| Improving Primary Care Team Guide

Publications

Publications

Business Case for Behavioral Health Integration

Learn about the concept of a business case and a process to develop one, through the lens of making the case for integrating behavioral health into a primary care practice. This presentation by Roger Chaufournier highlights reimbursement considerations and resources to help you build your business case for behavioral health integration.

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Attribution:

Roger Chaufournier
Publications

Medicare Chronic Care Management Payments and Financial Returns to Primary Care Practices

This study provides the cost benefits for team members other than providers to deliver chronic care management services. To make the business case, the study suggests that practices should have at least 130 Medicare patients. Basu S, Phillips RS, Bitton A, Song Z, Landon BE. Medicare Chronic Care Management Payments and Financial Returns to Primary Care Practices: A Modeling Study. Ann Intern Med. 2015 Sep 22. doi: 10.7326/M14-2677

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WorkflowTemplates, flow sheets and mapping aids

Workflow

Chronic Care Management fee Fact Sheet

Learn about the Chronic Care Management fee in this Fact Sheet from the Centers for Medicare & Medicaid Services (CMS). In recognizing the critical role of care management in primary care, CMS pays for care coordination services of Medicare beneficiaries with multiple chronic conditions.

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Attribution:

Centers for Medicare and Medicaid Services (CMS)
Workflow

Chronic Care Management fee FAQs

Get your questions answered about the Medicare Chronic Care Management fee, in this FAQ from the Centers for Medicare & Medicaid Services (CMS).

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Attribution:

Centers for Medicare and Medicaid Services (CMS)
Workflow

Chronic Care Management fee guidelines for RHCs and FQHCs

Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) may receive additional payment for the costs of care management services to Medicare beneficies. Learn about guidelines for using the Chronic Care Management fee in RHCs and FQHCs.

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Attribution:

Centers for Medicare and Medicaid Services (CMS)
Workflow

Billing for Certified Diabetes Educators (CDEs)

Billing for Certified Diabetes Educators (CDEs) depends on the payer. For more information, see this website.

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Workflow

Billing for Behavioral Health Specialists

Billing for Behavioral Health Specialists, such as licensed clinical social workers, depends on the payer and the state. Medicaid has national billing procedures, while Medicaid varies by states. The Center for Integrated Health Solutions offers financial worksheets for billing Medicaid in each state, which are useful for FQHCs to identify state-specific diagnostic codes and what professional credentials are needed to submit a payable claim.

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ToolkitsImplementation guides and other documents with extensive resources included

Toolkits

Chronic Care Management Tool Kit

Learn what practices can do to implement and bill the Chronic Care Management codes for services provided to Medicare beneficiaries with multiple chronic conditions. This toolkit from the American College of Physicians provides clear steps and example tools your practice can use to start capturing these payments.

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Attribution:

American College of Physicians

LEAP Learning ModuleOther helpful topics included in this website

LEAP Learning Module

Primary care function modules

Learn how high-performing teams carry out the functions of primary care, by working through modules on this website. From this link, you can choose to explore population management, medication management, behavioral health integration, and more!

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Case summariesVignettes, profiles and testimonial videos

Case summaries

Paying for Team-based care in a FFS setting

Team members at Vibrant Health Family Clinics in Ellsworth, Wisconsin, explain why they went to a team-based model and how they paid for it as a traditional fee-for-service practice.

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Publications

Business Case for Behavioral Health Integration

Medicare Chronic Care Management Payments and Financial Returns to Primary Care Practices

WorkflowTemplates, flow sheets and mapping aids

Chronic Care Management fee Fact Sheet

Chronic Care Management fee FAQs

Chronic Care Management fee guidelines for RHCs and FQHCs

Billing for Certified Diabetes Educators (CDEs)

Billing for Behavioral Health Specialists

ToolkitsImplementation guides and other documents with extensive resources included

Chronic Care Management Tool Kit

LEAP Learning ModuleOther helpful topics included in this website

Primary care function modules

Case summariesVignettes, profiles and testimonial videos

Paying for Team-based care in a FFS setting