Opioid Practice Management Comes to e-Live Learning

Two ASAM members are bringing their expertise in the billing and coding functions of opioid practice management to ASAM’s e-Live Learning Center. The session, “Opioid Dependence Practice Management,” will cover both an overview of opioid dependence and tips for health insurance reimbursement through proper billing and coding.

The session was developed by John Femino, M.D., FASAM, MRO, Medical Director and President, Meadows Edge Recovery Center in North Kingstown, RI, ASAM Northeast Regional Director, and Immediate Past President of the Rhode Island Society of Addiction Medicine, and Stuart Gitlow, M.D., M.P.H., M.B.A., Executive Director, Annenberg Physician Training Program in Addictive Disease, Associate Clinical Professor, Mount Sinai School of Medicine in New York, ASAM Acting President and ASAM Delegate to AMA.

ASAM’s e-Live Learning Center provides members with an easy method of earning CME credits, whether it’s from the office or home, and now features an array of educational sessions. This newest session is timely because many physicians delegate the financial aspects of practice management to non-physician staff and may be missing opportunities for reimbursement. Both Dr. Femino and Dr. Gitlow concur that with a better understanding of opioid dependence and treatment within a practice, improved billing and coding will follow.

“The first half of this session begins by exploring the larger issue of defining opioid dependence and how it differs from opioid use,” Dr. Gitlow says. “Not all patients who use opioids have opioid dependence and not all patients with opioid dependence use opioids.”

Effective opioid practice management begins with thorough patient screenings and reliance on what literature has demonstrated as being a successful intervention for a substance use disorder, he notes. Addiction specialists must differentiate between patients who use opioids illicitly, but without related dysfunction, from patients who have a physiologic dependence to prescribed opioids. Likewise, he says it is important to screen for patients who have an addictive disease, but have never been exposed opioids, and those individuals who are in recovery and abstain from illicit opioid use.

Additionally, interventions often covered by health insurance providers include routine visits with an addiction specialist physician, routine urine drug screens, ongoing participation in AA/NA or comparable 12-step programming, potential use of buprenorphine-naloxone, a full medical workup (including a psychiatric workup after an appropriate period of abstinence), and increased intensity of treatment if symptoms worsen.

The second-half of this new e-Live Learning Center session focuses on the practical aspects of coding, billing, and using office-based treatments for addiction and medications related to addiction. This particular series focuses on the use of buprenorphine. Both medical and behavioral health providers must understand the scope of their practices and insurance benefits by provider type, Dr. Femino says.

“If you are a medical provider, you might not be accessing the behavioral side of the health insurance benefit,” he says. “Conversely, as a behavioral health provider, you may have reciprocal exclusions.”

The learning objective for this session is for physicians to understand how insurance providers process medical and behavioral health claims, Dr. Femino says. It’s only when physicians and counselors understand the system that they can take a “whole treatment” approach.

“What this session does is prepare providers to be proactive rather than reactive,” he says. “This better understanding not only helps in reimbursement, it also reduces claim denials for the patient and the resulting frustration and anger that go along.”

To access the ASAM’s e-Live Learning Center, visit¬†www.asam.org¬†and select the “Education” tab.