Complimentary from the Center
Written for the owner doing this arithmetic at the kitchen table.
- The role
- What is the job, and where are its boundaries?
- The team
- Who else has to be involved?
- The month
- How is the work tracked and coded?
- The rules
- What does each payer require?
- Source notes
- Where did this come from?
No form between you and the playbook. It is yours either way.
The BHCM Pivot Playbook is complete on its own. It answers one bounded question: what the care-manager role is, what it requires, and what remains unresolved. It is not a sample of something else.
Role design, workflow build-out, documentation and payer-specific implementation are a larger kit, and a different problem. Public guidance can explain a rule. Your state, licenses, payers, contracts and staffing decide what applies to you. Kedge Marketplace is where that individualized question gets answered: whether your own payer mix, licenses, contracts, and staffing can support the model, and what it would take.
Figure 01
Same clinician. Different role.
The care-manager role is a different clinical job inside a different care model. Relabeling therapy does not create it.
Current therapy role
- Individual therapy
- Visit-based work
- Counselor treatment record
- Paid under the applicable therapy billing rules
Possible care manager role
- Patient follow-up between visits
- Symptom tracking
- Brief interventions
- Care coordination
- Psychiatric case review
- Minutes tracked across the month
Collaborative Care
The medical practice bills the qualifying monthly Collaborative Care service when all of the model’s requirements are met.
CMS describes Collaborative Care as a defined team arrangement with specific service components and care-team roles, not a billing alternative for individual therapy.
Five things the model requires.
The model is not a switch a practice can flip alone. All five have to be true at once, and the playbook is honest about each of them.
- The clinician
- Can this person appropriately do the care manager job?
- The medical partner
- Is there a medical provider responsible for the patient’s medical care and billing?
- Psychiatric consultation
- Is a qualified psychiatric specialist available to review the patient list?
- Patient tracking
- Can the team track progress, minutes, and follow-up?
- Payer rules
- Does the insurer recognize the model, and what does it require?
If you are carrying several of them
The panel is what changes the arithmetic, not the number of clinicians.
A Collaborative Care team is paid monthly for the patients it follows, not per clinician. One care manager can carry a substantial panel, so a practice with several affected clinicians is usually deciding how many panels it can staff and fill, not whether each salary is covered on its own. The first months cost money while the panel builds. What the arithmetic looks like at maturity depends on the panel, the payer mix, and what those clinicians are generating today.
The playbook works the arithmetic through with the published thresholds. The worked example shows the shape of the ramp.
Where a practice starts
- 01 · Name the billing provider
- Which medical provider is responsible for these patients and will bill the monthly service.
- 02 · Choose the first patients
- A small starting group, so the workflow is learned before the panel grows.
- 03 · Set up the tracking
- Somewhere the team records symptom scores, follow-up, and minutes across the month.
Then psychiatric consultation and the payer confirmations, both of which the playbook covers.
This is not a billing workaround. Collaborative Care is a defined arrangement with published requirements in CMS booklet MLN909432, and the playbook shows the requirements rather than a way around them. It is written to be read by the person who signs off on compliance.
This is a model to evaluate, not a recommendation to convert every clinician.
Some practices will have the right medical partner, patient population, workforce, and payer mix. Others will not. The playbook is meant to help owners find that out before they reorganize anything.
An open question
Do care management hours count toward supervised experience?
A limited-license clinician is working toward full licensure, and Michigan requires supervised experience to get there. Whether qualifying work performed as a Collaborative Care behavioral health care manager counts toward those hours remains an open question Michigan should answer.
The playbook does not pretend the answer is settled.
It matters for the practice as well as the clinician: a role that does not count could slow someone’s path to full licensure. The policy work to seek a clear answer belongs with the Integral Neuroscience Initiative.
The exchange · about ten minutes
Ten minutes, if the playbook earned them.
We already have evidence that Michigan practices are changing hiring decisions as reimbursement rules change. What we do not yet know is the operational detail behind those decisions.
How many limited-license clinicians are affected? How many clinical hours are becoming harder to reimburse? What are owners doing with those positions? Could a care manager role preserve some of that workforce, and what would make the idea impossible? About ten minutes of your experience helps answer those questions. This is the longest of the six studies, because the practice side has the most moving parts. Findings go to respondents first.
If the playbook is useful, send it to whoever runs your billing. Most of the questions it answers land on their desk first.
About 10 minutes
Who you employ · hours at risk · hiring decisions · supervision capacity · whether a care manager role could work here · what would make it unworkable
The survey
The study is not collecting responses yet.
When it opens, the invitation you received will return you to this page. The playbook above is complete and yours to use now.
In the meantime, two things you can do now. Ask to be told when it opens, or ask for the findings without answering anything at all.
At the end, three permissions are asked separately: whether we may follow up, whether we may quote you anonymously, and whether you want the findings. None is required. You will see any proposed quote before we use it.