Sustaining Integration: It’s about more than money

Sustaining Integration: Its about more than money

Sustaining Integrated PracticeGetting PaidAlways improvingMovers & ShakersLeadership SupportLeadershipSupport

Who are we and where are we from?

MembersAffiliatesMaine Mental Health PartnersMiles Memorial HospitalSt. Andrews HospitalHome Health Visiting NursesMaine PHOMid-Coast HospitalMaineGeneral Medical CenterMaine Medical CenterPenobscot Bay Medical CenterStephens Memorial HospitalSt. Marys Regional Medical CenterWaldo County General HospitalSouthern Maine Medical CenterMaineHealth

Objectives:Participants will be able to:Describe factors that affect the present system of billing & reimbursement in an integrated settingIdentify reimbursement & programmatic elements that contribute to sustainable integrated programsIdentify strategies to support sustainability of integrated practice

What are you hoping to get out of this session?

Getting started: more than plunking a clinician in the practice and expecting it to work

Where to start?Who was first?

Start-Up Guide

Where are you in the process?

I. Pre-Hire clarify financial and billing arrangements

Overview of MHIClarify facility rules Understand services being delivered including potential new billing practices Discuss service with commercial insurersDevelop contractsTrain staff on behavioral health billingIdentify resource needs and ongoing review process

II. Hiring process - Credential and prepare for billing

Credentialing Behavioral vs. Medical?Help BHC understand link between service and billing codesClarify supervision requirementsFill out credentialing paperwork

III. Orient Behavioral Health Clinician (BHC) and prepare for billingIdentify staff needed for behavioral health billingConnect billers/coders with BHCTrack charges, denialsClarify expectationsMedical vs. behavioralDocumentationPrior authorization

IV. Ongoing support - Monitor reimbursement and continuously improve

Review practice level data:Services deliveredCharges billedPayments receivedCharges denied and reasonsOther problemsRegular meetings between BHC and billers to problem solveTrack bills to ensure proper coding, documentation and reimbursement

Getting Paid

Questions to ask:Licenses?Setting (who is billing, where are pts registered?)Payers and credentialingCommercial Medicare Medicaid

Types of Practice arrangements Mental Health Agency and Individual Behavioral Health ClinicianIndependent (Medical) Practice i.e., Doctors OfficeProvider Based - Hospital Owned PracticeFederally Qualified Health Center (FQHC)Rural Health Clinic (RHC)

What is your setting and practice type?

Mental Health Agency BillsProsNo additional:credentialing behavioral health contractingAffordableAllows independent practitioners to be co-locatedMay link to community mental healthConsIntended for persons with severe/persistent mental illnessIntended for longer term treatmentLimited H&B code billingExtensive paperworkMay require that practice get licensedSeparate registration processSeparate recordLess reimbursement?

Mental Health Agency challenges continuedAny time you introduce separate functions, you are getting away from integrated and coordinated treatment, or at least making it more difficult. Any time you require a comprehensive treatment plan, you are getting away from brief focused treatment, the treatment of choice in a primary care setting.

Provider Based or Independent Practice BillsProsIntended for patients in medical settingsSame medical recordSupports link between medical and mental healthHigher reimbursement?Cost of BHC covered by medical providerAble to bill H&B codesMedical practice ownership for integrated practice

ConsRequires medical practices to:CredentialContractBill commercial insuranceCost is generally with medical providerMay restrict to LCSWs or psychologists due to Medicare rulesRequires order from provider; documentation of ongoing involvement in treatment

FQHC or RHC BillsProsEncounter billing for all servicesCost generally covered by RHC/FQHCIntended for patients in medical settingsShared recordLink between medical and mental healthAble to bill H&B codesMedical practice ownership for integrated practiceReduced documentation

ConsMust be designated RHC/FQHCPreviously some confusion around codingRequires medical practices to take on behavioral health billingCredentialingContractingCommercial insurer confusionCost is generally with medical provider

Conclusion:Medical practices should do the billingNo need for patients to register in a new organizationAllowance for additional revenue through Health & Behavior codes only allowed in medical billingReduced and more reasonable documentation requirements; better matches practice needsBoth parties need to share investment in the successful outcome

Various payers and various rulesMedicare MedicaidCommercial InsurersMental Health vs. Medical codesLicensing rules

Medicare reimbursement ratesNHIC website: www.medicarenhiccom on Fee Schedule page.

