How Do My Patients Benefit?

Patients benefit because the BRE Program is based upon repetitive assessment evaluation and comparison of that data over time to determine if the dynamic, patient-take-home treatment plan is achieving its intended goals as it relates to mental health.  For chronic illness patients of all types, this can mean a huge reduction—through early detection—of common medication side-effects and interactions as well as other mental health incidences having to do with depression, addiction and cognitive decline. 

Early detection is achieved and documented as part of repetitive tracking over time. Coupled with the assessment tracking, is the customized creation of dynamic (meaning that they are updated monthly or following each encounter) treatment action plans (TAPs). 

Supervised BRE staff help to create action plan “menu-event” options based on directives from the billing Provider and from patient preferences.  Patients therefore benefit from a formula supported by extensive research that incorporates activities of many types depending on patient circumstance/condition.  Each TAP plan is further tracked and followed up using remote patient monitoring in between office visits and reported back to the billing provider and onsite BRE staff via software features.

What Kind Of Patients Benefit Most?

The BRE Program was designed to begin its entry point to mental health starting from each senior patient's annual mental health screen. It is determined during this annual encounter whether a senior patient with chronic illness conditions meets ICD, NCD and LCD qualifications for repetitive participation in the program during the following 12 months at each scheduled E & M visit, not to exceed once per month.  Participation determinations are made annually.

Repetition of data gathering from repeat assessment scores captured through the interactive testing process by BRE staff, allows the provider to track patient progress better and faster.  This helps avoid future complications that could otherwise go undetected at an early stage.  Prompt intervention, whether as a consequence of disease process, medication side-effects or interactions, including addiction concerns, provides better outcomes.

At a minimum, items of concern from any aspect of BRE interaction results in notification to the treating Providers for disposition.  Examples of serious concerns are: suicidal ideations, addiction treatment indications, positive side-effect or medication interaction suspicions, professional referral to neurology or psychiatry considerations, hospitalization consideration.

Added to each assessment process are two other components.  The first is remote patient monitoring using manual means whereby BRE staff speaks with patients by phone to gather monitoring data as well as use the same call to help determine if patient may require possible intervention by the Provider to avoid emergency services or hospitalizations prior to next scheduled visit. 

The second component is based on gathered assessment data, provider directives (if any), and by patient interview.  Using this combination of information, each patient is hard mailed a calendar-based treatment plan, customized and updated for each patient based on needs and personal circumstances following each BRE encounter.  Such take-home treatment plans are seasonal-weather and event sensitive and get seniors re-engaged with the local communities through physical and social activities.

The overall program results in happier senior patients by assessing, tracking and monitoring as well as treating depression, addiction and cognitive function through grass roots means in addition to good medicine practices.  Retiree Patients can live independently longer and more slowly progress to assisted living, nursing home or more restrictive and expensive living conditions. Part of the reasons for this is that the retired population has more free time to participate in many beneficial community activities.  Most communities are awash with organizations that cater to the senior community.

Politicians also know that no election can be won without support by seniors—voting seniors.

Is this Just a Glorified Assessment Program We Could Do Ourselves?

Different than any other mental health service or system, whether in a psychiatric office or any other medical office setting, this is a dedicated BRE Staff (certified) driven system. BRE staff are supervised by QHCP office staff, pursuant to the billing physician’s NPI reimbursement schedule. The entire program service is performed by professionally trained and educated “leased” staff to each participating client office on a billable hourly basis, charged in the arrears of services performed, allowing for efficient offices to bill and collect generally prior to reimbursement. 

The various components of the program are both insurance code compliant through documented actions in the software as well as by supervision confirmation by the billing and prescribing Physician.  Also added into the patient participation equation are recurring, interactive, standardized assessments such that graphical display comparing previous scores are possible and across many records simultaneously if desired; and the creation and implementation of a Treatment Action Plan which incorporates current medication regimes with social and physical activities suited to each patient. 

Some Treatment Action Plan activities might be community-based while others are within the confines of ones' living circumstances or personal ability limitations.  Each Treatment Action Plan is updated either monthly or following each encounter based on need and response, and regular tracking and monitoring is performed by supervised leased staff using remote patient monitoring and or telemedicine methods. 

