How To Get Paid For Measurement-Based Care
If your practice hasn’t started administering outcome measures or using measurement-based care, you should be. Why? Not only is it rapidly becoming the standard of care, but it allows you to achieve better patient outcomes faster, and you can get paid more for using it.
Measurement-based care is defined as the systematic administration of symptom rating scales and other assessment tools to track patient progress, inform and improve treatment outcomes, and measure results. You can learn more about what it is, why you should use it, and how to get started here.
Payers are motivated when it comes to measurement-based care as they recognize the correlation between better behavioral outcomes and improved physical health. They are motivated enough to actually pay more to clinicians who provide measurement-based care. Quality care takes time, and it should be rewarded and compensated.
CPT Codes for Measurement-Based Care
A newer (since 2015) standalone CPT code—96127—is approved by the Center for Medicare and Medicaid Services and is being reimbursed by major insurance companies like Aetna, Anthem, Cigna, Humana, United Healthcare, Medicare, and others (Banks para. 1). CPT code 96127 is used to report brief behavioral or emotional assessments for reimbursement.
To use CPT code 96217, you provide the outcome measure(s) to the patient, the patient takes the assessment(s), and the data is reviewed, summarized, and added to the patient’s notes. With the right EHR, such as Valant’s EHR for Behavioral Health, this entire process can be automated. From there, simply add CPT code 96217. It can be billed multiple times for each patient per visit. Using this billing code can generate anywhere from 5%-20% over your standard payment. Every plan is different so it is very important to check your fee schedules and with your network representative to see what is covered, what are the limits, and what are the guidelines. If your payer refuses to pay this CPT code, you may need to revisit your payor negotiation plan.
Doctor Melinda Fierros, president and CEO of Total Insight Psychiatric Services, spoke about billing with CPT code 96127.
“I heard about this code during my time in the military; they suggested we use it because they use a lot of measurements. I clued into this as I knew one day, I would be opening a practice of my own. In my mind, this was great because as a psychiatrist delivering quality care, it was important to me that I was recognized for my time and good work. Quality care takes time, and it should be rewarded and compensated.” Read more about Dr. Fierro’s experience here.
Don’t Leave Money on the Table
Becoming your own advocate comes down to learning how to better negotiate with payers. Your network representative is one of the first, and best places, to begin your process. Utilize your existing relationship or start building one. Set up regular check-in meetings and educate them on why paying a few dollars for this CPT code can save them thousands per year.
With the right behavioral health EHR, you can provide your payers with measurement-based care data as well as other types of data to bolster your case. Business data such as time-to-appointment, coupled with outcome data trends for individual patients or the entire practice, can be effective tools for negotiating better rates.
Getting paid for CPT code 96127 can actually add up to hundreds of thousands of dollars every year depending on the number of patients seen.
Fierros shared her keys to success, “Each time I attend the popular Behavioral Health Conferences (APA, AACAP) I always go to a coding session and they have been advocating we try to do this for a long time. I told my biller to make sure we ask about 96127 whenever we get the contracts and to make sure it is on the list of things that we’ll be billing frequently. I still see patients from insurances that don’t include reimbursement, but it adds up from those that do. I’m not doing extra work. I’m just getting rewarded for the work that I do.”
Aligning Your Business to the Value-Based Care Model
The industry is changing and moving towards a value-based care model. BlueCross BlueShield of Western New York is one example of a provider group with a value-based reimbursement plan. Value-based care is really about quality over quantity—better patient outcomes, less errors, improved patient and provider satisfaction, and lower costs. In a value-based care model, providers need to show they are offering better quality of care so they can be paid for value, not services. Payers will incorporate performance measures that document processes and outcomes and pay if those measures are met, and they are paying more for it.
This model is still immature in the behavioral health industry, but it is picking up steam and you should begin aligning your business to support it with the right tools and processes.
Choosing the Right Technology to Facilitate Measurement-Based Care
Implementing measurement-based care can be difficult without the right technology. While it is possible to facilitate the use of outcome measures manually, it is cumbersome to create meaningful data that payors need to compensate you for the higher-quality care you’re providing.
Using an EHR that is built for behavioral health and that automates the collection, tabulation, and reporting of outcomes data makes the process of implementing measurement-based care and getting paid for it fairly painless.
How Valant Supports Measurement-Based Care
Valant’s EHR not only automates the administration of outcome measures and other screening tools, but also provides seamless CPT code administration. For example, you can use 99215 in combination with 90838 plus you can add on 96127. Valant allows you to add as many codes as necessary for each session and for each of the measures you administered ensuring you get paid for the high-quality care you’re providing.
Want to see how Valant’s outcome measure automation works?