SBIRT Governor S Policy Subcommittee

SBIRT Governor’s Policy Subcommittee Billing and Reimbursement February 14, 2008 10am-noon Present: Brian Spoenseller, MD; Liz Bade, MD; Rich Brown, MPH, MD; Chris Wolf, Nancy Pulver, Shannon Wilber, Paul Moberg, PhD; Lilly Irvin-Vitela, MCRP I. Introductions All present introduced themselves by sharing their name, the organization(s) that they work with and why they are interested in working on the billing and reimbursement issues. II. Rich Brown gave a brief overview of WIPHL and SBIRT http://wiphl.com/about/index.php?category_id=3453

SBIRT Codes Medicaid H0049- Screening H0050- Brief Intervention

Medicare G0396- 15- 30 minutes G0397- 30 plus minutes

CPT 99408- 15-30 minutes 99409- 30 Plus minutes

III. Brain-storm session regarding key components of billing and reimbursement Barriers to Billing for SBIRT Services Clinic  Informed consent about associated costs  Patients may call and complain if they’re billed  Framing the value of services  With limited time in the clinic and the need for phone follow-up, a significant amount of services may not be billable  Lack of clarification for coders and billing specialists about use of SBIRT codes Policy  HCPCS SBIRT codes need to be turned on in Madison in order to be utilized  In order for codes to be activated, money needs to be allocated in the state budget for these services.  Codes have been turned on as part of BadgerCare plus but only for pregnant women. The optional reporting law for pregnant women is a deterrent for women to access SBIRT services.  Medicaid and Medicare cannot bill for services that other payers are not being billed for. Insurance  Lack of wide spread demand for services- Medicaid, Medicare, private, IHS  Competing health priorities and stigma around AODA as an issue for primary care  Need for WI specific cost offset study Strategies to Overcoming Barriers  Mid to long terms- Continue efforts to partner with State of WI on activation of SBIRT Medicaid Codes and engage in barrier reduction for services to pregnant women  Mid-long term- Continue and improve efforts to increase engagement of healthcare purchasers and insurance companies in utilizing CPT Codes  Short to Midterm- Explore the pros and cons of other utilizing other billing codes Evaluation and Management Incident II Substance Abuse and Counseling  Work with Insurance Commissioner to add SBIRT services as mandated services

IV. Next Steps Essential Tasks: Create a handbook for billing for SBIRT services Review model billing handbooks Include policy updates from Medicaid, Medicare, and CPT Outline pros and cons of using various billing codes Include checklist for implementation include template on documentation of services Clarification about the role of ancillary staff Guidance about appropriate use of codes to increase success when clinics are audited

V. Next Meeting: Thursday, March 6th 10-12