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Overview

NIATx-SI Business Practices for the Future Learning Collaborative Fee-for-Service . NIATx-SI: Business Practices for the Future Learning Collaborative Fee-for-Service, Cohort II. Overview. A recording of this call will be available on the NIATx website.

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Overview

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  1. NIATx-SI Business Practices for the Future Learning Collaborative Fee-for-Service NIATx-SI: Business Practices for the Future Learning Collaborative Fee-for-Service, Cohort II Overview

  2. A recording of this call will be available on the NIATx website

  3. Level IIWest Virginia, Iowa and Kentucky • Perform a walk-through of their billing process • Create a flow chart and assign staff to each process • Work to improve at least one step in their process (utilization review, accuracy of record keeping) and increase collections • Increase collections by a specified amount (will vary by agency) • Document the billing procedures and include all policies and procedures in a billing manual

  4. Goals • Decrease Denial Rate begin with Medicaid • Attract primary care and insurance providers • Statewide representation define value & identify positive outcomes across all providers • Get the message out there We take insurance (ask, remind and educate) • Barriers • Statewide problem with addiction (epidemic) • Would like to get more providers to join the collaborative Level II West Virginia Westbrook Health Prestera Southern Highlands CMHC Healthways Inc

  5. Level II • Goals • Improve Billing System • Decrease denial rate by half • Improve collection ratio to 95% • Get all information we need once (up front) to generate the bills • Bill at least once a week or daily • Be able to generate, submit, collect payments with as little human interaction as possible-automated • Increase the amount of electronic billing • Getting in networks so we can bill insurance companies • Bath in Cash • Have the billing roles and procedures systemized • Barriers • Overcoming resistance to change • Coordinating with EMR implementation • Time • Impact on workload • Learning about payer policies Iowa Center for Alcohol and Drug Services Prairie Ridge Zion Recovery Services Compass Pointe Community and Family Resources Alcohol and Dependency Svs for SE IA United Community Services Youth and Shelter Services Jackson Recovery Centers Crossroads Mental Health Center New Opportunities NE IA Behavioral Health

  6. Level II • Goals • Improve Collections • Barriers • Changing culture • Understanding Insurance Companies as a Customer • Electronic Billing Systems Kentucky Adanta Inc 4 Rivers Behavioral Health Mountain Comprehensive Care Center Cumberland River CCC Kentucky River Community Care Communicare Inc Pathways

  7. Level II • Goals • Increase Collections • Barriers New Hampshire

  8. Today’s presenter’s: Tim Smith & Eric Haram

  9. Daybreak and Private Pay

  10. Daybreak Youth Services • Outpatient and Inpatient treatment programs for adolescents in Spokane and Vancouver, Washington • Serving about 1,000 teens each year • $4.25 million annual revenue – Treatment svcs • Private revenue past 5 years: • Low = 24%, high = 32%, average = 26% • NIATx member since 2003

  11. Daybreak Youth Services AIM: Increase private revenues QUALITY INFRASTRUCTURE MARKETING

  12. Daybreak Youth Services • Culture = Market driven • Mandate from Governing Board 1986 • Pool of kids whose families have insurance • Build treatment reputation • “If you had a Million Dollars, would you send your kid to Daybreak?” • Shift from Block Grant to Fee for Service • Treat Medicaid like an Insurance company

  13. Daybreak Youth Services • INFRASTRUCTURE FOR PRIVATE INSURANCE • Fee structure • What is the market rate? • Sliding fees? • Scholarships / Financial Aid • Daily Service Activity Log for every transaction • Insurance Contracts • On-site or off-site billing? • Integration with EHR

  14. Daybreak Youth Services START THE CONVERSATION IMMEDIATELY • First Phone Call - “How will you be paying?” • Insurance verification prior to admission • Pre-Authorization required? • Insurance Utilization Reviews • Scheduling • Peparation • staff? MD? • Admission Interview • Financial Contract • Billing, Co-pay and Collection Policy • Who does this: Counselors or Support staff

  15. Daybreak Youth Services • Monitoring and Reports – Weekly and Monthly • “Funding Update” (Inpatient) • From Accounting and General Ledger • From SAL's • From Billing Software • From Electronic Health Record • Collections and Bad Debts • A/R Aging (Monthly) • Clinical Review of overdue accounts • Annual estimate of insurance “discounts”

  16. Daybreak Youth Services • QUESTIONS???? • Contact Info: • Tim Smith, Executive Director • tsmith@daybreakinfo.org

  17. Next Interest Circle Call • March 14, 2012 • 12N PST, 2PM CST, 3PM EST Schedule is posted on the NIATx website You will receive a hard copy this week

  18. A recording of this call will be available on the NIATx website

  19. Survey Questions

  20. Thank you

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