NIATx-SI Business Practices for the Future Round II Wrap-up

Submitted by: 11/12/2012 by Maureen Fitzgerald

More than 60 provider agencies in 7 states (California, Florida, Iowa, Kentucky, New Hampshire, New Jersey, and West Virginia) participated in the NIATx-SI Business Practices for the Future Learning Collaborative.

NIATx designed this yearlong learning collaborative to help providers develop business skills they’ll need to adapt to the changes anticipated with full implementation of health reform in 2014. Participants focused on learning how to bill for their services or improving an existing billing system to increase collections, reduce denials, or reduce billing errors.   

Technical assistance included coaching and regular teleconferences and webinars. The webinars featured expert guests on topics ranging from health reform to revenue management, contracting, and practice management.  All webinars are available for viewing on the NIATx website.

Participants in the collaborative used the NIATx Third-Party Billing Guide to create or improve their billing systems and also applied some of the Promising Practices to Increase Reimbursement on the NIATx Resource Center.

Participants in shared results of their projects in closeout meetings in October 2012.

Many of the organizations in the learning collaborative recognized the need to supplement government funding sources with revenue from other sources; some of them had never billed for services previously. They were placed in the “Level 1” group that focused on creating a billing system. Results included:

·      California Human Development (CHD) Outpatient Treatment in Santa Rosa met its goal to submit more claims to a specific payer. This was achieved in part by designating a single staff person to monitor third-party billing activities. CHD increased revenue and improved its capacity to serve low-income patients.

·      Human Services Associates (HSA) in Orlando worked on billing Medicaid, using the steps provided in the NIATx Third-Party Billing Guide. With its new capacity to bill Medicaid, HSA feels prepared for the rollout of managed care and anticipates continued increase in revenue.

·      The New Hampshire Providers Association recruited 7 substance abuse treatment organizations to participate in the collaborative. Five of these organizations had little or no experience with billing and successfully improved their ability to bill third-party payers.

·      Hope House of New Jersey increased fee-for-service revenue from 62% in November 2011 to 101% in May 2012. By participating in the collaborative, Hope House learned clinical staff need to be aware of the financial impact of the services they provide. Just as important was the realization that the need to generate revenue does not conflict with the agency mission to deliver quality service.

Another group of providers was assigned to Level 2 of the learning collaborative. While some providers in this group worked on creating a billing system, the majority of them worked on improving an existing system.

The Iowa Department of Public Health (IDPH) convened 11 outpatient treatment providers to participate in the project. This group of providers serves 61 of Iowa’s 99 counties and represents 48% of IDPH- funded substance abuse treatment programs. To reduce claims denials, the various teams established better systems to monitor and correct claims errors. To reduce days in accounts receivables, providers conducted outreach to clients, increased billing to twice monthly, and implemented electronic billing. Through these changes, all providers reported increased revenue and better communication with clients.  

The Kentucky Department for Behavioral Health,Developmental and Intellectual Disabilities (DBHDID) convened 8 behavioral health treatment providers to participate in the project. Two of the providers focused on learning how to bill for their services. The other six, which already had experience billing, concentrated on reducing denials and billing errors and increasing collections.

 “All made progress toward their goals,” says Lynn Posze, program administrator for the department.  Posze has been involved in many of the NIATx projects in Kentucky. The DBHDID has hosted several NIATx Change Leader Academies in the state, and has also offered incentive grants to the state’s community mental health centers to use the NIATx model to address access and retention issues. Kentucky was also a part of the Robert Wood Johnson Foundation-funded Advancing Recovery project (2006–2008).

The greatest benefit of participating in the collaborative for some of the providers in the Kentucky group, says Posze, “was realizing that they can bill for substance abuse services and then looking at their systems closely to figure out how to do it.”  She adds that in some cases, front office staff were not even asking patients for their insurance information because they assumed they could not bill for it. Making that simple change at the front desk had a big impact on those agencies. “A group of the patients these agencies serve do in fact have insurance that covers substance abuse treatment.”

Another important lesson for the Kentucky group was recognizing the importance of having credentialed staff on board, and making sure that clients with insurance get assigned to them. “Having properly credentialed staff has become even more important with Kentucky’s move to Medicaid managed care,” adds Posze. “The learning collaborative’s focus on meeting third-party payers’ requirements really brought this to our attention and highlighted the providers’ need to increase their master’s level credentialed workforce.”

 “Being involved in the collaborative allowed me to get to know the business side as well as the clinical side of the agencies involved,” says Posze. It also allowed those clinical and financial staff to interact with each other, since they don’t often work together on a shared project.

Posze recommends that any agency embarking on a NIATx change project include someone from the financial side of an agency. In fact, she recommended that agencies in the collaborative select a financial person as the change leader for billing projects. “I found that the staff from the financial or accounting departments of the agencies really took to the NIATx approach, since they are already focused on data. In some change projects, it’s hard to measure the impact of your change, but to accountants, it comes naturally.”

To view all the closeout presentations, visit NIATx-SI: Business Practices for the Future

Closeout Session

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