BHBusiness helps Ohio Agency Master Medicaid Billing

Submitted by: 10/09/2013 by Maureen Fitzgerald

Alcoholism Council of the Cincinnati Area, NCADD offers a range of programs serving children, adolescents, families, women, older adults and people with co-occurring substance abuse and mental health disorders. The Council’s information and referral services have provided a central point of access to the existing public system of care since 1949. In the past year, the Council has treated 3,000 individuals and provided prevention services to over 2,000 children and adults.

This organization is one of more than 20 providers from Indiana, Ohio, and Kentucky that participated in a BHBusiness: Mastering Essential Business Operations Learning Network: Third-party Billing and Compliance. This 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.

Daina Dennis, Special Projects Director, and three of her colleagues at the Alcoholism Council formed a team as part of their BHBusiness activity. They used the NIATx process to improve the billing process and reimbursement rates for Medicaid claims.  

“We decided to focus on Medicaid because our electronic health record went live in April 2013,” says Dennis. “We were overwhelmed with that process and didn’t feel it was the best time to start billing private insurance. At about that time, we learned that we had to apply to become an approved Medicaid provider (or “trading partner”), since our county would no longer be servicing the Medicaid billing. Creating a process for billing Medicaid seemed like a perfect match for our BHBusiness project.”

Dennis and her team quickly identified some of the issues that they needed to address in their Medicaid billing process.

“First, we were not doing a good job of identifying people who had Medicaid already or who met the eligibility requirements for coverage,” says Dennis.

A walk-through of the agency’s Medicaid billing workflow helped the team pinpoint changes they could make to improve it. These included:

  • Making the reception area more welcoming and improving the space to protect client privacy when requesting confidential information
  • Creating a process to confirm Medicaid coverage. “Clients would present their Medicaid cards at check-in, but the billing department often found out later that coverage had expired,” says Dennis. “We wanted to improve that process to capture Medicaid clients immediately and bill correctly.”  
  • Reducing staff burden for verifying Medicaid coverage. “First, we used the state’s Medicaid portal, but this was very time-consuming,” says Dennis. “We found a way around that by working with the county, which still maintains a system for verifying Medicaid coverage even though it no longer acts as payer.” 

When Dennis and her team began their project in April 2013, they set a goal to successfully bill 100% of clients covered by Medicaid (from a baseline of 0) by June 3, 2013.

As the charts below demonstrate, the changes made were successful, generating $84,831 in Medicaid revenue as of August 2013.

Figure 1

Note: an increase in rejected claims in mid-July was the result of programming error in the electronic health record that caused double billing. This problem was addressed quickly, resulting in nearly 100% approval the following week.


Figure 2

Having a system in place to bill Medicaid helps the Alcoholism Council serve more people, says Dennis.

“There’s no cap on the number of Medicaid eligible patients we can treat,” she explains. “This allows us to make better use of the county funding that is reserved for indigent patients. Shifting those clients to Medicaid increases our revenue.”  

Focusing on Medicaid billing rather than all third-party payers worked well for Dennis and her team. “BHBusiness enabled us to select an aim that would truly benefit our organization,” says Dennis. She and her team also appreciated the peer networking built in to the learning network.

“It was great to have the chance to connect with peers working on similar billing projects. We learned a lot from each other,” says Dennis.

An added benefit of participating in the Third-party Billing and Compliance Learning Network is that Dennis and her team are creating a billing policy and procedures manual.

“The requirement was to complete the billing manual table of contents. BHBusiness provided an example that got us started,” says Dennis.  The agency’s billing department recently lost a staff member, and Dennis says that having the manual outlined has been a great help while they work on filling the vacancy. “The manual will be an even bigger help once it’s completed.”  

Dennis and her team will continue to work on improving their Medicaid submissions to reduce the errors that result in claims denials.  She adds, “We’ll definitely use what we’ve learned in BHBusiness to keep improving the process.”

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. The project enrolled nearly 900 providers in its first offering of courses that began April 2013.  A new application period opened on September 16, 2013.

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