Targeted patients love the more hands on and response-oriented approach which results in less emergency interventions and other costs savings to payers and society.  Providers find that patients who are more active and on "routines" do better, require less total medications and less dosage amounts.  They are more productive with their time and less of a burden on social, society and family services.  People like to be independent and the BRE System assists with this.  Objective improvement is quantified through participation and results in better repetitive assessment scores and reporting from satisfied patients.

Physician time can actually be reduced across all considerations as the data extrapolated from the repetitive assessments can be quickly and easily reviewable in a user-friendly format.  Depending on Provider preference, they can determine how actively involved they wish to be in the entire process.  BRE Staff are well trained to execute on all aspects of the related system care process and bring to the attention of the Provider(s) patients for whom they have additional concerns.

In a time where insurance documentation is extremely important, the BRE Program leads the way with detailed information about each patient, based on a combination of multiple interactions as well as objective data gathered, compiled and evaluated.

How Does The Program Work In Detail?

The first step is to have a consult call with a BRE representative.  They will provide you with an evaluation form to help determine a proper quality payer mix volume.  As a rule, BRE does not work with offices that are predominantly Kaiser based.  Although BRE does not charge for hourly services based on reimbursement amounts, we are sensitive to the fact that each office has to make a profit for the services it provides, or it cannot stay in business to help patients or pay us for our fees.  On general principle, a typical office should expect to make 20-30% of gross billing or more with no upfront costs.

Following a payer mix and volume evaluation, photographs of the reception area are needed, or a draft layout of your reception area as this is where leased BRE staff predominantly administer the program, from in your office.  Patients' acknowledge an optional HIPAA privacy waiver as part of the process although their personal information is not shared with others.  However, the assessments and tests are generally not administered in a private interaction setting unless requested.  This also allows BRE Staffers to more efficiently interface across multiple patients relative to patient education as to why the Providers are prescribing participation for those that meet certain brain health risk profiles.

For patients who are adamant about not participating, there is a polite and professional waiver for them to sign acknowledging that they are ignoring the treating Providers' recommendations for annual screen and or recurring testing and that by doing so may have negative implications for the patient including potential insurance denials in the future if it was to be discovered that the patient refused to participate in care, particularly as this may relate to pre-existing conditions This might also hold true if there were any medication recalls that had deleterious side-effects or interactions and they were not detected early to afford rapid changes or discontinuation that otherwise might have been detected by repetitive mental health testing and evaluation.

At first, following the establishment of an existing patient relationship, patients can be asked to come to a scheduled E & M visit 30 minutes early for the first BRE interaction and thereafter, 15-20 minutes early.  This can be done by the front desk or by remote BRE support staff.  Face to face and assessment time varies from just a few minutes to 30 minutes on the initial BRE visit and from a few minutes to 20 minutes each visit thereafter, until the next annual encounter.  BRE is usually scheduled in advance of an existing E & M visits on the same day of service or can be scheduled separately, as many as 8-10 per hour depending on patient volume and the potential need for multiple BRE staff considerations.

The system allows for brain health education and testing interaction time across multiple patients encounters both face to face and away from the patient.  Part of the assessment testing portion simply requires patient responses to psych and neuropsych standardized test questions (including addiction and harm assessments as applicable).  A portion of this is interactive and requires documentation of other findings in the patient notes by BRE Staff while other portions are purely administrative and or require evaluation. 

Assessment and other gathered information is used to create treatment action plans for each patient.  The majority of the work product amalgamation is performed away from the patient by the clinical case manager(s), supplied by BRE.  Part of their job is to document findings and compile work product efficiently for the creation of the treatment action plans. Each plan is updated after each BRE encounter, customized for the patient, and incorporates any directives by the provider. 