Type of Provider% physician feeNotesMD/DO, Psychologist100%Or actual charge, whichever is lessPA, NP, CNS85%CSW (LCSW) 75%Reduced by any applicable deductible, outpatient mental health limitation

Outpatient mental health treatment limitationsApplies to claims for professional services furnished by physicians, clinical psychologists, clinical social workers, and other allied health professionals.

Start Date: Jan 1End Date:Dec 31Limitation PercentageMedicare paysPatient pays2010 201168.75%55%45%2012 201275%60%40%2013201381.25%65%35%2014onward100%80% 20%

Medicare mental health limitation exceptionsDiagnostic Services Limitation does not apply to diagnostic tests and evaluationsInclude psychiatric or psychological tests and interpretations, diagnostic consultations, and initial evaluations (90801)Diagnosis of Alzheimers Disease or Related Disorder Brief Office Visits for Monitoring or Changing Drug Prescriptions

New Mental Health Code Changes for 2013The old and the very new

Initial Psychiatric Evaluation2012 codes90801: psychiatric diagnostic evaluation 2013 codes90791: psychiatric diagnostic evaluation (no medical services) 90792: psychiatric diagnostic evaluation with medical services (E/M new patient codes may be used in lieu of 90792)

Outpatient Psychotherapy2012 Codes(Time is face-to-face with patient)

2013 Codes(Time is with patient and/or family)

CodeService: Outpatient PsychotherapyTime (min)9080420-3090805w/ E/M service 20-309080645-5090807w/ E/M service45-5090808 75-8090809w/ E/M service 75-80

CodeService: Outpatient PsychotherapyTime (min)90832Appropriate E/M code 30+90833add-on code 3090834Appropriate E/M code 45+90836add-on code 4590837Appropriate E/M code 60+90838add-on code 60

What do they mean for integrated practice?

MedicaidStates have flexibility:Covered mental health servicesTwo services (mental health and medical) on same dayContract with managed careBilling:Requires diagnosis and procedure codeSome states limit procedures, providers and/or practices that can use these codes

Commercial InsuranceInconsistencies among various insurersLack of clarity around covered servicesDifficulty finding experts to answer specific questions about reimbursementCarve outs Different systems Different reimbursement streams

Other problems?

Tips: Commercial InsurancesKnow expectations of payersClarify whether in-network medical and/or behavioral healthReimburse for Health & Behavior codes?Confusion about medical vs. behavioral health serviceBe clear at point of serviceHave documentation support serviceRecommendation to bill for service, if service was appropriately delivered, to establish need for reimbursement

Some key questionsPayment for 2 encounters in the same day?Reimbursement for Health & Behavior codes?Pre-authorization required for mental health visits?Full assessment required before treatment can begin?

Some additional considerationsTake this and make it much more difficult than it needs to be.

Health & Behavior (H&B) Codes 96150 96155

Billing for H&BMedical diagnosisMedical bill not mental healthBilled by practice with BHC:Hospital licensePrimary care officeRural Health ClinicFederally Qualified Health Center

Examples

Adult H&B examples55 year-old: Hx of AMI, HTN, cholesterol, family history of CVD. High risk - cardiac complications.

35 year-old: diagnosis chronic asthma, HTN, panic attacks. Seen for assessment and follow-up. Original assessment - emotional, social and medical history, including ability to manage problems r/t chronic asthma, hospitalizations & treatments.

Pediatric H&B examples10 yr-old: Dx - sickle cell anemia. Focus of assessment biopsychosocial factors r/t pain management and sickle cell disease.

