Frequently Asked Questions
In addition to these FAQ's, Learn More about the BRE program and how it benefits physicians and patients.
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).
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 the 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 result 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, and hospitalization considerations.
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.
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.
What Is The Difference Between The BRE Program And A Do-It Yourself System?
TO try and replicate all aspects of compliance that the BRE program provides, a practice would need to first create an assessment program that would meet the time element requirements of the CPT codes used. They would then have to create an internal process and hire between two to four staff to assess patients. In addition, the practice would need to create an electronic process to capture patient assessment answers, score them, and generate actionable, easy-to-read reports for the providers, along with a documentation component.
Even if a practice could accomplish the above, it would cost well over $150,000 and take eight months to implement. You would then be faced with dealing with staff turnover. The initial term of the BRE agreement is two years. Using BRE is a proven and much safer alternative with guaranteed income projections.
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.
The key to the success of the program requires a 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.
How Much Time Will The Program Take?
Providers have reported that overall time can be reduced because so much information related to a patient's 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.
BRE will coordinate the integration of the necessary time elements for the CPT codes into your EMR so the entire interaction and documentation requirements for the CPT codes can be easily handled during the patient's E&M visit.
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.
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.
How Much Money Can I Make?
The BRE program was designed to help practices earn a consistent and predictable income. Practices earn an average of $1,850 per year in profit from each participating patient. Furthermore, due to the predictable and consistent EBITDA generated by the BRE program, practices can realize a 10x-15x multiple of EBITDA for valuation purposes.
What Insurance Companies Pay For The Program?
Insurance Companies typically take the 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 ICDs and amended by LCDs and NCDs. Private payers that administer Medicare PPO and HMO policies typically follow CMS policies, but not always. We recommend a careful review of 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 Am I As A Client Protected From Insurance Reclaims
The BRE program ensures all work is 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 is unlikely to get one based on the due diligence required and cost considerations. This further solidifies BRE’s commitment to its valued Clients.