TAP directives can include the need to participate in addiction support groups.  They can include time-sensitive events in the community that could be date/season driven.  Other directives include repetitive participation such as physical activities, volunteer work, the need for Meals on Wheels, club and organization specific etc.  Patients, particularly seniors, like to be more involved and feel needed. Take-home treatment plans help to increase the feelings of being valued and important.  The BRE Program does this through the action plans which are created within the limitations of each participant.

Each time an assessment is performed starting at the office, there is an interaction with the BRE Clinical Case Manager to determine feedback and the need for adjustment to each take-home treatment plan.  This could also include medication modifications by the Physician.  Treatment Action Plans are either emailed or hard mailed to each participant.  During the time between office visits, patients are contacted for remote patient monitoring purposes or through telemedicine code interaction by BRE staff directly/indirectly supervised by the billing Physician.  Pre-approved and scripted contact by BRE staff is used to gather relevant information and to determine compliance with the treatment action plans as well as any other concerns by the patient that need to be conveyed to the Physician.

The combination of onsite and offsite interactions including work product evidenced by documentation notations in the software more than fulfills requirements for several CPT codes.  The annual screening codes can include G0396, G0442 and G0444 although the predominant work product and interaction is driven through codes 96130, 96132, 96138 and 99457.  These are complimented specifically by either relevant telemedicine codes for certain private payers or remote patient monitoring for senior patients who have chronic illness conditions or at the discretion of the Physician.

What Is The Difference Between The BRE Program And A Do-It Yourself System?

There are two primary differences between a do-it-yourself mental health program and the BRE System service.  The first difference includes dedicated and trained BRE staff members leased to your office that are invoiced to you based on billable insurance hours/tasks basis that are guaranteed to be error free.  If the staff BRE leased to you on a billable hourly basis makes an error, we don't charge you for that related time element unless corrected.

Second, in order to perform the required work tasks, documentation, and meet the insurance guideline time elements, there is a need for significant support staff also provided by BRE.  It is critical that all elements required by insurance be met and documented as you know. Work product produced by BRE staff is completed on and offsite, some face to face with patients, some interactively, some by gathering information using technology.  In addition to the patient interaction portion, the bulk of the work performed is away from the patient.

Onsite BRE Staff have been trained to use and coordinate with offsite leased staff such that you benefit from multiple staff member time, but only as it relates to 100% efficiency across billable insurance hours. You pay only for billable time, not clock time.  From face to face time to completion of a typical 96130, 96132 and 96138 coding encounter, including new or updated, take-home treatment plans is three (3) days or less turn around.  Remote patient monitoring by telephone is separately billed based on when it is performed using current code 99457.

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Compared to most in-office staff that you are paying by the clock hour, BRE staff are ONLY charged to you AFTER a reasonable reimbursement time (generally 28 days in the arears or longer from time of completed service).  This means parity between BRE staff fee invoice payment and billable services.  Client offices appreciate the fact that they don’t pay for staff inefficiencies.

Studies have shown that internal doctor office staff time is less than 60% efficient when compared to actual billable services.  This means that on an economic basis, you are paying your staff almost double what you think, with less accountable work is being performed.  No fault of yours or theirs, just the true hard facts of how most offices function because of various demands on time, prioritization of task mismanagement and other procedures and task needs.  Because BRE staff only performs one element of the care process, efficiency is naturally much higher.

Medical offices that use internal, do-it-yourself mental health assessments find that they have difficulty just keeping up with annual screen administration much less not having actionable information gained.  These types of tests result in virtually no follow through, no ongoing comparisons of data, and are basically just a static assessment at the moment the test is taken.  Clearly, they have no action plans to additionally benefit patients, and minimal production value contribution to the practice.  Often, the do-it-yourself plans are a logistical nightmare for staff who also hate to be involved with the process.

BRE is like having a dedicated strike-force with demonstrable results in terms of patient progress, documentation, insurance validation, patient betterment and office production.  The system results in lowered emergency services, extended time for patient living independence, and reduced burdens to society.  In many cases, senior patients re-commence with productive contributions to their local communities as a consequence of participation with the BRE System.

How Does The BRE Program Track Patient Progress?

