Florida providers learn to bill for services in NIATx learning collaborative

Like many states, Florida shows how improvement efforts in one or two organizations sparked the spread and diffusion of the NIATx model across the state. Southwest Florida Addiction Services in Fort Myers was a grantee of the Paths to Recovery II program (2005–2007) funded by the Robert Wood Johnson Foundation. The Center for Drug-free Living in Orlando participated in the CSAT-funded-STAR program (2004­–2005). Florida, through a collaboration with Florida Alcohol and Drug Abuse Association (FADAA) and the Department of Children and Families was a grantee of both the Advancing Recovery program (2006–2011), also funded by RWJF, and the Strengthening Treatment Access and Retention-State Implementation project, (2006–2010), funded by CSAT. It was also very active in the ACTION Campaign and several other NIATx sponsored projects.  

“Today, the NIATx model has become part of the organizational culture for many Florida treatment providers,” says Mary Booker, Assistant Director of FAADA. FADAA is a trade association of Florida substance abuse prevention and treatment providers, managing entities, community anti-drug coalitions and related vendors. It works with the state’s Department of Children and Families, the Substance Abuse Program Office, and other state level organizations to promote the adoption of evidence-based practices, support quality improvement projects, and keep providers informed on the latest research and policy issues.

FADAA recognized that the state’s movement toward managed care and changes anticipated with the Affordable Care Act would have quite an impact on small and mid-size providers that have relied solely on state block grant funding. When NIATx announced a second round of the Business Practices for the Future: Fee-for-Service Learning Collaborative in fall 2011, FADAA signed on as a convener, recruiting 7 provider agencies to participate. Says Mary, “We felt it was a critical tool to offer providers that did not have the infrastructure in place to bill third-party payers.”

The participating providers joined the collaborative to “get up to speed” on billing practices. Some of them did not have any experience billing and need to create a system, while others sought ways to improve an existing system. All members of the Florida collaborative were new to NIATx.

The collaborative began in January 2012 with a one-day face-to-face training, followed by monthly training webinars. NIATx coach Amy McIlvaine was available for phone and e-mail consultation throughout the 10-month project.

“Amy provided the guidance and encouragement this group needed,” says Mary. “Some of the teams were apprehensive at first by new approaches to organizational change, but Amy did such a great job of explaining the tools and approaches that the teams ‘got it’ by the end of the first day of the kick-off training.”

All the participating providers were pleased with the results they achieved:

• The Agency for Community Treatment Services (ACTS) in Tampa set an aim to increase third-party billing claims from 4 to 20 per month. ACTS examined all the processes related to billing and conducted a walk-through of billing workflow. It posted “Insurance Accepted” signs throughout the agency and trained clinicians, nurses, and program supervisors on insurance authorization requirements. As a result, ACTS increased third-party insurance revenue by approximately 30%.
• Better Way of Miami (BWM) wanted to increase admissions and billing for outpatient treatment services. Changes included having patients complete insurance verification forms at admission, designing and implementing a service ticket, and applying to become a certified Medicaid provider. As it builds capacity to bill third-party payers, BWM anticipates an increase in revenue.
• DISC Village, Inc., in Tallahassee set an aim to increase paid insurance claims and its copay collection rate. DISC had not worked with third-party payers in the past; the change team assessed DISC’s policies and identified the processes it needed to bill new payers. DISC also examined its fee scale and its systems for collecting copays, and establishing payment plans. By the end of the project, payment of copays had increased by 300%.  DISC will continue to work on improving its processes for billing third-party payers.
• Guidance/Care Center, Inc. in the Florida Keys wanted to increase collections for Therapeutic Behavior On-Site (TBOS) services by at least 100%. At the start of the project, TBOS represented 25% of the agency’s Medicaid covered business, with a collection rate of just 24%. GCC’s change team identified and addressed the reasons for claim denials. The collection rate steadily rose as the team improved the claims submission process. By the end of the project, TBOS collections had increased by 500% over the previous year. 
• Human Services Associates (HAS) in Orlando wanted to establish a system for billing Medicaid. It had just started to accept Medicaid recipients at its Adolescent Treatment program. The change team developed a process for billing, using the steps provided in the NIATx Third-Party Billing Guide. Successfully submitting Medicaid claims generated nearly $3,000 in revenue over a three-month period. As a result, HSA feels prepared for the rollout of managed care, anticipates a continued increase in revenue, and has increased its competitive advantage for grant awards and partnerships.
• Tri County Human Services (TCHS) based in Lakeland called its change project “Getting Through the River of Denials.” At the start of the project, its Highland County Outpatient program had a denial rate of 20% from third-party payers. The change team focused on a specific payer, examining and addressing the reasons for denials. By the end of the project, TCHS had decreased the denial rate, and 90% of rebilled claims had been paid. 
• Transition House in St. Cloud set a goal to bill and receive payment for four third-party insurance claims. This team established a process for obtaining insurance information from new patients. It also conducted a walk-through of the billing process, applied for Joint Commission accreditation and to become a certified payer with Medicaid and Medicare. The agency also began to contact private insurance providers to become part of their “panels.” Transition House met its goal to submit four claims and is awaiting payment.

In addition to improvements in third-party billing capacity, NIATx learning collaborative yielded other unanticipated results, just as valuable, says Mary.  One of them is workforce development.

“Often people who have not been recognized as leaders in the past will emerge as leaders when they’re part of an improvement project. By giving them control over the processes they manage, their confidence and competence becomes more evident to management, and this can help them advance professionally.” Seeing their peers excel creates buy-in from other staff members and makes participating in a change project very appealing, adds Mary.

The group had varying levels of experience working with third-party payers, but all benefitted through the peer networking built into the collaborative.  “Everyone wanted to share the knowledge they’d gained to help each other,” says Mary. “This really added to the success of the collaborative.”  Another key component was that agencies had support from top- and mid-level management to do their process improvement projects. “This allowed agencies to test changes and work on changing the culture.”  

For more information on the Florida team’s change projects, visit NIATx-SI: Business Practices for the Future Learning Collaborative Closeout Session.