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Billing for Collaborative Care Model: New Law in Illinois
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11/13/2019 at 8:34:11 PM GMT
Posts: 32
Billing for Collaborative Care Model: New Law in Illinois
Anyone out there with experience in billing for the Collaborative Care model?  Has this been financially sustainable? 

There is a changing landscape for integrated care reimbursement here in Illinois, at least in the world of Collaborative Care.  Illinois has become the first state to sign APA's model Collaborative Care legislation into law. On August 23, Illinois Governor J.B. Pritzker signed SB 2085, Psychiatric Collaborative Care, into law, which requires private insurers in Illinois and Illinois Medicaid to cover Collaborative Care CPT codes. This will definitely change the conversation around financial sustainability in the near future.  The new law takes effect Jan. 1, 2020.   

In the meantime, if anyone out there has experience in billing for Collaborative Care and would be willing to share a sample budget or 'pro forma' that would be great!  We're finding a tremendous need in our patient population, but having a harder time convincing administration to expand our workforce.  If we could show some figures on operating cost vs. revenue generated, we might have better success in advocating for more care managers.  We know Collaborative Care has good data too on healthcare cost savings as well.




I will loop in Steve Biljan who can provide financial data on the CoCM model dating back to mid July 2017 related to CoCM’s performance and sustainability here in Arizona where we have comprehensive coverage across the payor landscape (Medicare, Medicaid, Commercial).  We currently have 12 sites operating and all are generating positive revenue through the FFS revenue related to CoCM services.
All the best. 


There is a nice resource – a Financial Modeling Toolkit – on the AIMS center and American Psychiatric Association website. You can enter the code reimbursement by payer and see the cost/revenue. 
I think of it like the cost of a CoCM team (consider LCSW at $80 k with benefits and psychiatric consultant at 20k) to be 100k – the revenue for a full registry of 60-80 patients can be (depending on payer) around 115 – 125 k – so there is a margin but you have to keep the registry full and the billing team on their toes.



Last edited Wednesday, November 13, 2019

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