To effectively track patient progress for mental health requires repetitive assessment and interactive testing over time (multiple data points).  In this way, statistical information can be gathered and compared using color-coded graphical displays for efficiency as well as through outlier identification.  Once a baseline is established as a consequence of the initial testing and assessment process, then an ongoing and recurring tracking system for those same parameters can be achieved.  Because patients favorably respond to the take-home treatment plans for physical and social activities, consistent improvement scores are not unusual.

Key to success of the program requires prompt review of medications when assessment scores decline as this often correlates with any negative changes.  The combination of assessment objectivity along with inter-office-encounter communication vis a vie remote patient monitoring by phone allows an extension of the office to stay on top of critical information.  Added to this is the general feedback from patients about the love and care they receive from office communication.

Careful reduction of medications might also be achievable through the benefits of the treatment action plans that call for more physical activity participation, also tracked by the testing and assessment outcomes.  Other than “outlier assessment score” attention, attending Providers just need to approve and review work product from the supervised leased BRE staff by check box.

How Much Work Does The Billing Provider Have To Do?

One of the outstanding benefits of the BRE Program is that billing Physicians can be as hands on as they prefer.  Some Providers prefer that BRE staff perform all assessment and take-home treatment plan creation and only notify them when medication review, modifications or changes as well as new potential diagnoses are needed.  Clearly, triggers for referrals or more complex care decisions are always made by the Providers.

Clearly, BRE staff make no recommendations about medication prescription issues nor are they permitted to discuss them with patients.  However, during remote patient monitoring calls, relevant  information as may be reported by the patient, including compliance with medication instructions, can be communicated to the attending Provider at the office for disposition. 

In all cases, BRE software uniquely documents all work product in compliance with insurance codes being utilized.  The billing Physician will have a work screen dedicated to reviewing and accepting (check box) the time-element and supported work-product for each code description. This would also be for patients who did not qualify for reassessment inclusion other than annual mental health screens. 

The billing Physician can freely make changes outside of guideline recommendations for ICD, LCD and NCD qualifiers based on other clinical findings or risk factors as they may independently determine.  BRE staff are expertly trained to perform tasks that will only qualify patients according to the guidelines.  Unless otherwise directed, one way or another by the billing Physician, or by patient consent waiver not to participate when in fact they do meet medical necessity guidelines for inclusion BRE staff simply follow guideline inclusion rules.

Following the initial implementation of the program, billing Physicians and BRE staff learn to work with one another seamlessly and in a way that is time respectful for both, mostly as a result of the efficiency of the software and outlier findings.  Depending on Practitioner preference, their time requirement for the program can range from minimal to moderate.  This process is entirely up to the discretion of the billing Provider and the way they like to practice medicine.  All required work product will be performed by the BRE staff for supervised services billing under the supervising Physician's NPI.

BRE Staff, although directly reporting to the supervising Physician or other office QHCP, may not perform other office duties or make determinations of any kind other than recommendations that may be accepted or rejected by the billing Physician.  BRE staff are not allowed to make coffee runs, pick up kids from school or perform other duties.

How Much Time Will The Program Take?

Providers have reported that overall time can be reduced because so much information related to a patients' reported status can be gained from the assessment testing process.  This means that tracking a patient for mental health reasons overlaps with the usual interaction between patient and Provider.  Therefore, tracking results can be both informative across all treatment considerations as well as for interactions between treated conditions and mental health.

Because the time elements and task functions required by coding guidelines are handled across multiple patients in one setting, as well as by remote BRE Staff for follow up and treatment action plan support, the need for time element by the Provider is minimized unless they would prefer to be more involved.

In most cases, experienced BRE staff understand the elements needed as a consequence of assessment scoring and patient interaction.  This leads to the creation of a dynamic treatment action plans that is effective, updated regularly and demonstrable over time.

How Much Space Will The Program Take?

The BRE staff member (CCM) works out of your waiting room. We set up a small podium for the CCM to work from, which takes up a 3' x 3' space.  

Who Implements The Program?

The BRE Program is 100% BRE staff driven through trained and leased staff to your office, charged according to an insurance billable hourly basis.  There is no do-it-yourself option and other office staff may not operate the system, although we expect everyone's cooperation in supporting the program because of the significant benefits.

