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Overview

NIATx-SI Business Practices for the Future Learning Collaborative Fee-for-Service Cohort II Informational Call Jeanne Pulvermacher, Project Director Funding provided by: CSAT . Overview. Fee-for-Service Cohort II November 2011-October 2012.

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Overview

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  1. NIATx-SI Business Practices for the Future Learning Collaborative Fee-for-Service Cohort II Informational Call Jeanne Pulvermacher, Project Director Funding provided by: CSAT Overview

  2. Fee-for-Service Cohort II November 2011-October 2012 Develop the capacity to bill third-party payers. • Training on the core components of implementing third-party billing systems • Identify common areas where billing systems function poorly • Learn improvement techniques that work • Know and understand The NIATx Third-party Billing Guide

  3. Six regional teams will be chosen and will be assigned to one of two levels in the NIATx Fee-for-Service Capacity Pyramid: • Ideally each provider in a team will fit in the same level.

  4. Regional Team • A Convener – someone from the state, county, provider association, health system, or intermediary • 10 to 12 local non-profit, community-based addiction treatment providers • Coach – NIATx Process Improvement expert • NIATx staff – liaison and support for each team • Jeanne Pulvermacher, Project Manager • Amy McIlvaine, Educational Services Director

  5. Expected Outcomes • Each team will gain a greater understanding of the changes anticipated with healthcare reform. • Coaching and monthly calls will help teams develop or improve their systems for billing third-party payers. • Treatment providers within each team will develop or improve their collections performance. • Conveners will build their teams’ capacity for peer-to-peer mentoring and sharing best practices. • Each team will achieve locally specific milestones to build better and more robust business models.

  6. Level IAim = Design a third-party billing system • Routinely request insurance cards and verify coverage • Request prior authorization and document authorization limits • Provide and document services using correct billing codes and amounts • Submit at least six invoices for payment, noting if bill was paid, denied or no response given • Make corrections and resubmit • Document the billing procedure for those steps and write up a policy and procedure to be included in the agency billing manual

  7. Level II Aim = Improve Collections • 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 provider) • Document the billing procedures and include all policies and procedures in a billing manual

  8. Who should apply

  9. Timeline

  10. Timeline

  11. Timeline

  12. 1.5 day Kick-Off MeetingNovember 2011 • Meetings typically take place at a convener’s or provider’s office building. • Convener responsible for securing the meeting space and other local costs associated with the meeting. • NIATx staff, coaches, conveners, and providers will attend Providers will learn: • NIATx Process Improvement 101, • system design and change strategies • review the NIATx Third-party Billing Guide. • Each team will develop an organization-specific “Business Practice Implementation Plan.”

  13. Demonstration PeriodNovember 2011-August 2012 • Monthly Interest Circle Calls for Level 1 and 2 NIATx will provide content experts for these calls. • Coaching: each region is assigned a NIATx coach to • Facilitate monthly calls to review each provider’s progress • Participate on monthly interest circle and skill builder calls • Attend the face-to-face meetings • 15 days of technical assistance allowed • NIATx will facilitate Level I and Level II monthly project review and skill-building calls with coaches and conveners.

  14. Mid-ProjectReview Webinar April 2012 • Two people from each local project, their coach, and NIATx staff will attend a mid-project review webinar • check-in and review of project outcomes to date • identifying timelines and milestones needed to achieve project goals.

  15. Close Out Meeting & SustainabilityAugust-September 2012 • Each convener will present their change project story at an in-person closeout session. (Place TBD) • Each local convener and key providers from the regional team will present their change projects during one of two scheduled webinars for all members of the collaborative. • Each convener will submit a completed project charter of outcomes and outline next steps for sustainability and dissemination to at least five additional provider sites.

  16. Questions?

  17. Contact Information Jeanne Pulvermacher Jeanne.pulvermacher@chess.wisc.edu 608-513-9430

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