How to start Collaborative Care in a small clinic: a 30-day plan
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Quick answer
A small clinic can start Collaborative Care in about a month: name a treating practitioner, a behavioral health care manager and a psychiatric consultant (week 1); set up consent, the PHQ-9 and GAD-7 and a registry (week 2); enroll patients and hold the first caseload review (week 3); then total the minutes and file the first claim (week 4).
What Asendar is: New tools for therapists. Asendar is a new category of therapy tool, a new way of seeing the problem. It does not replace your notes, your assessments or your EHR; it adds real insight from real conversations. Collaborative Care is one way clinics use it.
Collaborative Care (CoCM) is a team model in which a treating practitioner, a behavioral health care manager and a psychiatric consultant work from a shared registry and validated rating scales to treat behavioral health conditions in primary care.
Week 1: pick the team and the patients
- Treating practitioner (often the PCP or nurse practitioner): directs care, makes the initiating visit, and bills.
- Behavioral health care manager (BHCM): follows each patient between visits, runs the rating scales, logs minutes, and keeps the registry current.
- Psychiatric consultant: reviews the caseload with the care manager on a regular schedule and advises the treating practitioner. Contracted or telehealth is common.
- Who you will enroll first: for example, adults with a PHQ-9 of 10 or more at a recent visit. Start with 10 to 20 patients.
Week 2: consent, scales and the registry
Consent. Medicare accepts verbal consent if it is documented. A plain script:
“Our clinic offers Collaborative Care. A care manager on our team will check in with you between visits, and a psychiatric specialist will review your care with us and suggest changes. It is billed like other services, so you may owe a copay or coinsurance. You can stop at any time. Would you like to take part?”
Record the date, who explained it, and that the patient agreed. Check your other payers' consent rules.
Scales. Use the PHQ-9 for depression and the GAD-7 for anxiety at enrollment, then at least monthly.
Registry. Set up one row or record per patient: enrollment date, baseline and latest scores, minutes this month, and the date of the last caseload review. Start with the free registry template or follow the registry setup checklist.
Week 3: enroll, log minutes, hold the first caseload review
- The treating practitioner holds or confirms the initiating visit and refers each patient.
- The care manager contacts each patient, gets consent, takes baseline scores, and logs every contact's minutes the same day.
- First caseload review: the care manager and psychiatric consultant go through the registry, starting with patients who are not improving. Record the consultant's recommendations and send them to the treating practitioner.
Week 4: close the month and file the first claim
- Total each patient's care-manager minutes for the calendar month.
- A first month with 36 or more minutes supports 99492; 86 or more adds one unit of 99494. A month with 16 to 35 minutes can support G2214 for Medicare.
- Check the documentation: consent, initiating visit, scales, minutes, caseload review.
- Bill under the treating practitioner. Then look at who fell short and why.
Check any month in the free CoCM billing calculator, and walk through the billing checklist before the first claim.
Before you start
- Confirm your Medicare and Medicaid billing rules (see the checklist).
- Agree how the psychiatric consultant is paid: CoCM codes are billed by the treating practitioner, and the consultant is usually contracted.
- Decide where the registry lives. A spreadsheet works for a pilot if it is HIPAA-safe; see spreadsheet vs software.
Common questions
How long does it take to start Collaborative Care?
A small clinic with a care manager and a psychiatric consultant in place can enroll patients within a few weeks. Hiring or contracting those roles is usually what takes longest.
Who can be the behavioral health care manager?
CMS describes a designated member of the care team with formal education or specialized training in behavioral health, such as a nurse, social worker or psychologist, working under the treating practitioner. Check the CMS booklet for the full definition.
Does the psychiatric consultant have to see the patient?
No. The consultant reviews the caseload with the care manager and advises the treating practitioner. They do not usually see the patient.
How many patients should a small clinic start with?
Many start with 10 to 20 so the team can learn the workflow before the caseload grows.
Do I need software to start CoCM?
No. A registry is required, but it can start as a spreadsheet. Software helps as the caseload grows.
Published by Asendar™ (Ignite Synergy™). Education only, not medical, legal or billing advice. Payers set their own rules: verify with your payer and your Medicare Administrative Contractor before you bill.
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