Each BRE staff member (Clinical Case Manager) is trained to work with the remote BRE staff for your office that helps support and supervise the program.  Although these are people that you may not meet, they do provide significant work product to help support the onsite CCM's.

Even though BRE staff are trained to perform all functions and aspects of the program, any additional work done by providers is generally not counted towards the required insurance time elements and content needed to fulfill CMS and AMA coding requirements.  This means that your office will be invoiced for the billable hours as described by each code used or BRE will assign a billable hourly time element to codes that better represent work product required.  An example of this is code 99453 whereby the specified billable hourly time by BRE probably represents most of the actual reimbursement in order to pay for the additional costs of education and remote patient monitoring equipment.

How Do You Know Insurance Will Reimburse?

BRE staff works with each office uniquely in that a reasonable game plan is designed to attend to all senior patients that have the highest mental health risks fairly.  In the case of offices with significant senior coverage plans including PPO, HMO or Medicare Advantage Plans, it is up to existing office staff to perform verification or authorization of benefits concomitantly to other services as may be determined by the office.  It is also up to your staff and business process to deal with co-pays and deductibles per office policy.  BRE does provide sample paperwork for co-pay collection process as may be preferred by some offices.

BRE highly recommends quality payer mixes for chronic illness senior patients as they have the most amount of time to dedicate to their treatment plan as well as require more intense monitoring because of their existing disease process.  The combination of time during the day (because of retired status) and the reimbursement for Remote Patient Monitoring give a particular benefit to the senior population that is generally not available to younger patients.

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If you have a significant amount of payer mix that includes CMS or other programs that pay according to Medicare Fee schedules and requirements, this is a proven option for business consideration.  In certain areas, Tri Care for senior military patients may be possible but would have to be determined on a case by case basis.

BRE provides an error free work product guarantee relative to its process, advisory, substantiation and coding compliance.  It does not extend to co-pays and deductibles as these are out of the scope of the program.  BRE Staffing services invoices each participating office in the arrears depending on what type of participation is selected and the anticipated hourly billing volume.  Generally, invoices are due during the following month after services have been completed for the relevant coding sequence applicable.

In most cases, client offices have no out of pocket, upfront costs and will likely reap net financial rewards of 20-30% or more of the gross amount billed for BRE related services.

How Much Do You Receive In Reimbursement For The Average Patient?

The primary goal of the BRE Program is to improve patient outcomes while saving payers money through avoiding costly residential options for care including emergency services and hospitalizations or pre-mature assisted or senior living expenses.

Additionally, the program can save significant costs of very expensive treatments and medications that insurance companies hate as a result of early detection and less expensive care options. Obviously, we also want patients to contribute back to their communities in the form of participation and other volunteer based involvement because the program, as an extension of your office, helped them do so.

That being said, for patients with determined risk factors according to LCD, NCD and ICD guidelines, who qualify for medical necessity for annual inclusion, the yearly payer reimbursement including offsite monitoring can range from as little as $1,000 per patient per year to as much as $5,000 per patient, per year, exclusive of medications or other therapies and services.  We therefore want to make sure we target the right patients and provide the best possible outcomes for the patients while reducing other costly measures.

Billable hours to support these collections according to coding requirements range from 10-40 hours per patient, per year.  Only a fraction of this time is face to face with BRE staff, as most of the work is performed as a product of non-face to face documentation, interpretations, evaluation, creation and updating of the treatment action plan, and patient follow up monitoring.

Most offices report that chronic illness senior patients participating in the BRE Program are worth an extra $1,000 net each over the course of 10-12 office encounters for other reasons per year.

How Does BRE Address The Mental Health Component For Care Differently?

The patient facing aspects of the BRE Program are always about "Brain Health" not Mental or Behavioral Health.  Patients are educated correctly about this through both remote and onsite BRE staff interaction.  Brain Health can be affected by many things including high risk factors for the most commonly prescribed medications that include cognitive, addictive or depressive side effects.  Clearly not all patients are created the same and what might cause deleterious side effects to one patient doesn't affect another even after ten or more years of use.

