While it is important to note that you can get a positive screening ROI without revenue from screening reimbursement, getting reimbursement certainly makes the analysis easier. Unfortunately screening reimbursement varies wildly so you have to test for it. However, at the end of the day, screening is a service that you provide and you should get paid for it.
Notes And Proper Documentation
It is important that reimbursement be billed correctly and supported with proper documentation. Getting reimbursed or not, can come down to how the reimbursement request is handled.
Psychological Screening Codes
Initially simply CPT 96100 and now broken out into CPT 96101 to 96103. These codes work in specialty areas where there is not an issue applying a psychological diagnosis. You don’t want to use them for detection screening in Primary Care, but they can make sense if an in-depth assessment like the QPD is required.
Health & Behavior Codes
H&B codes 96150 and 96151 are intended to be used to identify psychological, behavioral, emotional, cognitive and social factors. The focus is on bio-psycho-social factors important to physical health problems and treatments. Screening and assessment used to support these assessment procedures should be reimbursable.
Other Screening Reimbursement Codes
Billing code CPT 96110 was setup to pay for screenings like the ASQ-3 and ASQ:SE-2. Medicaid in Colorado will reimburse $10 per year for basic screening. IBH programs and Health Policy administrators see the value of screening and are working hard to make it reimbursable. Investigate what works in your setting.
Create A Profit Center
Don’t make the Business Case dependent on reimbursement, but at the same time you should be able to get paid for screening. When you can get it, it can become a profit center or at least fund the screening program, covering costs for screening when you cannot get paid.