Nationwide Client Base

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Brentwood, TN 37027 615.309.6053 www.healthtechs3.com

5110 Maryland Way 2745 North Dallas Pkwy

Suite 200 Suite 100

Dallas, TX 75093 800.228.0647 www.gaffeythealthcare.com

Managing Behavioral Health Patients in your Primary Care Practice with

Collaborative Care Management

March 18, 2021

Presented By: Faith Jones, MSN, RN, NEA-BC

Nationwide Client Base

Currently provides hospital

management, consulting services and technology to:

• Serving community, district, non-profit and Critical Access hospitals

Example Managed Hospital Client: Barrett Hospital and Healthcare in Dillon, MT, Ranked as a Top 100 Critical Access Hospital for 8 years in a row

Example technology and AR services client includes two-hospital NFP system in southeast GA with numerous associated physician practices

Preferred vendor to: • California Critical Access

Hospital Network

• Western Healthcare Alliance Partner with Illinois Critical Access Hospital Network • Vizient Group Purchasing

Organization

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• Executive management & leadership development

• Community health needs assessment

• Lean culture

• Executive and interim recruitment

• CEOs, CFOs, CNOs

• VP and Department Directors

• Performance optimization & margin improvement • Revenue cycle & business office improvement

• AR outsourcing

• Continuous survey readiness • Care coordination

• Swing bed consulting

Governance & Strategy

Recruitment Clinical Care & Operations

Finance

Areas of Expertise

Strategy – Solutions - Support

Interim Executive Services

 The Right Executive – our experience and

understanding of your hospital is the key to placing the right executive

 Immediate Response – Interim needs are typically immediate. Our bench strength allows us to find the right executive quickly to provide a seamless transition

 Experience – over 49 years of supporting executives & teams in hospitals and healthcare companies of all sizes

 Support Services – our business is managing hospitals more efficiently. We provide comprehensive support services to all our Interim Executives

 Our Depth:

We support all positions from middle management and up including clinical managers, HR up to CEO, CFO, CNO, CIO & Clinic Administration

 Interim Executive Placement Services:

“Blue Mountain Hospital District has benefited from the interim executive placement services

HealthTech S3 provides. Our current CFO started as an interim placement for BMHD, prior to joining our organization in a permanent capacity. The success with this placement has motivated us to consult Health Tech with two subsequent interim executive needs.” Derek Daly, CEO BMHD

Staffing Community Hospitals since 1971

HealthTechS3

Design.Build.Optimize High Performance Teams

Retained Contingency Interim Contract

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Mentoring/Support Team

Every Interim Executive is backed by a support team and mentor who help ensure that the team gets the right results

HealthTechS3

Design.Build.Optimize High Performance Teams

Retained Contingency Interim Contract

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6 © HTS3 2020|

You may type a question in the text box if you have a question during the presentation

We will try to cover all of your questions – but if we don’t get to them during the webinar we will follow-up with you by e-mail

You may also send questions after the webinar to our team (contact information is included at the end of the presentation)

The webinar will be recorded and the recording will be available on the HealthTechS3 web site:

www.healthtechs3.com

HealthTechS3 hopes that the information contained herein will be informative and helpful on industry topics. However, please note that this information is not intended to be definitive. HealthTechS3 and its affiliates expressly disclaim any and all liability, whatsoever, for any such information and for any use made thereof. HealthTechS3 does not and shall not have any authority

to develop substantive billing or coding policies for any hospital, clinic or their respective personnel, and any such final responsibility remains exclusively with the hospital, clinic or their respective personnel. HealthTechS3 recommends that hospitals, clinics, their respective personnel, and all other third party recipients of this information consult original source materials and

qualified healthcare regulatory counsel for specific guidance in healthcare reimbursement and regulatory matters.

Instructions for today’s Webinar

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Today’s Objectives

Upon completion of the webinar, the participant will understand:

1. The reimbursement model for general BHI and CoCM

2. The care and documentation requirements for BHI and

CoCM

3. The relationship between the patient, the care coordinator,

the primary care provider, and the psychiatric medical

provider

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Presenter

Faith Jones began her healthcare career in the US Navy over 35 years ago. She has worked in a variety of roles in clinical practice, education, management, administration, consulting, and healthcare compliance.

Her knowledge and experience span various settings from ambulatory to inpatient to post-acute. In her leadership roles she has been responsible for operational leadership for all clinical functions including multiple nursing specialties, pharmacy, laboratory, imaging, nutrition, therapies, as well as administrative functions related to quality management, case management, medical staff credentialing, staff education, and corporate compliance.