Following proper patient education about the tests, and why repetitive data is so important for tracking and monitoring purposes, each qualified patient is accepted or rejected based on ICD, NCD and LCD guidelines. This qualification is determined during the annual mental health screen encounter.  Only those that qualify for repetitive participation receive a treatment action plan.

TAP's are made for each participating patient and updated monthly or quarterly based on the most recent encounter as well as content and defined events/activities.  These are physical and social activity plans that are based upon community or other consideration events.  Patients, as part of their care are asked to participate and tracked through the process with the help of remote BRE staff, family and friends-- all who play an active role in helping each patient.

Research has shown that such social and physical engagements are very beneficial for patients.  In addition to creating dynamic treatment action plans, the follow up by BRE staff between office visits is a huge component to success.  Obviously, each office encounter also requires each patient to be repetitively reassessed for progress using interactive and standardized tests with the aid of BRE staff onsite.

The end result is a demonstrable scoring system predicated upon the various components of the program.

Is There Insurance Billing Support?

Insurance billing is handled in one of two ways.  The first option is to select from a short list of proven billers and allow them to perform the billing administration which extends our error free guarantee through the collection process, not just the administrative process.  We do not benefit from billing services; we just want to make sure that you collect for services provided.

The other option is that you can use your existing billing department and we will provide them access to a dedicated insurance portal window within the BRE software.  This window, following acceptance and approval by the billing physician, will self-populate the CPT codes used as well as the corresponding ICD diagnosis codes determined.  In this case, the error free guarantee does NOT include through your staff or outsourced collection process. 

Notes from the BRE patient records may be seamlessly copy and pasted, dragged and dropped or pdf'd into the office primary billing EHR system.  However, BRE is a stand-alone Mental Health EHR with very high cyber security protection.  Therefore, notating in the office primary EHR to reference the BRE EHR is far easier than transcribing all notes and results.  Graphical interfaces would overload most office EHR’s because of the sheer file sizes.

What Is Included In The Program?

The Behavioral Response Evaluation Program includes everything necessary, including leased-staff, hardware and software technology to perform EHR drop-down menu selections to determine ICD, LCD, NCD guideline qualification for potential participation.  Following medical necessity qualification performed each year, patients participate in recurring interactive and static assessment tests followed by a customized treatment action plan with remote staff follow up for each patient.

This is a turnkey approach and system for tracking, monitoring, assessing, evaluating and adjusting the various aspects of mental health care for most MAC part B healthcare practices of any type or specialty catering to the senior population. 

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The primary focus for most patients with mild to moderate mental health conditions is the community-based activity participation on many levels.

What Kind Of Target Patient Volume Is Required To Participate

Assuming a quality payer mix of senior insureds, the ideal patients who respond best to the program, yet have the most relevant risk factors, are retired patients with chronic disease conditions, mostly pain. 

A participating office must have at least 200 of these types of patient case visits per month, more is better.

How Long Does It Take To Begin?

This varies significantly based on the number of new client offices in the queue at any time.  It could be as short as within a month of executing the participation agreements or could be longer.  Part of our process is to ensure success, not just for your office, but for the sponsors that invest to make the program and process possible.  We also want you to gain satisfied patient support for the program which takes time and education as well as multiple follow up points including updating and changing treatment action plans regularly.

How Long Do I Have To Commit To The Program?

Offices need to understand that to set up a new client office costs hundreds of thousands of dollars.  This includes very expensive software user-licenses in addition to staff recruitment, training, salaries, local and central office supervision and travel costs for set up specialists, all prior to any collections from your office for services provided typically in the arears of insurance collection timing.  This means that this is not a trial or demo basis, that it is something that you truly want to participate in and make it work in your office without question.  We have no reservations making this happen but we do need the support of all providers being on board and helping to make this a standard of care—not an optional care service—for all patients who qualify.

