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When Billing Codes Fall Short: Unbillable Time in Collaborative Care for Co-occurring Opioid Use and Mental Health
Rebecca L Weir1, Lia Pak1, Colleen M McCullough1
1RAND, Santa Monica, CA.
Objective:
Considerable time spent on delivering the collaborative care model (CoCM) for patients with co-occurring opioid use and mental health conditions is not billable under relevant billing codes for Medicare or Medicaid behavioral health integration. In this follow-up study, the authors explored associations between patients' characteristics and the likelihood of receiving unbillable services.
Methods:
Billable time was estimated by applying billing code rules to documentation of CoCM delivery from a clinical trial (N=381 patients). Multivariate logistic regressions revealed patient characteristics associated with receiving >15 minutes in ≥1 months of unbillable outreach before CoCM engagement or care time that exceeded code maxima.
Results:
Overall, 43% of the patients received unbillable outreach, and 59% exceeded billable time. Health system, age, stimulant use, and worry about housing were significantly or marginally associated with exceeding billable time; health system also predicted unbillable outreach.
Conclusions:
Policymakers should consider modifying CoCM billing codes to adequately reimburse efforts to engage and serve this complex patient population.
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