She currently implements care coordination programs focusing on the Medicare population and teaches care coordination concepts nationally. She also holds a Green Belt in Healthcare and is a Certified Lean Instructor.

[email protected] 307-272-2207

Faith M Jones, MSN, RN, NEA-BC Director of Care Coordination and

Lean Consulting

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Care Coordination Growth and Development

2013/2015: TCM / CCM Care Management 2016:Chronic Care Management for RHCs and FQHCs and Advance Care Planning 2017: Complex CCM, Behavior Health Integration, Collaborative Care Management 2018: RHC and FQHC Care Management and the Diabetes Prevention Program 2019:Team based Documentation, Chronic Care Remote Physiological Monitoring (CCRPM) 2020:Additional Time allowed for CCM, Expand to allow for billing of concurrent services, Principal Care Management (PCM) 2021: Change the G-Code to CPT for additional time for CCM Team Based Care AWV 2011 9 © HTS3 2020| 10

BHI vs IBH

Terminology Matters

BHI

– Behavioral Health Integration

• Care Coordination Model

IBH

– Integrated Behavioral Health

• Care Delivery Model

This Photoby Unknown Author is licensed under CC BY-SA

This Photoby Unknown Author is licensed under CC BY-NC-ND

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Service

Components

• CCM initiated by the primary care provider

• Availability of electronic

communication with patient and care giver

• Collaboration and communication with community resources & referrals

• After hours coverage

• Patient Centered Care Plan

• Primary Care Provider supervision of clinical staff

Patient Eligibility

• Medicare Patient

• Two or more chronic conditions expected to last at least 12 months or until the death of the patient

• At significant risk of death, acute exacerbation, decompensation, or functional decline without management • Patient Consent

• Documentation of at least 20 minutes per calendar month spent coordinating care

Elements of Chronic Care Management

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• BHI initiated by the primary care provider • Initial assessment

• Initiating visit (if required, separately billed) • Administration of applicable validated rating

scale(s)

• Systematic assessment and monitoring, using applicable validated clinical rating scales

• Care planning by the primary care team jointly with the beneficiary, with care plan revision for patients whose condition is not improving

• Facilitation and coordination of behavioral health treatment

• Continuous relationship with a designated member of the care team

• “Any mental, behavioral health, or psychiatric condition being treated by the billing practitioner, including substance use disorders, that, in the clinical judgment of the billing practitioner, warrants BHI services. The diagnosis or diagnoses could be either pre-existing or made by the billing practitioner and may be refined over time”.

• Patient Consent

• Documentation of at least 20 minutes per calendar month

Elements of Behavioral Health Integration

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/BehavioralHealthIntegration.pdf

Service

Components

Patient Eligibility

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CCM and General BHI Care Team

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/BehavioralHealthIntegration.pdf Team Based Care

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• Documentation of at least 20 minutes per calendar month • Does not include administrative or clerical staff time. • Supervision

• CCM and BHI services are typically not personally performed by the billing provider

• The services provided by the care coordinator and staff are assigned general supervision by the billing provider

• General supervision is defined as the service being furnished under the overall direction and control of the billing practitioner, and his or her physical presence is not required during service provision.

Time Tracking

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CCM

General BHI

• 1 Behavioral Health Diagnosis – determined by PCP

• Patient Consent (verbal or written)

• BHI initiated by the primary care provider • At a visit

• Visit not required for “established patient” Established = seen in 12 months

• Plan of Care including rating scale

• 2 Chronic Conditions – determined by PCP

• Patient Consent (verbal or written)

• CCM initiated by the primary care provider • At a visit

• Visit not required for “established patient” Established = seen in 12 months

• Plan of Care

Patient Eligibility Comparing CCM and BHI

Care Management 2021

Billed per calendar month for 20 plus minutes of BHI care coordination CPT Code 99484

National Average Reimbursement ~$44.40

Billing Code for FFS

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Billed per calendar month for 20 plus minutes of CCM care coordination OR

Billed per calendar month for 60 plus minutes of Complex Chronic Care Management OR

Billed per calendar month for 30 plus minutes of Provider Chronic Care Management OR

Billed per calendar month for 20 plus minutes of BHI care coordination CPT Code G0511

Billing Code for RHCs and FQHCs

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Collaborative Care Management Team

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Collaborative Care Management Team

What is CoCM?

A model of behavioral health integration that enhances “usual” primary care by adding two key services: care management support for patients receiving behavioral health treatment; and regular psychiatric inter-specialty consultation to the primary care team, particularly regarding patients whose conditions are not improving.