Clearly there are unforeseen exceptions to every rule, but out of respect for the financial interests of others, including the aforementioned costs and time elements, please do NOT participate if you have any reservations in doing so.  Trust in the fact that we have the most to lose if things do not run as they should.

Please note that BRE is first committed is to the patients that will be mutually served by our process and administered through expert BRE staff leased to you under your medical supervision.  The second commitment is to the staff professionals that we recruit and train with the intention of this being a long-term engagement at your office as a valued team member leased through us, trained by us, supported by us, but under the medical supervision of the attending Physicians and QHCPs.

We also have commitments to our investors and stakeholders who make this possible and to you as a valued client as well as to our Company, our internal personnel and service professionals that we heavily rely on.  It takes a team effort to make this work and if an office is not committed on every level for success, then the program is destined to fail.  Clearly, we are here to provide the majority of the work element, but you must do your part including paying your invoices in a timely fashion.

The minimum requirement to participate is two (2) years unless we are unable to deliver services as promised.  In order to protect our investors for the capital that they must advance for each new client office, we have a responsibility to show a fair profit for the time and money invested.  We also have the same for ourselves and our staff and need to amortize the training and other associated support costs that are ongoing and ever escalating.  Therefore, two years or more is the minimum required time to accomplish this.  We fully hope that you will love our services and our advanced thought planning process that you will be a client for a life time.

It is our sincere belief that after two (2) years you will not want to go back to administering a mental health program yourself and that you will want to continue to work with BRE for yourself and your patients' benefits.  If you have multiple offices, we believe that after a short while in the first location you will want to expand to all.  Providers are expected to place on file an appropriate ACH for which the Company will receive payment following invoice. You will have 72 hours to review each invoice prior to ACH submission for services payment.

How Many Patients Can Start The Program Per Day?

Whether a patient is new to the BRE Program following approval during the annual screening event or is participating in a repeat assessment testing process during each year following an annual qualification, a single system supported by one or more BRE staff person in your office, is capable of performing more than 60 such mental health encounters in a given day, providing space is available.  Please remember that the 60 in-office encounters are only a fraction of a completed encounter code (for codes 96130 & 32) as most of the work is not done on a face to face basis.

Participants must understand that there is considerably more work required following each in-office encounter for each patient and subsequent code billed for completed services.  The normal turnaround time from start to finish for the assessment and treatment plan portions of the coding currently used is three (3) days.  Although some of the time-element might concomitantly serve multiple patient interactions and be billed as such supported by multiple BRE staff, the work product produced will more than satisfy any reasonable requirement for how much time and work product element was allocated to each patient.

Patients receive the best of care because they are not only supported by the providers, core office staff and in-office BRE staff but by a team of BRE staff and professional experts remotely.

Is The BRE Program Compatible With My EHR?

The answer to this is yes and no.  We purposely do not have the BRE software automatically populate into your EHR because the amount of information in terms of data, notes and treatment action plans would be overwhelming and are often not critical elements.  We also have concerns over many popular EHR’s that have had clients’ victim to ransomware attacks.  Our system has NASA type cyber security and clearly more than HIPAA compliant.

From a compatibility perspective, the program is designed to allow billing physicians, coders, billers and or BRE staff, to copy and paste or drag and drop or pdf relevant data from BRE software into your every-day office billing EHR.  In most cases, a foot note referencing the BRE Mental Health EHR suffices to substantiate the existence of additional information retrievable as well as basic notes that may be relevant.

Transcribing selected notes from the BRE EHR also allows for selectivity of information that can exclude the potential of "back and forth" notations between Provider directives, onsite BRE staff, remote BRE staff and other components to the program.

As much as documentation is important, BRE details and supports every element of the process well beyond what might be reasonable and necessary to place into a permanent EHR setting.  We also don't want to overwhelm providers with review information that they deem is not necessary or requires too much time for them to read when they are faced with demanding patient volumes and E & M schedules.  This gives each office extreme flexibility to operate how it sees fit.

How Much Money Can I Make?

The BRE Program was clearly designed to help patients first.  It has taken more than 4 years to design, develop, organize, coordinate, program, experiment and refine.  The result is an optimal EHR tool and treatment action creation system to accommodate every patient who qualifies for its intended use.  As time goes on, capabilities continue to be enhanced.

