I/T/U SOONERCARE 101 LEARNING OBJECTIVES BH Rules Eligible BH - PowerPoint PPT Presentation

Sep 06, 2022 •321 likes •505 views

I/T/U SOONERCARE 101 LEARNING OBJECTIVES BH Rules Eligible BH Services Billing Issues EVER HAVE THIS FEELING? STAYING IN BOUNDS BEHAVIORAL HEALTH RULES Chapter 30 Medical providers FFS Subchapter 5 Individual

I/T/U SOONERCARE 101
LEARNING OBJECTIVES  BH Rules  Eligible BH Services  Billing Issues
EVER HAVE THIS FEELING?
STAYING IN BOUNDS
BEHAVIORAL HEALTH RULES  Chapter 30 – Medical providers FFS  Subchapter 5 – Individual Providers & Specialties  Part 21 - Outpatient Behavioral Health Services  Part 25 – Psychologists  Part 26 - Licensed Behavioral Health Services  Part 110 – Indian Health Services, Tribal Programs, and Urban Indian Clinics (I/T/US)
BEHAVIORAL HEALTH SERVICES
BEHAVIORAL HEALTH SERVICES  “means professional medical services for the treatment of a mental health and/or addiction disorder(s ).”  - 317:30-5-1087.2 Terms and definitions
BEHAVIORAL HEALTH SERVICES  (1) Mental Health Assessment/Evaluation Testing;  (2) Alcohol and/or Substance Abuse Services Assessment and Treatment Plan Development;  (3)Crisis Intervention Services;  (4) Medication Training and Support;  (5) Individual/interactive Psychotherapy;  (6) Group Psychotherapy; and  (7) Family Psychotherapy.
ANYONE ELSE EVER FEEL LIKE THIS?
BEHAVIORAL HEALTH SERVICES  Behavioral health professional therapy services are covered when provided in accordance with a documented individualized treatment plan, developed to treat the identified mental health and/or substance abuse disorder(s). A minimum of a 45 to 50 minute standard clinical session must be completed by an I/T/U in order to bill an encounter for the session.
317:30-5-1091.8 DEFINITION OF I/T/U SERVICES  (d) I/T/U outpatient encounters include but are not limited to:  (8) Behavioral health professional services and services and supplies incidental to the services of LBHPs; and
BEHAVIORAL HEALTH RULES  Licensed Behavioral Health Providers (LBHP’s)  Allopathic or Osteopathic Physicians with a current license and board certification in psychiatry or a current resident  Practitioners with license to practice:  (A) Psychologist,  (B) Social Worker (clinical specialty only),  (C) Professional Counselor,  (D) Marriage and Family Therapist,  (E) Behavioral Practitioner, or  (F) Alcohol and Drug Counselor.
BEHAVIORAL HEALTH RULES  A.P.N. – certification in psych. mental health  P.A. with specialized mental health training  Practitioners who have completed education requirements to begin an internship or a post- doctoral fellowship in an accredited clinical academic training program *  L.B.H.P. candidates* *with special requirements
WHAT REQUIRES A SIGNATURE?  Assessments and progress notes must be signed by the practitioner providing the service.  Service plans must be signed by the member (if over age 14), by the parent or guardian if under 18, and by the primary LBHP.
HOW DO I GET HERE?
 THIS IS HOW!   Behavioral Health Revenue Code : 513  OHCA Provider Letter 2006-08  Billing should be done under this revenue code, not procedure codes.
QUESTIONS/COMMENTS/POINTS OF CONCERN?

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