Posted by Behavioral Health Billing Solutions, LLC.
August 1st is a day away, ARE YOU READY?
On July 23rd, ODM held a follow up Stakeholder’s meeting to announce upcoming changes that include new services, new rates and changes to providers that can provide certain services. I’ve spent 5 hours today scouring the new, updated manual and comparing to our existing code and pricing grid and I can say that it wasn’t the easiest thing to do. I’m grateful I have a good team that made notes on the changes so I knew where to look.
Here is a link to the webinar and here is a link to the updated manual. I recommend you read them both top to bottom like I did, making notes as you go.
I did have a few important takeaways from my review. Some may have actually been there but they provided some clarity for me since I had some recent questions about these topics.
Roll-ups: I’m pretty sure this was existing but I had someone ask about it last week so perhaps it is worth repeating. This is a commonly asked question.
Claims Detail Rollup for Same Day Services:
When the same service(s) are provided to the same patient on the same day, claims need to be “rolled up” and submitted as one detail line even if the services are not provided continuously on the same day.
Services that need to be rolled must be rolled by the same date of service, same client, same HCPCS code, same modifier(s), same individual rendering practitioner NPI, same supervisor NPI, and same place of service.
Example 1: Amy Smith, RN (NPI 9876543210) and John Jones, RN (NPI 9876543211) each provide two 15-minute nursing services (H2019) to Betty Brown.
The correct way to bill these services is by submitting two detail lines on a single claim.
1. Claim detail one would be: Amy Smith, RN, NPI in rendering provider field: 9876543210, with two units of H2019.
2. Second claim detail would be: John Jones, RN, NPI in rendering provider field: 9876543211, with two units of H2019.
It would be inappropriate to roll these services under either just Amy or John and bill 4 units of H2019 since Amy and John are separately enrolled in MITS with their own unique NPIs.
If a LSW and a LPC provide individual CPST to the same client on the same day, those services may be not be rolled because the practitioner NPIs are different.
Another frequent question we receive is how a Care Management Specialist and Qualifact Mental Health Specialist reach that designation. Under the new dual provider standards, a CMS can also be a QMHS and therefore provide service to both SUD and MH clients. Since many clients are dual diagnosis, this is a practice I highly recommend. However, not being clinical, I’m always stumped by what’s involved in the process to become either. Please see below for guidance from BH Redesign manual that I found very helpful.
* Care Management Specialist (CMS)
A care management specialist (CMS) is an individual who has received training for or education in alcohol and other drug addiction, abuse, and recovery and who has demonstrated, prior to or within ninety days of hire, competencies in fundamental alcohol and other drug addiction, abuse, and recovery. A CMS is an individual who is not otherwise designated as a provider or supervisor, and who is not required to perform duties covered under the scope of practice according to Ohio professional licensure. A CMS must be supervised by an individual qualified to be an alcohol and drug treatment services supervisor.
Fundamental competencies shall include, at a minimum:
An understanding of alcohol and other drug treatment and recovery. An understanding of how to engage a person in treatment and recovery. An understanding of other healthcare systems, social service systems and the criminal justice system.
*Qualified Mental Health Specialist (QMHS)
A qualified mental health specialist (QMHS) is an individual who has received training or education in mental health competencies and who has demonstrated, prior to or within ninety days of hire, competencies in basic mental health skills along with competencies established by the agency, and who are not otherwise designated as providers or supervisors, and who are not required to perform duties covered under the scope of practice according to Ohio professional licensure.
Basic mental health competencies shall include, at a minimum:
Be at least 18 years old. Have a high school diploma or equivalent. An understanding of mental illness, psychiatric symptoms, and impact on functioning and behavior. An understanding of how to therapeutically engage a mentally ill person. o Concepts of recovery/resiliency. Crisis response procedures. An understanding of the community mental health system. De-escalation techniques. Understanding how his/her behavior can impact the behavior of individuals with mental illness.
Hopefully you find this information as helpful as I did because I think it is important to utilize your staff in the best way to provide complete services to your clients. As always, BHBS is here to help. Just email firstname.lastname@example.org.