8 yr-old: juvenile rheumatoid arthritis (JRA) for reassessment & treatment. Original referral for nausea, vomiting, panic reactions prior to weekly injections of methotrexate. Assessment: Child - history of JRA, when methotrexate was started, who gives medication, reactions, management of past responses, anxiety & depression questionnaires; Mother - problem-solving skills.

Adolescent H&B examples16-year-old: fibromyalgia, hx numerous pain episodes, poor school attendance, isolation from peers. Prior to disease: school attendance normal, difficulties with peers not reported. Previous attempts by rheumatology service & pain team: manage pain and facilitate positive school adjustment not successful.

15-year-old: acute lymphoblastic leukemia recently began maintenance phase of treatment. Monthly blood cell counts suggest chemotherapy was not being taken, physician spent considerable time with patient discussing potential consequences. Referral for suspected non-adherence.

Meet Denise

DeniseExperiencing great deal of anxiety after separating from husband and starting new jobHas asthma, not managing it well2 children at home, now a single parent, no time for herself

OptionsReferral: improve asthma management

Health and Behavior AssessmentMedical referral and diagnosisBrief, focused assessment and interventionReferral: reduce anxiety

Mental Health AssessmentMedical referral needed?Mental Health diagnosisComprehensive assessment and treatment

The CodesH&B codes96150: Assessment96151: Reassessment96152:Individual intervention96153:Group intervention96154:Family interventionMental Health Codes90801:Initial Assessment90804, 90806, 90808: Individual Therapy 90807, 90809:Ind. Therapy + E/M90846, 90847:Family Therapy90853:Group Therapy90862: Med Management

Insurance RamificationsH&B codes:Covered by some insurers, not allDiscipline reimbursable for some, not allMedical benefit: No pre-auth, no carve-out, no different co-payMedical practice billsMental Health codes:Covered by most insurersGenerally reimbursableContract & credentialing with behavioral health carve-out neededMay eventually need pre-auth May require larger co-pay

Back to Denise What do you do?Depends on:NeedsDiagnosisService deliveredReimbursement will depend on insurance and discipline of clinicianCan go from H&B to mental health, but not both together

Its easy to get overwhelmed!

Theres HopeMany of us: Are successfully working with integrated practices.Have overcome the challenges of the complicated system.Have strong support for this work.We can talk with each other and share what we know.

Measuring Quality

Quality Measures

Quality Measures - ClinicianBuilding relationships/trust = increased referralsTraining/Measuring core competenciesPatient outcomes:Are patients getting betterAre patients engaged in treatment

Quality Measures - PracticePatient show rate Billing/productivity Access - 3rd next available apptLevel of integration Site Self Assessment (SSA) www.mehaf.org Screening yes/noPatient satisfaction

Quality Measures -ProgramFTE and type of BHCProcess ImprovementProvider/staff satisfactionFinancial/reimbursement trends/patternsImproved access to community resources

Ongoing Support

Administrative Team Meeting: the friendly forumClinicians, provider rep, billers/coders, practice managers, leadershipData - show rates, referrals, volume: Whats working, not working? Targets?Payment information: Codes reimbursed/ deniedCommunication issues/improvement suggestions: R/t patients, providers, practiceClinical practice issues: E.g. length of sessions, frequency/duration of treatment

Sample Agenda

Aim of this meeting: To continue to monitor and promote progress of integrated behavioral health servicesTimeItemAim/Action15 minReview todays agendaAny updatesPractice concernsOrganization 15 minReview DashboardsInformation sharing and planning15 minProcess Improvement:Site Self AssessmentsReview and Set Goal(s) Information and goal setting15 minBilling and reimbursement concernsProblem solving15 minIT/IS issuesProblem solving10 minLarger system connectionsInformation5 minPlan agenda for next meeting Planning

Sample Dashboard

MeasuresOct-11Nov-11Dec-11 Jan-12TotalAverageHrs clinical time available 8060808030075# Arrived6045656023057.5# No show157121448123rd next available(days)121041Charges$14,362$10,620$18,700$16,455$60,137$15,034

