Using the NIATX Billing Guide

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Using the NIATX Billing Guide

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1. Using the NIATX Billing Guide Clara Boyden, AOD Program Manager Behavioral Health & Recovery Services San Mateo County

2. Pigeon Point Lighthouse San Mateo County A little about San Mateo County…

3. Purpose of Today To share San Mateo County’s experiences and learnings in using the NIATX Billing Guide to design a billing system with the AOD providers within our system. Getting started from ground zero Strategies to build and keep momentum Challenges…more than just a new process

4. Context of our NIATX efforts Patient Protection and Affordable Care Act Wellstone/Domenici Mental Health Parity and Addiction Equity Act Local opportunity through California’s 1115 Medicaid waiver & County ACE Program SMC Providers have limited experience or infrastructure for billing outside Federal Block Grant

5. NIATx System Improvement Learning Collaborative

6. BHRS Goals and Objectives By June 30, 2011, each provider will send at least one Fee for Service paper bill to health insurance for care reimbursement. Complete an analysis of current billing system capacity including staff knowledge, skills, and ability and infrastructure. Acquire knowledge of all billing system functions, requirements from Medicaid and OHC providers.

7. BHRS Goals and Objectives Determine the feasibility of cross provider sharing of billing functions and develop a business plan to implement (if feasible). Identify billing system specifications, including requirements to ensure compatibility with BHRS electronic health record used by mental health providers.

8. Getting Started Self Assessment NIATX Survey and Walk Through Pilot Test SMC Health Insurance Coverage Survey SMC Provider Staffing Questionnaire Assess Current Billing System/Infrastructure Provider Interviews Interest-Public billing vs. Private billing

9. NIATX Survey Results Number of Contracts with Insurers None 46.2% One to Two 38.5% Two-Five 7% More than Five 7% Claim Rejection Rate Less than 20% 62.5% Between 20-40% 12.5% Greater than 60% 25.0%

10. BHRS Health Insurance Study Purpose: to obtain a snapshot of current BHRS clients in relation to: Current health insurance coverage Potential eligibility for health insurance Health service utilization in prior 12 months Conducted in summer 2010 Providers requested to administer scantron survey to all clients currently enrolled in care. Total BHRS respondents = 1206

11. BHRS Health Insurance Study: AOD Highlights 375 respondents from AOD programs 58% of respondents currently had health insurance coverage 18% currently receiving disability income 83% with annual income less than $20 K

12. Provider Staffing Questionnaire Conducted in October 2010 10 of 13 providers responded 90% of respondents have at least one licensed staff already working within the Agency 80% of respondents have at least one licensed staff already working within the AOD program areas Purpose: to understand the ability of AOD providers to meet the credentialing requirements of some insurance providers within existing staffing 10 of 13 providers responded to date Purpose: to understand the ability of AOD providers to meet the credentialing requirements of some insurance providers within existing staffing 10 of 13 providers responded to date

13. Designing our Learning Collaborative Use of NIATX processes & tools– establish change team & other resources Incorporate learning from previous “learning collaborative” Build Momentum-contact frequency Greater Accountability Drive the process Workplan Design

14. Easy Does it! Use the Billing Guide to plot your course Map out “micro steps” Start small Dual focus (FFS public vs private) Workplan flexibility

15. Strategies to Build Momentum Connect to other efforts In person convenings Establish Change Leaders and Change Teams Shared workplan Regular calls Provider liaisons/partner

16. More Strategies for Success Establish workgroups as needed Consider Site visits Trainings & Roleplays NIATX webinars, site, tools Bring in subject matter experts Consider provider networks Workgroups (cheat sheet, authorizations, --importance to get etc) Site visits (understand unique needs and progress of individual agencies, helps with buy in) Trainings & Roleplays – example of ours NIATX Resources: webinars, site, tools Bring in subject matter experts – NIATX is also helpful for this. Consider provider networks (for billing, contracts, WSN example)Workgroups (cheat sheet, authorizations, --importance to get etc) Site visits (understand unique needs and progress of individual agencies, helps with buy in) Trainings & Roleplays – example of ours NIATX Resources: webinars, site, tools Bring in subject matter experts – NIATX is also helpful for this. Consider provider networks (for billing, contracts, WSN example)

17. Challenges Program Design Organizational Culture Philosophy Policies & Procedures Business practices & tools Staff competencies and credentialing The kind of change discussed here is vast organizational transformation. Organizations that succeed under health reform will make significant modifications in their: ? Program Design – 90 day program – individualized care – very challenging to staff who have been through program, changes the dynamics Organization Culture - ? Philosophy - who we serve / clients (historically, most severe, less early intervention)…can consider service people who have risky use but who are not ? Policies & Procedures, who does what (screening, billing, authorization, Documentation UM, …) ? Business practices - changes to referral sources (ie: from criminal justics, cps primary to health care) ? Business tools ? Staff competencies , training and credentialing The kind of change discussed here is vast organizational transformation. Organizations that succeed under health reform will make significant modifications in their: ? Program Design – 90 day program – individualized care – very challenging to staff who have been through program, changes the dynamics Organization Culture - ? Philosophy - who we serve / clients (historically, most severe, less early intervention)…can consider service people who have risky use but who are not ? Policies & Procedures, who does what (screening, billing, authorization, Documentation UM, …) ? Business practices - changes to referral sources (ie: from criminal justics, cps primary to health care) ? Business tools ? Staff competencies , training and credentialing

19. Questions?

20. Thank you! Clara Boyden 650-802-5101 [email protected]

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