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Integrated Care Billing

Different payment structures are available when MedFTs are working in medical or healthcare facilities. Four of the most common are fee for service, PMPM, Grants, and Incident to billing. The type of billing used depends on the care setting that the medical family thearpist is working in.


Fee-for-Service

Fee-for-service: the MedFT bills insurance for their   services using available CPT codes

PMPM

Per Member/Per Month (PMPM) billing: the MedFT does not bill separately. Instead, the organization has an agreement with an insurance company wherein the organization bills the insurance a flat fee monthly for each patient.

Grants

Grants: the MedFT’s position and services are sustained by grant funding. Billing may or may not occur.

Incident-to-billing 

Incident-to-billing (specific to Medicare): Bills outpatient services provided by a non-physician provider. The problem must be first identified and addressed by the physician provider. The physician provider must create the care plan, which includes mental health support, and involved in ongoing care. The physician offers direct supervision, is in the area where care is delivered (e.g., in the office), and able to offer immediate assistance. Certain documentation requirements must be met. This is billed under the physician.