As a consequence of all of this, it is not an inexpensive program to implement in any office although it appears to be seamless to most offices and is very efficient.

In order for the program to be supported by consistent payer reimbursement, it also needed to meet the requirements for insurance coding while reducing overall costs and improving and documenting patient progress outcome.

Achieving all of this has been a challenge, but the resulting benefits include a meaningful increase to office production.  Depending on how the program is used within an office and with respect to payer mix and patient volume, a small office might only benefit by a couple of hundred thousand dollars per year in net income after expenses.  A more modest office could easily generate over a million dollars while larger offices could be in the many millions of dollars.

What Insurance Companies Pay For The Program?

Insurance Companies typically take lead from Medicare.  Medicare is also the only payer that publishes a fee schedule range for reimbursement.  BRE follows the guidelines according to Medicare as defined by ICD’s and amended by LCD's and NCD's.  Private payers that administer Medicare PPO and HMO policies typically follow CMS policies, but not always.  We therefore recommend careful review into your own healthcare insurance policy payer mix to ensure that the policies cover the relevant reimbursement codes newly released for 2019-2020 as they relate to mental health and the effective use of this program.

How Much Does It Cost?

Participation in the BRE Program can start from nothing upfront as it can be sponsored by the Company and its investor sponsors.  For a limited number of offices, self-sponsoring is possible, and depending on how large your office or offices are will determine that cost.  Suffice to say that investors who sponsor office participation through the Company in the form of sponsoring upfront costs expect to make an attractive return on their money.

Investors or self-sponsored offices make money as a consequence of participation in the revenue stream from hourly leased staff charges to each office just like any outsourced employment company would make.  The only difference here is that in order to be fair to participating offices and BRE providing the trained and dedicated staff, is that staff are charged based on billable hours as set-forth by AMA CPT coding and CMS requirement guidelines.  If there is not a billable time-element defined for a particular procedure code, or there is one that is not reflective of the actual work product involved, BRE assigns/adjusts one that is reasonable.

The hourly rate charged by BRE is determined based on a number of factors.  Most of this has to do with location and commensurate local labor costs in addition to long-distance corporate and other local supervisory and support costs.  BRE does not charge according to a percentage of collections or as a revenue or fee splitting scheme. In cases where a participating office is permitted to self-sponsor, the projected return on this can be attractive but requires permission by BRE Management who will provide details.

Assuming your local MAC B administrator and or PPO, HMO, and Medicare plans pay comparably, you should expect to collect from payers more than 95% of the bills submitted.  According to national statistics, 81% of Medicare Insureds have supplemental insurance.  As a general estimate, a client office should expect to make 20-30% or more on gross collections with NO additional staffing costs or time elements attributable to the BRE work product.

Most private medical offices in the USA struggle to have a 13% margin.  Participation in BRE can more than double this amount so from a financial perspective is very attractive to most qualified and accepted offices.

Can I Be A Financial Sponsor And How Much Does That Cost?

Of course.  However, we only accept investors as we have vetted and qualified offices to match up with as well as how much waiting time there might be as this is on a first in-next to deploy basis.  We simply cannot have a new investor jump ahead of others already committed.

The cost to participate as sponsor for other offices should be discussed with your Company representative as it can vary depending on many factors.  That being stated, anticipated returns are attractive and are the reason we are able to target such a rapid expansion pace.  Thank you loyal investors.

How Am I As A Client Protected From Insurance Reclaims

If you are a current client of BRE, it is understood that BRE provides an element of an error free guarantee in terms of time and task requirements performed according to insurance stipulations made by CMS, ICD, LCD and NCD policies and updates.  BRE has procured a multimillion dollar errors and omissions and audit risk insurance policy by a major insurance company to protect and address any matters concerning reclamations where BRE may be at fault.

No other Company in the space currently has such a policy and unlikely to get one based on due diligence required and cost considerations.  This further solidifies BRE’s commitment to its valued Clients.