When Billing Codes Fall Short: Unbillable Time in Collaborative Care for Co-occurring Opioid Use and Mental Health...

Area of Science:

• Health Services Research
• Behavioral Health Integration
• Opioid Use Disorder Treatment

Background:

• Collaborative Care Model (CoCM) is crucial for patients with co-occurring opioid use and mental health conditions.
• Current Medicare and Medicaid billing codes often do not cover the time spent delivering CoCM for these complex patients.

Purpose of the Study:

• To explore patient characteristics associated with receiving unbillable services within the CoCM.
• To identify factors contributing to non-reimbursable time in behavioral health integration.

Main Methods:

• Analysis of clinical trial data (N=381) documenting CoCM delivery.
• Estimation of billable time using relevant billing code rules.
• Multivariate logistic regression to identify predictors of unbillable outreach and exceeded care time.

Main Results:

• 43% of patients received unbillable outreach services.
• 59% of patients experienced care time exceeding billing code maxima.
• Patient factors like health system, age, stimulant use, and housing concerns were associated with exceeding billable time.

Conclusions:

• Significant portions of CoCM delivery for complex patients remain unbillable.
• Current reimbursement structures may not adequately support the engagement and care of patients with co-occurring conditions.
• Policy recommendations include modifying CoCM billing codes to ensure appropriate reimbursement.