CPT Coding
Home >>

Washington State has been at the forefront of healthcare reform, particularly in behavioral health. The state’s Behavioral Health Integration (BHI) model aims to enhance access to mental health and substance use disorder services by integrating them into primary care settings. While this initiative improves patient care, it also comes with new complexities in medical billing and reimbursement for providers.

Understanding Behavioral Health Integration in Washington

Behavioral Health Integration (BHI) is a coordinated care model that combines mental health, substance use disorder (SUD) treatment, and physical healthcare all under one system. Washington adopted this approach to improve patient outcomes by streamlining access to behavioral health services within primary care settings.

Key Components of Washington’s BHI Model:

• Integrated Care Teams: Collaborative teams of primary care providers, behavioral health specialists, and care coordinators.
• Care Coordination: Ensuring seamless referrals and follow-ups between behavioral health and medical professionals.
• Value-Based Payment Models: Emphasizing quality outcomes rather than just fee-for-service payments.
• Medicaid Transformation Project (MTP): Washington’s initiative to improve Medicaid-funded behavioral healthcare through regional Accountable Communities of Health (ACHs).

How BHI Affects Billing and Reimbursement

1. New CPT Codes for Integrated Care Services

To ensure CPT coding compliance and avoid fraud, healthcare organizations should implement the following best practices:

Billing under the BHI model requires providers to use specific Current Procedural Terminology (CPT) codes for integrated services. Some commonly used CPT codes include:

• 99492 - Initial psychiatric collaborative care management (CoCM) services.
• 99493 - Subsequent CoCM services.
• 99494 - Additional 30-minute increments of CoCM services.
• G2214 - Brief BHI services for general integration efforts.

2. Complex Reimbursement Structures

• Depending on the patient’s care plan, providers may need to bill under both medical and behavioral health service codes.
• Medicaid, Medicare, and private insurers- all have different reimbursement policies for integrated care services.
• Some payers require pre-authorization of patients for certain mental health treatments.

3. Credentialing and Contracting Challenges

• To receive accurate reimbursement, behavioral health specialists must be properly credentialed under integrated care networks.
• Many providers face delays in contracting with Managed Care Organizations (MCOs) for Medicaid reimbursement.

4. Increased Documentation Requirements

• Washington requires detailed care coordination notes when billing for integrated services.
• Providers must track patient progress and submit regular reports to justify their reimbursements.
• Denials due to insufficient documentation are common under the new BHI billing structure.

Best Practices for Navigating BHI Billing Challenges

1. Staying Updated on Washington’s Medicaid & Insurance Policies

• Washington’s Medicaid program frequently updates its billing policies for integrated care.
• Regularly check with MCOs and private insurers to stay informed about reimbursement changes.

2. Staying Updated on Washington’s Medicaid & Insurance Policies

• Washington’s Medicaid program frequently updates its billing policies for integrated care.
• Regularly check with MCOs and private insurers to stay informed about reimbursement changes.

3. Training Staff Members on Integrated Care Billing Codes

• Make sure that your billing teams understand CoCM and BHI-specific CPT codes.
• Investing in continuing education for medical coders and billing staff is important to stay updated..

4. Utilize Technology for Efficient Billing

• Use electronic health records (EHRs) that support integrated care billing.
• Use standardized templates to streamline documentation for insurance claims.

5. Improve Care Coordination Documentation

• Maintain comprehensive patient records that clearly outline behavioral and primary care interventions.
• Implement automated claim scrubbing to reduce errors and denials.

6. Work with a Specialized Billing Service

• Consider partnering with a behavioral health billing company, like Instapay Healthcare Services that understands Washington’s BHI model as well as behavioral and mental health billing regulations of Washington.
• Outsourcing helps reduce administrative burdens and improves reimbursement rates.

Washington’s Behavioral Health Integration Model is transforming mental health and substance use disorder treatment by improving access and care coordination. However, these advancements also bring with them the billing challenges, including complex reimbursement structures, credentialing hurdles, and increased documentation requirements.

By staying informed about Medicaid policies, training staff, leveraging technology, and improving documentation, providers can successfully navigate BHI billing complexities and ensure timely reimbursements.

Administrative tasks like these take up a lot of time and need special attention to not make any errors. Outsourcing to an expert billing provider comes in handy during times like these. Instapay Healthcare Services is an all-round behavioral and mental health billing provider. From pre-authorization to reimbursement follow-ups, providers can rely on us for all their billing needs.

For more insights on behavioral health billing, stay connected with Instapay Healthcare Services—your trusted mental health and behavioral billing partner in Washington.