Posted by Behavioral Health Billing Solutions, LLC

Sent a letter to the Editorial section of several publications over the weekend…..


Dear Editor,

As the owner of a Behavioral Health Billing Consultation and EHR Implementation agency, I’m in a unique position to provide insight on the issue of the Ohio Behavioral Health redesign and whether or not agencies and vendors are ready.

I am well versed in the redesign, strong experience in behavioral health billing and working with agencies that use a variety of vendors. I am also testing for two software vendors that between them, represent about 90 Behavioral Health agencies in Ohio.

I have direct, first-hand knowledge that these vendors and others, as well as the agencies they provide software for may not be ready in time to meet the scheduled deadline.

The issue is related to recent policy changes that occurred April 12, 2017. While I agree with the changes in policy, it forced vendors to go back to the drawing table.

Recently at a work group, we demonstrated inconsistencies between the information available to us and the information we are being told is needed for claims to be paid. The information is still incorrect. 

We also asked for the following information on testing to be provided and have requested it again for this week’s meeting. 

How many Trading Partners have tested?

For how many Medicaid Providers?

A pass/fail percentage?

A percentage of billed verses paid claims?

We hope to receive answers to our questions at this week’s EDI Workgroup.

Getting this information is critical to determine whether or not ALL agencies and vendors are ready.

This is not ONLY a small agency issue. Let’s ask for information that demonstrates agencies are ready, a hands raised question, if you will. I deal with large and small agencies and not a single vendor is ready and that’s not the fault of the vendor, it’s due to the changing requirements of the Ohio Rules.

Recently, I spoke to an agency whose plans include an inability to bill for 6 months because they do not believe their vendor will be ready. Think about this…. What agency can sustain not being able to bill for one month, let alone 6? The vendor this agency uses is not one I am testing for but I know them well. I do not know their plans for the redesign and I’m fairly certain, neither do their clients.

Yes, I have been able to successfully bill test files out of both systems. However, my completed testing CANNOT be counted as successful. The functionality needed to meet the changes simply does not exist in either. Plus, the reimbursement is 25%-70%, not the 96%-98% my clients normally receive.

And don’t forget, there are 146 Behavioral Health Agencies with no affiliated providers. This is a REQUIRED first step in the process to initiate the coding changes. An agency without affiliated providers may not be able to bill as of July 1st and they will be unable to request a prior authorization, which is now required for some services.

What does this mean to Ohio BH agencies and the communities we serve?

It means that a small percentage of agencies will be able to bill as of July 1st. Most don’t have the level of expertise to navigate the technical knowledge that is necessary to make this work if their software is not ready.

So smaller agencies in Ohio and potential large ones, will be in financial trouble immediately. Impact to their communities will mean no access to service, longer wait times for treatment, and the public will not be able to receive treatment they need.

A DECREASE in access to service does nothing to assist with the epidemic in our state.

Let me close with the fact that I agree the proposed changes to behavioral health are needed for us to be compliant with national coding standards.

The fact is that once the Ohio rules that drive these changes are finalized, vendors and agencies should have 6 months to develop software, train billing staff and implement the necessary clinical changes at the agency level. The rules are not final.

 My hope is the Ohio Senate honors the request in HB49 to delay the Ohio Behavioral Health Redesign from July 1, 2017 to January 1, 2018 so we can have time to prepare once the rules are final.

Respectfully, Teresa Heim

Behavioral Health Billing Solutions, LLC