Increased collections and third-party contracts: NIATx Fee-for Service Learning Collaborative Closeout

Submitted by: 09/23/2011 by Maureen Fitzgerald

The NIATx-SI Business Practices for the Future Learning Collaborative held a close-out session at the 2011 NIATx Summit/SAAS Annual Conference in Boston.

The collaborative consisted of six “conveners” (provider associations, counties, cities, or health systems) who recruited and supported six to ten treatment providers. Together, they worked to implement, optimize, or maximize a system to bill third-party payers. Participating organizations had a variety of experience in working with third-party payers, ranging from little to none to extensive.

“For those with no experience, the focus was on creating a billing system,” says Project Manager Jeanne Pulvermacher. “For those with more experience, the aim was to improve collection rates with payers or add more contracts.” (See related story from the Counseling Center in Portsmouth, Ohio.)

Over the course of the ten-month collaborative, the participants received technical assistance from a NIATx coach and were encouraged to use the NIATx Third-party Billing Guide as a resource.

Creativity and persistence contributed to the participants’ success, says Jeanne, along with having a clear, specific goal. “The teams that used the NIATx Third-party Billing Guide and followed it closely also made great progress,” she adds.

For many of the organizations, the insurance credentialing process presented a challenge, as did changes in staff. Another significant challenge some of the organizations faced was changing agency culture. “Beginning to think of the agency as a ‘business’ that needs to generate revenue is a big shift, especially for organizations that have relied solely on block grants,” says Jeanne. 

The six conveners included:

  • Baltimore Substance Abuse Systems (bSAS): Improved collections
  • Iowa Department of Public Health: Secured 21 additional third-party contracts
  • Milwaukee County WIser Choice: Increased Medicaid and other billing revenues
  • Montana Chemical Dependency Bureau: Increased third-party payments
  • Ohio Council of Behavioral Health and Family Services Providers: Reduced monthly losses from claim denials
  • San Mateo County, California: Established Medicaid substance abuse treatment coverage for county residents

To view the PowerPoints conveners presented at the closeout session, visit:

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