Billing and Reimbursement

It is important that SBIRT implementation, like most clinical procedures, take place in the context of sustainable business practices. Many SBHCs have a variety of revenue sources, such as private insurance billing capacity, Medicaid reimbursement, and access to state and federal substance abuse prevention and treatment funding. SBHCs must work with their sponsoring organizations to understand their reimbursement options and seek reimbursement when possible.

In many states, billing codes are available to seek reimbursement from Medicaid and commercial insurance whenever a student completes a validated screening tool and receives a brief intervention if both actions last at least 15 minutes in total. Brief interventions must be performed face-to-face, and only certain health professionals are allowed to bill these codes independently, according to Medicaid rules in each state. Documentation in the patient chart must meet the criteria required by each code.

To ensure sustainable billing practices, SBHCs may benefit from a feature in the electronic health record that automates the use of SBIRT billing codes. A “SmartPhrase” or “DotPhrase,” for example, can automatically apply the correct billing and diagnoses codes, as well as populate the progress notes of a patient chart with text that meets billing requirements.

Confidentiality concerns are a critical part of the decision-making process around billing, particularly if a young person is old enough to consent to services on their own. This confidentiality may be breached, for example, when an Explanation of Benefits letter is sent to a student’s home containing procedural and diagnoses codes, alerting a parent to what was discussed during a medical visit. SBHC staff must work with their sponsoring organizations to identify billing practices that do not have the potential to breach patient confidentiality.

Although it is certainly possible to bill for SBIRT, we acknowledge that billing may be challenging. For example, the 15-minute increment required for billing can be counter to the “brief” nature of the SBIRT process, posing a challenge for providers trying to be efficient with multiple issues in a visit, while still billing appropriately.

Regardless of billing potential, it is important for providers and administrators to understand the value of SBIRT as a best clinical practice and quality care for patients.