Financial Tracking

CPT TOTALS

PORTLAND 2010

days per mos at Portland345345244

JanFebMarAprilMayJuneJulyAugSeptOctNovDecCPT GRAND TOTAL

C - Consult to Provider21334625329

90801-Initial Assessment712775946663

90847 Family therapy1010000013

90806 Individual therapy0000101305

90846 Family w/o pt1212110019

TOTALS:11151212111671411109

WESTBROOK 2010

days per mos at Westbrook122121122

JanFebMarAprilMayJuneJulyAugSeptOctNovDecCPT GRAND TOTAL


90801-Initial Assessment15401123421

90847 Family therapy0011010003


90846 Family w/o pt0000000000

TOTALS:25615237738

CPT TOTALS

1220

2511

2210

3910

1300

2310

3610

1412

3610

Consult

90801 - Initial Assessment

90847 - Family Tx

90806 - Ind. Tx

Month

# of Services

Sept Portland

C - Consult to Provider

90801-Initial Assessment

90847 Family therapy

90806 Individual therapy

90846 Family w/o pt

Sept Wstbrk


90801-Initial Assessment

90847 Family therapy

90806 Individual therapy

90846 Family w/o pt

Aug Ptland

SeptemberGreta Roderick MMP Portland Reimbursement Tracking

DATE OF SERVICESERVICE CODE BILLEDREIMBURSEMENT FACTORINSURANCE FACTOR

9/19080141

9084641

meeting 1 hour00

paperwork 1 hour00

phone calls .5000

9/89080143

9080143

meeting 1 hour00

paperwork 1 hour00

C00

phone calls .2500

9/229080143

9080143

paperwork 1.5 hours00

C00

phone calls .2500

9/299084741

9080141

meeting 1 hour00

C00

phone calls .5000

3216

TOTAL SERVICE CODES BILLEDTOTAL REIMBURSEMENT FACTORSINSURANCE FACTOR


90801 Initial Asessment62414

90847 FAMILY THERAPY141

90846-FAMILY W/O PT141

90806- TX W PT000

Reimbursement Codes and Values

Mental Health CodesHealth and Behavior CodesE&M CodesNon-Billable Activities

90801 = 496150 = 2-499201-99205 = 1-4DI - Dual Interview with Physician = 0

Initial AssessmentH&B AssessmentNew Pt.

90804 = 296151 = 1-499211-99215 = 1-2PO Parents only before 90801 = 0

Ind TherapyH&B ReassessmentEstablished Pt.

