On May 12th, the U.S. Centers for Medicare and Medicaid Services (CMS) issued proposed revisions to the Certified Community Behavioral Health Clinic (CCBHC) Prospective Payment System Guidance. Among other changes, the guidance proposes three approaches for creating a separate daily cost-based rate for mobile crisis and on-site crisis stabilization services, as well as an expanded list of optional measures for quality bonus payments. States not participating in the CCBHC demonstration should consider updating their CCBHC state plan payment methodology in accordance with the new PPS methods, rebased rate schedule, and quality bonus changes.
As a Certified Community Behavioral Health Clinic (CCBHC), it’s crucial to keep pace with the latest payment method guidelines issued by CMS. Failing to comply with these guidelines can lead to funding loss, reduced revenue, and legal consequences. However, for CCBHCs still using paper-based records or outdated electronic health record (EHR) systems, staying in the know can be daunting. If you’re considering becoming a CCBHC or struggling to keep up, you need an EHR that keeps you compliant and up to date. Here are some key aspects to consider:
CPT Codes
Incorrect billing codes are a common error for providers, especially when it comes to tricky modifiers. That’s why you need an EHR like EchoVantage, which includes up-to-date AMA CPT codes to eliminate the need for manual research and ensure fewer mistakes. Standardized codes also make data analysis a breeze, highlighting inconsistencies and providing opportunities for improvement in accuracy and completeness.
Configurable Service Definitions
Delivering a wide range of specialized services is a core requirement for CCBHCs, but billing for them can be a complex process. With evolving service requirements and updates, it can be challenging to keep pace. Moreover, the transition to new services takes time, and agencies need to ensure that their staff, equipment, and facilities are well-equipped to offer them. This is where service definitions come in handy.
Service Definitions serve as the bedrock for setting up services that providers use as criteria to apply consistent and acceptable charges to payers. These configurations flow through all claim and billing processes. Therefore, it is crucial to accurately enter component details to uniquely identify each Service Definition during setup to avoid Service Entry and Fiscal Overview Functions errors during billing procedures.
Having agile service definitions is essential for your EHR. By using this function correctly, you can establish a reliable procedure for setting up billing and documentation for services, with the flexibility to make updates as they happen.
Supporting Reimbursement Claims
Bespoke Reporting
Custom reports are a must-have for any CCBHC looking to stay on top of their CMS compliance. With the right EHR, you can easily create reports that track patient data, Medicaid beneficiaries, and specific services provided. This information is vital in ensuring that you’re meeting CMS guidelines for payment methods, especially considering every state has unique requirements. Configurable reports allow you to fine-tune your metrics until you’re exceeding requirements and staying up-to-date with changes. Plus, these reports provide easily digestible graphs that highlight areas for improvement. Additionally, utilizing the right reporting tools can help you qualify for the Quality Bonus Payment Measure Set, which requires six quality measures:
- Screening for Clinical Depression and Follow-Up Plan
- Screening for Clinical High-Risk Status and Follow-Up Plan
- Suicide Risk Assessment
- Timely Initiation of Care
- Medication Management: Body Mass Index (BMI) Screening and Follow-Up
- Initiation and Engagement of Alcohol and Other Drug Dependence Treatment.
Whether you meet the requirements or not, our data will serve as a valuable tool to help you track, measure and improve the quality of care and performance over time. Tailor your reporting to identify areas for improvement and implement new strategies that will drive progress and success.
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Demonstrating Outcomes
It’s important to ensure that your EHR is based on evidence-based practices and can support your treatment planning by offering interventions and objectives based on assessment results to achieve positive outcomes. Clinical tools that support your treatment plan are crucial to providing high-quality care. Don’t forget to choose an EHR that can integrate multi-disciplinary tools as CCBHCs must provide comprehensive care that addresses all aspects of a client’s therapeutic journey, both mental and physical.
Cost Report Facilitation
CCBHCs are required to create cost reports annually, and these reports should be submitted within 150 days after the close of the CCBHC’s fiscal year. They determine a CCBHC’s eligibility for PPS payments and recertification. CMS also uses these reports to ascertain if a CCBHC’s funds are adequately allocated to approved programs and their services. Cost reports ensure that the CCBHCs are within budget and receiving payment according to their established payment rates, parameters, and relevant contracts. Providing an accurate cost report is absolutely essential for CCBHCs, and some revised guidance from CMS also requires rebased rates to be calculated at specific frequencies.
Make sure your EHR has the ability to accurately and efficiently track financial records with enough detail to create a meaningful cost report that meets the 45 CFR §75 guidelines. Look for all-in-one features that automatically flow and populate data, eliminating the need for manual entry. By reducing these redundancies, you can channel your energies toward developing more impactful reports.
Modern EHR systems can help CCBHCs organize, reconcile, and verify costs to ensure that the resulting cost report is accurate and complete. Integrated financial statements in an EHR can provide a comprehensive view of financial data, making the reporting process seamless for future audits and reviews by regulators. This way, you can create high-quality reports that precisely reflect your budgetary needs without compromising your time with clients. Remember, these reports are important, but they don’t define your entire role.
Between the complex, ever-changing guidelines and requirements, and the challenges of substance use recovery treatments, it’s easy to feel overwhelmed by it all. But by making technology work for you, you can create organized and comprehensive strategies to keep up with PPS guidelines. EchoVantage is an EHR that works with leading CCBHCs to provide the tools you need to comply with federal and state requirements. With built-in billing and coding functionality, real-time updates, customizable reporting, and streamlined workflows, EchoVantage can help you ensure that you are providing high-quality care and getting the data to demonstrate that you’re achieving these results.
