MECCA Services Adds Contracts with Third-party Payers

Submitted by: 06/09/2011 by NIATx NPO
Keywords: Third-party Billing

MECCA Services offers substance abuse and behavioral health services with eight locations in central Iowa. MECCA was among the first organizations to adopt the NIATx model to improve access to and retention in treatment, as a grantee in the Paths to Recovery Program. Since then, process improvement has become part of MECCA’s culture. The agency participated in the NIATx-SI Business Practices for the Future Learning Collaborative, which focused on working with third-party payers.

“We’re looking ahead to the changes expected in 2014 and wanted to improve our ability to bill third-party payers by increasing contracts,” says Ron Berg, CEO of Mecca.

When the learning collaborative launched in October 2010, Mecca had just a few formal contracts with third-party payers, but lots of experience billing through single case agreements.

Working with Chris Auner as the project change leader, Berg set a goal to negotiate a contract with at least one third-party payer by the end of the ten-month collaborative. He focused on Mecca’s Synchrony program, which was created specifically to provide EAP services for area businesses.

“All of the Synchrony staff are either licensed as mental health counselors or independent social workers,” says Berg. “We found that clients referred to us through an EAP often developed a therapeutic relationship with a counselor and wanted to continue after the four or five sessions covered by the EAP.”

However, because MECCA had only a facility contract with Wellmark Blue Cross and Blue Shield (the payer covering the EAP benefit), clients who wanted to continue to see a particular Synchrony counselor would have to pay a deductible of $500 to $1,000, depending on their particular plan benefit design.

“We were losing clients because of that high deductible,” says Berg. “We learned that if we could credential our counselors individually with Wellmark, clients would only have to pay a small co-pay of $10.00-$15.00.”

Berg reports that Wellmark was very receptive to establishing contracts with the four individual counselors. They completed the required paper application forms, rather than using a credentialing clearing house.

“We learned a lot about how to submit the credentialing paperwork and were able to apply what we learned when we worked on a contract with a second payer—Priority Health Network,” says Berg.

Berg anticipates that the contracts will increase revenue for the Synchrony program. “We can now accept clients from any referral source and be on the same footing as other individual providers in the area”, says Berg, adding that this also removes a barrier to treatment and improves customer service.

Because all prior payments to Synchrony had been as a facility, Berg had to make adjustments to the billing process. This included switching to the CMS 1500 billing form. His team recently submitted their first successful claim for a service they had not been able to bill for in the past.

The NIATx principals helped focus this project to prepare for a new funding environment, says Berg. “Our customers were saying that they wanted to continue services at Synchrony but the deductible was too big. So this project definitely sought to understand and involve the customer.” He and Auner also looked outside the field: “We looked to the for-profit organizations for ideas and inspiration. “

The NIATx-SI Business Practices for the Future Learning Collaborative will have a close-out session at the upcoming Summit in Boston. Berg says he feels better prepared to work with third-party payers as a result of the collaborative.

Berg’s lesson to other organizations seeking to increase their contracts with third-party payers? “Having contracts with third-party payers for individual counselors as well as a facility contract gives you more options for seeking reimbursement.”

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