90806 = 496152 & 96153 = 1-499401-99404 = 1-4C - Consult to Provider = 0

Ind TherapyH&B InterventionPrev Med

Ind Counseling

90847 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0

Family Tx with and without PtH&B Intervention with Family and Pt.Prev Med

Grp Counseling

MaineCare = 1Medicare = 2Commercial = 3Self Pay = 1

Aug Wstbrk

SeptemberGreta Roderick MMP Westbrook Reimbursement Tracking


9/39080141

9080143

paperwork 1 hr00

C00

phone calls .2500

9/179080143

9080143

C00

C00

paperwork 1 hr00

phone calls .2500




90801 INITIAL ASSESSMENT41610

90806 INDIVIDUAL THERAPY000









Ind Counseling

90847 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


July Ptland

AUGUSTGreta Roderick MMP Portland Reimbursement Tracking


8/49080143

9080641

consult00

consult00

mtng00

paperwork 1hr00

8/119080641

9080643

9080143

consult00

mtng00

paperwork 2hrs00

phonecalls .7500

8/189080143

9080143

consult00

consult00

paperwork 1.500

email/phonecalls .7500

8/259080143

9080143

mtng00

email/phonecalls .5000

3623






90806- TX W PT3125









Ind Counseling

90847 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


July Wstbrk

AUGUSTGreta Roderick MMP Westbrook Reimbursement Tracking


8/69080141

9080143

consult00

consult00

paperwork 2hrs00

phonecalls 1hr00

8/209080141

9080641

consult00

paperwork 100

emails/phonecalls 1hr00

166














Ind Counseling

90847 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


June Ptland

JULYGreta Roderick MMP Portland Reimbursement Tracking


7/211 hr paperwork00

1 hr meeting00

.5 hrs consultation00

9080143

9080643

7/281.5 hrs paperwork00

1 hr phone calls00

.75 hours meeting00

.5 hrs consultation00

9080141

9080143

9080143

2013

TOTAL SERVICE CODES BILLEDTOTAL REIMBURSEMENT FACTORS





90806- TX W PT1









Ind Counseling

90847 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


June Wstbrk

JULYGreta Roderick MMP Westbrook Reimbursement Tracking


7/232 hrs of paperwork00

1 hr phonecalls00

.5 hrs consult00

9080141

9080141

82














Ind Counseling

90847 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


May Ptland

JUNEGreta Roderick MMP Portland Reimbursement Tracking


6/21 hr meeting00

C00

paperwork 1hr00

9080143

6/91 hr meeting00

C00

2hrs paperwork00

9080143

9080143

9080143

6/16C00

6/231 hr meeting00

C00

C00

9080141

9080143

9084641

2hrs paperwork00

6/30C00

2 hrs of paperwork& phonecalls00

9080143

9080143

9080141

4024






90806- TX W PT0









Ind Counseling

90847 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


May Wstbrk

JUNEGreta Roderick MMP Westbrook Reimbursement Tracking


6/252 hrs of paperwork & phone calls00

9080141

9084743

84





90806 INDIVIDUAL THERAPY









Ind Counseling

90847 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


April Ptland

MayGreta Roderick MMP Portland Reimbursement Tracking


5/59080141

9084641

meeting 1 hr00

C00

calls & paperwork 1 hr00

5/129080141

9080141

meeting 1 hr/pwork00

C00

5/199080143

9080643

C00

paperwork 1 hr00

5/269080141

meeting/pwork00

C00

2811






90806- TX W PT1









Ind Counseling

90847 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


April Wstbrk

MayGreta Roderick MMP Westbrook Reimbursement Tracking


5/14C00

5/289080143

9080643

C00

C00

paperwork 1 hr00

86














Ind Counseling

90847 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


Run chart example

AprilGreta Roderick MMP Portland Reimbursement Tracking


4/79084641

9080143

9080143

M00

C00

paperwork 1.5 hrs00

4/149084643

9080141

C00

M00

paperwork 2 hrs00

4/219080141

9080141

4/289080143

9080143

C00

paperwork 1 hr00

3619














Ind Counseling

90846 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


Sheet1

AprilGreta Roderick MMP Westbrook Reimbursement Tracking


4/169084743

paperwork .50














Ind Counseling

90846 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


Mrch Portland

0

24

12

12

28

28

16

8

24

8

8

24

4

12

36

0

20

28

24

28

16

28

24

24

8

24

24

8

Week

Total # of Sessions

Mrch Wstbrk

WeekTotal

10

224

312

412

528

628

716

88

924

108

118

1224

134

1412

1536

160

1720

1828

1924

2028

2116

2228

2324

2424

258

2624

2724

288

Feb Portland

MarchGreta Roderick MMP Portland Reimbursement Tracking


3/3Consult0

3/109084643

9080143

meeting00

paperwork 1.5 hrs00

3/179080143

