Learning to bill third-party payers: NIATx Learning Collaborative in San Mateo County

Behavioral Health and Recovery Services (BHRS) is the county agency that provides substance abuse treatment and mental health services for children and adults in San Mateo County, California. BHRS is one of several payers participating in the NIATX Business Practices for the Future Learning Collaborative.

Clara Boyden, AOD Program Manager for BHRS, is no stranger to the NIATx model. In a previous project, she and her team used NIATx techniques to promote county-wide improvement and build the agency’s capacity to serve clients. When NIATx announced the Business Practices for the Future Learning Collaborative, Clara was eager to get involved.

“The timing was just right,” she adds. “The focus on billing fee-for-service will help our providers prepare for the changes anticipated in 2014.” The NIATx Third-party Billing Guide, combined with coaching, shows BHRS how to design its billing system from the ground up. The team also aims to improve their system’s ability to access other healthcare insurance resources.

“We’re focusing our efforts on the most basic NIATx fee-for-service tools because San Mateo County providers have little or no experience or infrastructure for billing outside of the federal block grant,” explains Clara.

Through the learning collaborative, all the BHRS contracted providers are encouraged to pursue new reimbursement sources—either through Medical (the California Medicaid program) or private insurance. This collaborative has established a modest goal for its providers. By June 30, 2011, each provider will:

• Send at least one fee-for-service paper bill to a health insurance company for care reimbursement
• Complete an analysis of current billing system capacity, including staff knowledge, skills, and infrastructure
• Acquire knowledge of all billing system functions and requirements from Medicaid and other healthcare providers

Clara shared lessons that her collaborative has learned so far an ACTION Campaign webinar on February 10, 2010. To view the completed webinar, and all other ACTION Campaign webinars, please visit http://www.niatx.net//Action/Webinars.aspx.