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

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

Level II West 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

Level II West Virginia Westbrook Health Prestera Southern Highlands CMHC Healthways Inc 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 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 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

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

Level II New Hampshire Goals Increase Collections Barriers

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

Daybreak and Private Pay

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

Daybreak Youth Services QUALITY INFRASTRUCTUREMARKETING AIM: Increase private revenues

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

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

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

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”

Daybreak Youth Services – QUESTIONS???? – Contact Info: – Tim Smith, Executive Director –

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

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

Survey Questions