meeting00

Consult00

paperwork .5 hrs00

3/249080141

9080141

9084741

meeting00

Consult00

paperwork /phone work 2hrs00

3/319080143

9080143

9080141

meeting00

paperwork/phone work 2hrs00

3619





908461









Ind Counseling

90846 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


Feb.Westbrook

MarchGreta Roderick MMP Westbrook Reimbursement Tracking


3/59080143

9080141

paperwork 1

3/199080141

9080141

9084743

consult00

paperwork .500

209













Ind Counseling

90846 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


Jan. Portland

FebruaryGreta Roderick MMP Portland Reimbursement Tracking


2/39080143

9080143

9080141

9080143

9084643

9084600

M00

C00

paperwork 3 hours00

2/109080143

9080143

M00

paperwork 100

2/179080143

9080141

9080141

paperwork 1.5 hrs00

2/249080143

9080143

9080141

5222




90847 Family Therapy0


90846 -Family w/o pt2









Ind Counseling

90846 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


Jan Wstbrk

FebruaryGreta Roderick MMP WestBrook Reimbursement Tracking


2/59080143

9080143

papework 2 hrs00

2/199080143

9080141

9080141

paperwork 1.5 hrs00

2011





90846 Fam w/o pt.0









Ind Counseling

90846 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


June Portland

JanuaryGreta Roderick MMP Portland Reimbursement Tracking


1/69080143

9080141

9080143

M00

C00

paperwork 1.5 hours00

1/139080143

9080141

M00

C00

paperwork 1.5 hrs00

90846(can't bill)00

1/209080143

9080143

9084743

M00

paperwork 1.5 hrs00

3220




90847 Family Therapy1


90846 Fam w/o pt1









Ind Counseling

90846 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


June Westbrook

JanuaryGreta Roderick MMP WestBrook Reimbursement Tracking


1/89080143

C00

paperwork .500

43





90806 Indiv. Therapy0









Ind Counseling

90846 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


July Portland

JuneGreta Roderick MMP Portland Reimbursement Tracking

DATE OF SERVICESERVICE CODE BILLEDREIMBURSEMENT FACTORINSURANCE FACTORTOTAL



90801 INITIAL ASSESSMENT

90847 FAMILY THERAPY









Ind Counseling

90846 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


July Wtbrk

JUNEGreta Roderick MMP Westbrook Reimbursement Tracking














Ind Counseling

90846 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


AUG Ptlnd

Greta Roderick MMP Portland Reimbursement Tracking














Ind Counseling

90846 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


AUG Westbk

Greta Roderick MMP Westbrook Reimbursement Tracking














Ind Counseling

90846 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


Sept Ptlnd
















Ind Counseling

90846 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


Greta Roderick MMP Westbrook Reimbursement Tracking






90806 INDIVIDUAL THERAPY









Ind Counseling

90846 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling




4/1/099084743

9080141

M00

Paperwork 1 hr00

4/8/099084753

M00

Paperwork .10 hrs00

4/29/099080143

PO00

C00

Paperwork .75 hrs00

1710














Ind Counseling

90846 & 90846 =496154 = 1-499411-99412 = 2-4M Meeting = 0


Grp Counseling


Movers and Shakers(what really makes it sustainable)Willingness to learn new thingsAbility to tolerate bumps and address problemsCapacity of team to work together to move this forward

LeadershipWilling to take risk, create vision, support process improvement, and believe in the purpose of the integrated service

Were optimistic about the future of integrated behavioral health and primary care

Resourceswww.mehaf.org Maine Health Access Foundationwww.thenationalcouncil.org the National Council for Community Behavioral Healthcarewww.ibhp.org Integrated Behavioral Health Projectwww.mainehealth.org/mentalhealthintegration

Medicare Linkshttp://www.cms.gov/Manuals/IOM/list.asphttp://www.cms.gov/Transmittals/01_overview.aspMedicare Documentation Guidelines for Evaluation and Managements Services 95 & 97http://www.cms.gov/MLNEdWebGuide/25_EMDOC.aspNHIC http://www.medicarenhic.com/

ContactsMary Jean Mork, LCSW, [email protected], 207-662-2490Cynthia Cartwright, MT RN MSEd, [email protected], 207-662-3529Melissa (Missy) Cormier, LCSW [email protected], 207-661-7128Neil Korsen, MD MS, [email protected]

Employment of the staff & supervisionPatient registrationBilling for Behavioral Health Actual reimbursement Documentation***

Documents

Sustaining Integration: It’s about more than money