Community Care Services

Community Care Services in Taunton, Massachusetts, is a private, non-profit corporation that provides emotional, educational, and behavioral support to children, adults, elders, and families throughout southeastern Massachusetts and Rhode Island. Clients make 5,000 visits per year to two clinic sites. Community Care Services accepts more than 35 insurance plans, with 98 percent of its budget covered by public and private insurance.

Increase Collection of Client Co-pays

Community Care Services wanted to increase the collection of client co-pays and overdue bills. The agency had more than $60,000 in unpaid bills from active and discharged clients. Clinicians received regular reports and reminders from the billing department on overdue co-pays, unpaid balances, and errors in authorizations.

The change team for this project included representatives from the clinical team and the billing department. Together, they tested the following changes:

• Having clients sign a co-pay agreement on their first visit
• Sending clinicians and front desk staff daily e-mail summaries of co-pays and money owed
• Informing clinicians of client payments at the beginning of each session (and by email the day before)
• Setting up a phone and e-mail reminder system for clients with unpaid balances more than 180 days; reminders come directly from a billing department representative every week

The agency increased the average collection of money owed from 72% in 2009 to 96% over the same period (January through October) in 2010. This reduced the total amount of unpaid bills to less than $10,000. An added benefit of this change project was the improved relationship between the clinical and billing departments.

Before the change project, there was some tension between the clinicians and billing department staff. By working together on rapid-cycle changes, the two departments gained an appreciation that they have the same goals—to provide excellent service and maximize efficiency. Communication is key: billing staff and clinicians need to hear from each other about the challenges they both face in meeting client needs.

• Budget expectations: This project revealed that the billing staff and the clinical staff were using numbers from conflicting budgets. This led to clinicians feeling criticized about not meeting fiscal goals.
• Creating on-going communication between the billing office, the chief fiscal officer, clinic director, and clinic staff has produced a number of secondary gains, including financial reports that are easier to understand and discuss as a group

This change project is in sustain mode. The change team is now working on improving the process for continued authorizations, which has proven to be a challenge given the number of insurance companies Community Care Services works with.

Figure 1