BHBusiness course helps Texas agency treat more clients with health insurance

The South East Texas Council on Alcohol and Drug Abuse (SETCADA) has been providing substance abuse treatment and prevention services since 1958. The non-profit agency includes four locations that offer outpatient and residential services for adult men, along with outpatient services for women and adolescents. The federal block grant funds services for 75% of the agency’s clients.

Carrie Arriete, Billing and Intake Coordinator for SETCADA, participated in BHbusiness Learning Network on Third-party Billing and Compliance. Offered by SAMHSA at no cost to participants, BHBusiness Learning Networks provide online training, peer networking, and guidance from expert coaches. The National Council manages the program, in collaboration with NIATx and Advocates for Human Potential.

Carrie manages a variety of tasks related to working with third-party payers. She handles the intake, approval, and billing for any client with Medicaid or private insurance, and also negotiates contracts.

Her experience with billing began in 2010, when the state required contracted agencies to bill Medicaid for substance abuse treatment before billing the block grant. SETCADA had relied mainly on the block grant for funding until then, so Carrie set about teaching herself how to submit claims.

 “I attended some trainings along the way that were somewhat helpful, but BHBusiness Plus really got my attention because it was specific to behavioral health,” says Carrie.

She adds that the agency began to see more clients with health insurance coverage in early 2014, so timing of the course was ideal. “It sounded like exactly what we needed,” says Carrie. “We knew we had to create a better process to take care of more clients with health insurance.”

The fact that the training was offered at no cost made it even more appealing, especially to Carrie’s boss.

The learning network that Carrie joined began in March and ended in September 2014. Like many others who have taken advantage of the SAMHSA-funded training, Carrie liked being able to fit the coursework into her busy schedule. She also like the way the course presented complex information in manageable amounts.

“Sometimes when you run into a billing or compliance problem there’s so much information it can be confusing. BHBusiness presented information in a concise way that worked well for me,” she says.

In addition, the online videos, readings, and homework assignments brought some major insight into what was really happening at the agency.

“One of the biggest lessons for me and other participants came in the beginning with the walk-through exercise,” says Carrie. It was through the walk-through that she and her team recognized that they were not identifying all the clients with Medicaid correctly. Backtracking to request retroactive prior authorizations was not always successful, resulting in a loss of revenue.

“We realized we had to start thinking of ourselves as similar to a doctor’s office, where asking for insurance is standard procedure when a client walks in the door,” comments Carrie.

She and her team made changes to capture insurance information more accurately. They also started to use a script when talking with clients on the phone. This helped to make sure that all staff were giving consistent information about services and asking for insurance information in the same way. Carrie added “smiley faces” to remind staff to smile when reading from the script.

“We wanted to encourage callers and give them hope at that first call,” she explains.

The data collected on admissions shows that these changes made a difference: Clients admitted with insurance doubled between the third and fourth quarters of this fiscal year. Carrie attributes that increase in part to what she learned by participating in the BHbusiness learning network.

“The BHbusiness learning network was a great experience for me,” says Carrie. “It’s an excellent opportunity to really focus on making small changes that can have a huge impact for your agency.”

For more information on SAMHSA’s BHbusiness Plus, visit www.bhbusiness.org

Now accepting applications for learning networks starting in February 2015!