and incurred during the demonstration phase. The cost of DCO services is included in the CCBHC PPS rates, and DCO encounters are treated as CCBHC encounters for purposes of the PPS. If there is one thing a provider needs to get right on the forefront of operations as a new CCBHC, it’s ensuring it is paid sufficiently for the service rendered to secure operational sustainability. The CMS released its template CCBHC Cost Report and CCBHC Cost Report Instructions for use by states participating in the two-year Demonstration Program. The CMS CCBHC cost report and instructions assist states in developing their unique PPS-1 rates...
Impact to Oregon’s Changing Behavioral Health Landscape

Impact to Oregon’s Changing Behavioral Health Landscape

Who will be affected by the CCBHC demonstration program beginning spring 2017? The Excellence in Mental Health Act demonstration program will result in profound changes to this country’s mental health landscape. First, behavioral health clientele and members of our communities will benefit directly. We expect to see better needs assessment, client reach, access, and depth of care. CCBHCs will also better integrate care with the clients’ primary care provider to ensure the clients’ health is reviewed holistically. Second, behavioral health providers becoming CCBHCs will see an array of new opportunities and requirements: CCBHCs will become a new provider type in Medicaid. CCBHCs will be defined by their trauma-informed care and recovery and wellness focus, not just on their comprehensive range of services provided. Trauma-informed care is the foundation of the new CCBHC standard of care. CCBHCs will be eligible for improved billings through a prospective payment system (PPS) aimed to reimburse providers consistent with expected costs of servicing clients in their communities. This allows CCBHCs access to reimbursements for client services not typically funded through current payers. CCBHCs are responsible for meeting unique requirements and for providing nine required services. This includes coordination of care through community health and social service provider partnerships. Finally, community health and social service providers working with CCBHCs will see both benefits and requirements increase. These organizations, coined “Designated Collaborating Organizations (DCOs),” will partner with CCBHCs through contractual agreements to provide supporting services to CCBHC clients. DCOs will see expanded demand for their reserves, coupled with new and better paying funding streams. DCOs will be required to provide services consistent with CCBHC standards.   We...
Oregon Selected for New Behavioral Health Program

Oregon Selected for New Behavioral Health Program

The US Department of Health & Human Services, through the Substance Abuse and Mental Health Services Administration (SAMHSA), has recently announced that Oregon has been selected as one of eight states to participate in the newly created Certified Community Behavioral Health Clinic (CCBHC) two-year demonstration program. Oregon behavioral health providers applying to be CCBHC certified are expected to be CCBHC operational no later than June 30, 2017. CCBHCs were created through Section 223 of the Protecting Access to Medicare Act, establishing a demonstration program through the Excellence in Mental Health Act. The Excellence in Mental Health Act demonstration program is an initiative to grow and improve access to mental health and addiction care in a supportive and collaborative community-based environment. The Excellence in Mental Health Act established a federal definition and criteria for CCBHCs and provided that CCBHCs would be eligible for an increased Medicaid reimbursement rate based on their state approved costs of care. CCBHCs are responsible for directly providing (or contracting with partner organizations to provide) required services, with an emphasis on 24-hour crisis care, utilization of evidence-based practices, coordination of care, and integration with primary care service. The Federal Government estimates that the demonstration program is expected to infuse more than $1.1 billion into the communities served by CCBHCs, making it one of the largest investments in mental health and addiction care ever. See full press release here: https://www.thenationalcouncil.org/capitol-connector/2016/12/samhsa-announces-states-selected-ccbhc-demonstration/   We are committed to staying abreast of developing news and update regarding this development. We recognize that many aspects of the regulation are subject to change.   Mathew Hamlin, CPA is a member of the Jones...
Jones & Roth Launches New Behavioral Health Practice

Jones & Roth Launches New Behavioral Health Practice

Jones & Roth CPAs and Business Advisors are pleased to announce that the Firm has formalized a niche practice devoted to serving Behavioral Health Clinics. Jones & Roth has been serving the behavioral health community for over 15 years through its specialized healthcare and nonprofit practice areas. This new initiative to formalize the Behavior Health practice is in response to the recent announcement by The Substance Abuse and Mental Health Services Administration (SAMHSA) that there has been a selection of eight states to participate in the Certified Community Behavioral Health Clinic (CCBHC) demonstration under the Excellence in Mental Health Act. Beginning in 2017, certified clinics in the eight states will receive an enhanced Medicaid payment rate based on their anticipated costs of providing an expanded array of addiction and mental health services, along with basic primary care screening and coordination with primary care. The eight selected states include: Minnesota, Missouri, New York, New Jersey, Nevada, Oklahoma, Oregon and Pennsylvania. Jones & Roth anticipates that CCBHCs working with SAMHSA will benefit from a wide array of services including: · Prospective Payment System (PPS) rate costing and reporting advisory services · Medicaid wraparound (and other third party payer) billing best practices to ensure timely and accurate collections · Oregon CCBHC program best practices to maintain certification and to secure further funding · Program costing and functional expense allocation advisory · Annual financial statement audit and tax preparation The Jones & Roth Behavioral Health Practice will be led by Mathew Hamlin, CPA, Senior Manager and Brian Newton, CPA, Partner & Shareholder. “The new CCBHC program is a very exciting opportunity for behavioral health...