BHBusiness Learning Network helps provider increase reimbursements in record time

Submitted by: 09/05/2013 by Maureen Fitzgerald

NorthKey Community Care provides serves 8 counties in northern Kentucky, with 18 locations providing inpatient and outpatient mental health, substance use disorders and intellectual disability services.

NorthKey is one of more than 100 providers from Indiana, Ohio, and Kentucky that have joined a BHBusiness: Mastering Essential Business Operations Learning Network:  Third-party Billing and Compliance Learning Network. The Third-party Billing and Compliance Learning Network offers training on implementing third-party billing systems that follow compliance measures, the common areas where billing systems function poorly, and improvement techniques that work.

BHBusiness: Mastering Essential Business Operations is a series of online courses designed to help executives prepare their mental health, substance use disorder, or behavioral health organizations for the seismic changes occurring now in the behavioral health field. Having strong business operations is crucial for providers to meet the challenges of the evolving healthcare marketplace and position their organizations for growth. Funded by SAMHSA and coordinated by State Association of Addiction Services (SAAS) in partnership with NIATx, AHP, and the National Council, BHbusiness is provided at no cost to participants. BHbusiness enrolled nearly 900 providers in its first offering of courses that began April 2013 and are planned to end in September 2013.

The learning networks will be offered again, with an application period expected to begin in fall 2013.

NorthKey has been billing third-party payers since opening its doors in 1966, says Debra Russ, Patient Accounts Manager. “Even though we think we have a wonderful system, we recognize that we always have more to learn,” says Russ, who is participating in the learning network along with other staff from NorthKey.

As Patient Accounts Manager, Russ oversees that billing is done in a timely manner. In 2013, she helped billing staff adjust to new CPT code changes and the addition of two additional managed care organizations (MCOs). She trains staff and keeps abreast of changes for all the third-party payers NorthKey works with, which include the state’s Medicaid and Medicare programs. She also sets up all the billing codes and reimbursement rates to be generated through a bill.

The BHBusiness learning network differs from other trainings that Russ has attended. “This course is really hands-on and interactive,” says Russ. “Having homework and coaching calls puts everything in perspective.” Support from expert coach Elizabeth Strauss has been particularly helpful, says Russ. “I’ve never been in a course that included so much follow-up and help from a coach,” says Russ. “It makes all the difference in keeping us on track.”

Russ also likes the online component of the BHBusiness Learning Network. “You have to allow time to do the work—but it’s spaced out at a manageable pace. I can do the assigned readings or homework on non-peak hours, or my team and I can complete the work as a group.”

As part of their work for the course, Russ and her team decided to work on a change project to reduce claim denials, using the NIATx rapid-cycle change approach.

“We selected one of the five MCOs that we contract with and worked on figuring out why claims were not being paid,” explains Russ. To make the project manageable, the team divided the project into three rapid cycles, splitting the aging account receivables into three groups alphabetically.

The team found that claims were being denied for three primary reasons: a missing authorization, a simple billing error (like charging the wrong payer), or in the case of third-party liability clients, the need to confirm whether or not the client really has an additional commercial insurance payer along with their MCO. They compiled they information for each denied claim on a simple Excel spreadsheet and sent it to the MCO.

“In the case of missing authorizations, we were able to send proof that the service was authorized, and that the problem was really with the MCO’s system, rather than ours,” Russ confirmed.

Organizing the data and attaching supporting documentation was worth the effort. “This process seemed to produce a rapid pay response from the MCO by eliminating reasons for further delays.” 

In the first cycle, the team reprocessed 285 claims; 250 (88%) were reimbursed within two weeks. In the second cycle, the team reprocessed 350 claims and 287 (82%) of them were reimbursed one week later. The two cycles combined generated reimbursements of over $53,000.

 “And this was just from compiling the information and sending it directly to the MCO,” says Russ. “Having such a quick turn-around was big wake up call for us. In the past, we would have caught up with the AR balance eventually, maybe six months later. By collecting within weeks, we were able to count that revenue in the current fiscal year and improve our bottom line.”

Participating in the BHBusiness learning collaborative helped the NorthKey team improve its collections process and in other ways as well. “Networking with others, the tutorials, and the coaching opened our minds up to different ways of doing things,” says Russ. “I would definitely recommend it to any provider organization looking for ways to think outside of the box.”

Visit BHBusiness: Mastering Essential Business Operations for updates on the next round of learning networks.

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