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• Enrolled as a BHI Patient

• All elements of General BHI apply

• Behavioral health care manager performs proactive, systematic follow-up using

validated rating scales and a registry

• Assesses treatment adherence, tolerability, and clinical response using validated

rating scales; may provide brief evidence-based psychosocial interventions such

as behavioral activation or motivational interviewing

• Regular case load review with psychiatric consultant – The primary care team

regularly (at least weekly) reviews the beneficiary’s treatment plan and status

with the psychiatric consultant and maintains or adjusts treatment, including

referral to behavioral health specialty care as needed

Elements of Collaborative Care Management

Service Components

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General BHI and Collaborative Care Management

Month

1 Month2 Month3 Month4 Month5 Month6 Month7 Month8 Month9 Month10 Month11 Month12

Billed per calendar month for 1st_{month of at least 70 plus minutes of BHI care coordination with}

Psychiatric Medical Consults CPT Code 99492

Billed per calendar month for subsequent month of at least 60 plus minutes of BHI care coordination with Psychiatric Medical Consults

CPT Code 99493

Billed with 99492 or 99493 for additional 30 minutes per calendar month of BHI care coordination with Psychiatric Medical Consults

CPT Code 99494

Billing Code for FFS

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Collaborative Care Management 2021

Billed per calendar month for 1st_{month of at least 70 plus minutes of Psych collaborative}

care

OR

Billed per calendar month for subsequent month of at least 60 plus minutes of Psych collaborative care

CPT Code G0512

Billing Code for RHCs and FQHCs

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Models – Individual vs Consortium

Individual

– one practice care coordinator with psychiatric medical provider • Case Conferences set up weekly

• Using audiovisual technology • Using a registry platform

Consortium

– Several practices care coordinators with one psychiatric medical provider • Case Conferences set up weekly for the group

• Using audiovisual technology

• Using a registry platform where each practice can share information with the psychiatric medical provider

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Online Courses for Care Coordination

Scheduled Courses and Self-Paced Courses

All provide Continuing Education Credit

Check out website:

Current listing:

https://www.healthtechs3.com/certificate-courses/

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Actions Leaders Must Immediately STOP in Order to Increase Diversity

Presenter: Kevin Hardy, Dir. Executive & Interim Recruiting, HealthTechS3

Date: April 9, 2021 Time: 12pm CST

https://bit.ly/3kYl3Cf

Remote Patient Monitoring vs. Remote Physiological Monitoring -RPM: Know Your Acronyms

Presenter: Faith M Jones, MSN, RN, NEA-BC - Director of Care Coordination and Lean Consulting, HealthTechS3

Date: April 14, 2021 Time: 12pm CST

https://bit.ly/3kYzZ3q

Swing Bed as a Service Line: Opportunity for Success

Presenter: Carolyn St.Charles, RN, BSN, MBA – Chief Clinical Officer Date: April 23, 2021 Time: 12pm CST

https://bit.ly/30o77rB

Data Data Everywhere and Not a Drop to Drink

Presenter: Carolyn St.Charles, RN, BSN, MBA – Chief Clinical Officer Date: May 21, 2021 Time: 12pm CST

https://bit.ly/38jsq28

Small Town, Big Surgery, No Problem

Host: Carolyn St.Charles, RN, BSN, MBA – Chief Clinical Officer Presenter: Graham Russell, RN - COO, MESA Healthcare, Inc. Date: June 4, 2021 Time: 12pm CST

https://bit.ly/3ryuJ8Y

Lessons Learned From the COVID-19 Pandemic and the Impact on Healthcare Delivery in the United States

Presenter: Peter Goodspeed, VP Executive Search, HealthTechS3 Date: June 7, 2021 Time: 12pm CST

https://bit.ly/3rvupaX

Action Planning and Communication: The Vital Elements to Patient Engagement

Host: Faith M Jones, MSN, RN, NEA-BC - Director of Care Coordination and Lean Consulting, HealthTechS3

Presenter: Kara Beech, BSBA, SHRM-CP, Beech Creative Group, LLC Date: June 17, 2021 Time: 12pm CST

https://bit.ly/3bqYhj3

The Hiring System & Its Hidden Obstacles: A Roadmap to Increasing Diversity at Your Company

Presenter: Kevin Hardy, Dir. Exec. & Interim Recruiting, HealthTechS3 Date: June 25, 2021 Time: 12pm CST

https://bit.ly/3kTCK5W

ALL WEBINARS ARE RECORDED

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THANK YOU

We hope this information has been helpful!

Please contact us if you would like to discuss our services or if you have additional questions

HealthTechS3

5110 Maryland Way, Suite 200 Brentwood, TN 37027

[email protected]

307.272.2207

Website: www.healthtechs3.com Faith Jones

Director of Care Coordination & Lean Consulting