SBIRT - Coding for SBI Reimbursement

Most doctors and nurses don't know this, but reimbursement for screening and brief intervention is available through commercial insurance CPT codes, Medicare G codes, and Medicaid HCPCS codes.

The Substance Abuse & Mental Health Services Administration or SAMHSA is working with the Centers for Medicare and Medicaid Services (CMS) to educate practitioners about the importance of SBIRT coverage and the Medicare billing rules around these services.

SBIRT services are defined as alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST) and brief intervention.

Commercial Insurance billing codes are CPT 99408 and CPT 99409.
Medicare codes are G0396 and G0397
Medicaid codes are H0049 and H0050

You can learn more about SBIRT coverage here and you can also purchase a novel nursing continuing education activity titled the "SBIRT Substance Use NursingMentor" here: cmecorner.com/sbirt

Industry executives discussing telemedicine "Policy Priorities" here at #ATA2012

Here at the American Telemedicine Association (ATA) 2012 annual conference, everyone is talking about health policy. One of the last sessions this year was the Industry Executive Panel 9: Policy Priorities. What policy issues are most critical? What kind of change do we need? Participants included: Verizon, Intel, Aligne Health Resources, and UnitedHealth Group.

Reimbursement is a recurrent theme that revolves around telemedicine. Who should be paying for these types of services? Right now, some payors are involved, but we need to see to see large employers getting involved since telemedicine is more cost-effective and efficient.

Telemedicine is not the current standard of care because patients still want the live interaction with their physicians. However, newer digital tools are overcoming certain barriers that are allowing physicians to have meaningful interactions with patients. Plus, non face-to-face care can be safer for patients who are at risk of catching dangerous infections in the clinical setting.


Interstate medical licensure is another barrier in the United States for physicians who want to engage in telemedicine. Will we see a national telemedicine license someday? Given that every state has different requirements and regulations around medical licensure, I'm not too sure that we'll see this anytime in the near future. I don't think the state licensing boards want to move in this direction. But then again, the VA Health System has embraced the concept of a national medical license by allowing physicians to provide care to veterans as long as they have an active medical license in some state. Perhaps the short-term solution is a national database of telemedicine credentialing for patients covered through government insurance plans.

Why physicians will always lose the reimbursement game

Got another e-mail from Sermo's founder Daniel Palestrant, MD. This one was titled, "Why physicians will always lose the reimbursement game." If you're interested in seeing the contents of this letter, then you'll have to get on Sermo (which is currently only available for U.S. physicians).

If you've been following the news, you know that the House Democrats recently unveiled a massive health care reform plan. According to CNN, "House Democrats unveiled their revised version of health care reform Tuesday, offering a proposal that includes a government-funded health insurance option, requires both individuals and employers to participate, and taxes the wealthy to help cover costs... Democratic House leaders said the measure, titled "America's Affordable Health Choices Act," met the requirements set by President Obama for health care reform by lowering costs to consumers and businesses, letting people keep their current plan if desired, and preventing denial of coverage due to pre-existing medical conditions."

Specific provisions of the bill include:

-- A Health Insurance Exchange providing individuals and small business with choices for coverage, including a government-funded public option.

-- No more coverage exclusion for pre-existing conditions.

-- Affordability credits for low- and moderate-income individuals and families, available to those with incomes up to 400 percent of the federal poverty level, or $43,000 for individuals and $88,000 for a family of four.

-- Limits on annual out-of-pocket spending.

-- Expanded Medicaid coverage to individuals and families with incomes at or below 133 percent of the federal poverty level.

-- Required participation by individuals, with a penalty of 2.5 percent of adjusted gross income for non-compliance.

-- Requirement that businesses with payrolls exceeding $250,000 provide their employees with health coverage or contribute up to 8 percent of their payroll on their behalf.

-- A series of measures intended to reduce costs of Medicaid, Medicare and other existing systems.

So how will these changes impact physician reimbursement? If we're trying to cut costs in healthcare, then it seems only logical that we'll be cutting some costs in physician reimbursement (although this may impact certain specialties more than others). Will physicians choose to transition into non-clinical areas and leave clinical medicine? Read the CNN article here.

Things are getting ugly between Sermo and the AMA

Wow, things are starting to get quite nasty here. The marriage has turned into an ugly divorce. When Sermo announced its partnership with the AMA, I was optimistic. However, they have had an ugly split recently and they're now at war.

I just got an e-mail from Sermo's founder Dr. Daniel Palestrant. The subject line reads: "From the Founder: CPT - Why physicians always get screwed, thanks AMA"

He highlights the results of a recent survey that included over 4,000 US physicians and it generated over 700 comments on Sermo. The results are quite striking:

• 75% of physicians surveyed are not members of the AMA.
• 89% of physicians claim, "The AMA does not speak for me."
• 91% of physicians surveyed do not believe the AMA accurately reflects their opinion as physicians.

Now, the focus on Sermo is shifting towards Current Procedure Terminology (CPT) coding. Here's some background on CPT codes:

For most physicians, Current Procedure Terminology or CPT codes have become a defining aspect of how we must practice medicine. They have become the "currency" of healthcare, mandating all manner of payments to physicians from the most complex surgical procedures to routine office visits. In the process, the CPT coding system has turned into an incredibly complex system of codes, modifiers, and exceptions. Add to that the RVU formulas, and it is no wonder that most physicians are drowning in paperwork.

So, now it's time to consider some questions related to CPT codes:

• Who publishes these CPT codes?
  
• Is it right that the AMA makes more money from selling licensing for CPT codes than it does from membership dues?
  
• Should our government continue to support the AMA’s monopoly on CPT codes?
• Who should manage CPT codes?

If you're a U.S. physician, have you joined Sermo? Are you a member of the AMA?