Doing the Right Thing for Patients Adds to Your Bottom Line and Saves Time

Importance of Mental Health and Wellness

1 in 4 adults in the US suffer from a mental disorder and many of those go undiagnosed. By offering your patients a screening and mental health assessment while they are in the waiting or exam room, you can greatly increase the chances of diagnosing and treating those who may be suffering from mental illness.  This allows you to get paid for something you are already doing while turning patient wait time into productive time.

Save Time on office visits involving mental health

Computer based assessments can help reduce visit times by up to 43%, over traditional encounters involving depression and other mental health conditions. By having all relevant data, including suicidality, before you enter the room you are equipped to make an appropriate plan without uncorking the bottle of emotion that can come when discussing mental health issues.

Optimizing your Revenue – Key Questions

When considering options for depression screening and mental health assessments for your patients, consider the following to maximize your revenue while reducing staff time spent administering and scoring paper tests. 

·       How many billable codes are included and which ones are they?

·       Do you have to choose the tests to administer or does the application choose based on a screening?

·       Does the application offer a logic engine to reduce the number of questions patients must answer, and reduce frustration?

·       Is there a fee per patient assessment taken?  If so, how is billing to your practice managed and does it require work to manage and reconcile billing from the assessment provider?

  • Are there any additional maintenance fees required?
  • Does the application work on both Apple and Android devices?
  • Does the application offer a kiosk mode where you can hand the tablet to the patient, they enter own their personal information, take the test and return the tablet, ready for the next patient; no intervention by clinical staff required.

Billable to Insurance*

Computer based depression screening and mental health assessments are billable to insurance and may utilize the following CPT codes:

  • CPT 96103: provided there is medical necessity, CPT code 96103 may be billed once per encounter, regardless of the number of assessments administered. As of January 2015, average reimbursement rates ranged between $27 and $55, depending on the payor.  CPT 96103 should not be billed more often than every 2 weeks.  CPT code 96103 is reimbursed by Medicare, and most major insurance providers. It is important to review each insurer’s specific guidelines. … read more here
  • CPT 96127: reimbursements average between $7-$20 per screening and can be billed on the same date of service as other common services such as psychiatry or therapy appointments and is appropriate when used as part of a standard clinical intake.  Primary care and other specialists may use CPT code 96127 when screening and assessing their patients, up to four times per year per patient… read more here
  • CPT 99408/99409: Substance Use Disorder screening and assessment with brief intervention have reimbursements averaging between $20-$65.  You can bill for a positive Screening, Brief Intervention, and Referral Treatment (SBIRT) on adults when there is patient intervention time spent that is 15 minutes or greater… read more here

*All billing information should be verified by a billing professional.  Reimbursement rates are based on estimated insurance averages.  Actual reimbursements may vary significantly.

The Importance of MIPS quality measures

Computer based depression screening and mental health assessments help providers meet up to 15 MIPS quality measures.  MIPS is CMS’ largest value-based care payment program, and will help spur the transformation of the healthcare industry from fee-for-service to pay-for-value. It is expected that more than ½ a million clinicians’ 2017 MIPS scores will be publicly published by CMS, which will further aid the movement towards Alternative Payment Models (APMs).  

The Bipartisan Budget Act has mandated that CMS must gradually increase the MIPS performance threshold each year, such that MIPS can be likened to a treadmill which speeds up over time, motivating organizations and clinicians to keep up with, or exceed the pace of competition.  From the web site: “Depending on the data you submit by March 31, 2018, your 2019 Medicare payments will be adjusted up, down, or not at all.  CMS will provide additional information on payment adjustments for 2020 and beyond beginning next year.”  …read more here.

Learn about more mental health billing codes