Please take a moment to watch this brief introduction video.
You will discover how BRE benefits senior chronic pain patients and the physicians that serve them.
The BRE program can significantly increase practice net income and business valuation.
BRE's doctor-designed program was created for the specific needs of pain management providers.
BRE was designed to meet all ICD, NCD, and LCD guidelines and payer requirements.
This presentation will describe how BRE seamlessly integrates into the practice, and how the program works with both patients and doctors.
BRE offers both physicians and qualified third-party investors a unique opportunity to generate significant monthly income and wealth creation.
Patients benefit because the BRE Program is based upon repetitive assessment evaluation and comparison of that data over time to determine if the dynamic treatment plan is achieving its intended goals as it relates to mental health. For chronic condition patients of all types, this can mean a huge reduction through early detection of common medication side-effects as well as other mental health incidences having to do with depression, addictions and cognitive decline.
Early detection is achieved and documented as well as consistent 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 options based on directives from the billing Provider and from patient preferences. Each are approved by the billing Provider. Patients therefore benefit from a formula supported by 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.
The BRE Program was designed to begin its entry point to mental health starting from each patient's annual mental health screen. However, chronic condition patients of more senior age typically benefit most because of repetition of data points and because this patient population has more time available to spend on treatment action plans away from the office setting.
As part of the possible qualification process during the standardized annual mental health testing screening process, additional questions are asked, and more determinations made, specifically related to ICD, LCD and NCD guidelines to establish (or not) medical necessity for the next twelve months. This process both benefits patients who need inclusion into a more aggressive tracking and brain health related care program, but also demonstrates to payers, and for liability protection for the Physician that appropriate detection and care are being rendered for this high risk population sector. Each encounter results in changes and or adjustments to treatment plans—no exceptions.
For geographical areas that have no current medical necessity guidelines, the BRE Program has added risk factor determination questions from samples of other areas that do. The intent is not to put patients through the repetitive testing portion of the program that do not need it. For patients that do need the extra care considerations, participation in the BRE Program can be life changing and certainly reduce societal burdens as the population continues to live longer.
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. During face to face assessment time, additional information is gathered by the attending BRE staff Clinical Case Manager including through the use of FDA cleared Micro Electro Cranial Stimulation (MECS) both as a calming therapy (well documented in the research) as well as an inference to help determine a patient's likely response to supportive care options either in their community or at their place of residence.
Patients that refuse or do not respond favorably to MECS therapy are often found to be over medicated either by misuse or from using recreational substances. In particular, these patients require an escalation in care review by the Provider such as the potential for a residential or hospitalization option as may be determined.
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.
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 driven system implemented under each billing Physician's supervision. The entire program service is performed by professionally trained and educated "leased" staff to each participating office on a billable hourly basis, charged in the arrears of services performed allowing for efficient offices to bill and collect first.
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 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; the creation and implementation of a Treatment Action Plan which incorporates current medication regimes with 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 fewer 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 Program assists with this. Objective improvement is quantified through participation and results in better scoring from repetitive assessments and reporting from satisfied patients.
Physician time can actually be reduced across all considerations as the data extrapolated from the repetitive assessments is 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 care process and bring to the attention of the Provider(s) patients for whom they have additional concerns.
In a time where 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.
There are two primary differences between a do-it-yourself mental health plan and the BRE Program. The first includes dedicated staff members leased to your office that are invoiced to you based on billable hours that are guaranteed to be error free. If the staff BRE leases to you on a billable hourly basis makes an error, we don't charge you for that related time element.
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. It is critical that all elements required by insurance be met. Without multiple interactions capability with patients in a single setting and additional non-face to face time work product, it is impossible to bill for the services likely to be accomplished by BRE even within a 24 hour period. 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 hours. You pay only for billable time.
Compared to most in-office staff who are not charging you by the billable hour, studies have shown that their time is less than 60% efficient when compared to billable services. This means that on an economic basis, you are paying them almost double what you think and far less work is being performed. No fault of yours or theirs, just the true hard facts of how most offices are run because of various demands on time and procedures.
Offices who use internal do-it-yourself mental health systems find that they have difficulty even keeping up with annual screens and no additional actionable information is obtained. The usual tests have virtually no follow through, no ongoing comparisons and are basically just a static assessment from the moment the information is gathered. Clearly, no action plans to additionally benefit patients, and minimal production value to the practice. Often, the do-it-yourself plans are a logistical nightmare for staff who also hate to be involved.
BRE is like having a dedicated strike force with demonstrable results in terms of patient progress, documentation, insurance validation, patient betterment and office production.
One of the outstanding benefits of the BRE Program is that billing Physicians can be as hands on as they like or just follow the outcomes save for any medication review, modifications or changes as well as new potential diagnoses. BRE staff make no recommendations about prescription issues nor are they permitted to discuss them with patients other than to gather relevant patient reported information as including compliance with medication instructions as directed by the Physician.
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 being utilized. 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 qualify according to the guidelines only, 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.
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 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 or pick up kids from school.
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 simultaneously 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 to create treatment action plans that is effective, updated and demonstrable over time.
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.
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.
By Patient permission, the vast majority of the program is implemented, coordinated and executed from your office reception area. Assuming there is a place for a small workstation area for the BRE Clinical Case Manager(s) and a place to hang a supporting wall poster, no dedicated private exam room is mandated.
Most importantly, Clinical Case Managers leased to you by BRE are trained to perform services efficiently and compliantly resulting in maximum productivity. Without this ability that can only be afforded through the use of the waiting area, the number of patients in most chronic condition and high patient volume offices would not be possible.
In certain cases, it is possible to section off a portion of the reception area using portable walls although this is usually not necessary. Having sufficient space in a waiting room is a key element for the success of the program, no exceptions.
The BRE Program is 100% BRE staff driven through trained and leased and staff to your office, charged on 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 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 or other office staff are not counted towards the required insurance time elements and content needed to fulfill insurance 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 better representing 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 cover the costs of education and remote patient monitoring equipment.
BRE staff works with each office uniquely in that a reasonable game plan is designed to attend to all patients with the highest mental health risks fairly. In the case of offices with significant private payers (if even accepted for inclusion), it is up to existing office staff to perform verification or authorization of benefits concomitantly to other services. It is also up to your staff and business process to deal with co-pays and deductibles per office policy. BRE highly recommends quality payer mixes for chronic condition senior patients as they have the most amount of time to dedicate to their treatment as well as require more intense monitoring because of their existing disease process.
If your office has a significant amount of private payer policies with high deductibles, there may be considerable push back by patients to come out of pocket for the BRE services. This is a determination that only you and your office staff can make. 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.
BRE provides an error free guarantee relative to its process, verification, 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.
It is advisable to determine a quality payer mix in advance of participation. On average, a participating office should expect that they will pay hourly rates based on billable hours that will result in net income to the practice in the range of 25-30% of what is billed and collected depending on the types of insurances and mixes that you accept and offer within your practice. This should be discussed in detail with your BRE representative.
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 through 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 involvement because our program 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. 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, interpretation, evaluation, creation and updating of the treatment action plan and patient follow up monitoring.
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; 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. 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 attached as a pdf into the office primary EHR. However, BRE is a stand-alone Mental Health EHR. Therefore, notating in the office primary EHR to reference the BRE EHR is far easier than transcribing notes and results. Graphical interfaces would overload most office EHR’s because of the sheer volume size.
That depends. 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.
Assuming a quality payer mix, the ideal patients who respond best to the program, yet have the most relevant risk factors, are senior patients with two or more chronic disease processes.
A participating office must have at least ten (7-10) of these types of patient cases per day, more is better.
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.
Participation in the BRE Program can start from nothing up front 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.
In addition to the billable hourly fee invoiced in the arrears, each office will be charged a nominal data storage, software usage, technical support and content licensing fee by the program developer--not BRE--that you will pay by advance credit card on file, charged weekly, commencing immediately with your start date.
You should understand that the fees that you will be invoiced by BRE will be significant, but far less than one would expect to pay for the money that you will make. If your office will not support at least $350,000 per year in projected gross reimbursement, even for the smallest of offices, BRE would not accept you as a client, even if you were willing to self-sponsor the upfront costs without investment by BRE stakeholders.
The 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 arrears 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.