Convener: Lynn Posze Coach: Elizabeth Strauss Participating Providers: Adanta, Inc. Communicare, Inc. Cumberland River Comprehensive Care Center Kentucky River Community Care Mountain Comprehensive Care Center Chrysalis House, Inc. Pathways Transitions, Inc. Fee For Service Project 2012

AIM Increase collection rate from Anthem Blue Cross/Blue Shield (4 providers) Reduce denial rate – from Anthem Blue Cross/Blue Shield (1 provider) – from Medicaid MCO’s (1 provider) Create billing process to be capable of billing one third party payor (2 providers)

Why focus on Collection Rate rather than Denial Rate? Reducing denials is one strategy to increase collections… however, focusing only on denials does not address the following: – Bills NOT sent to insurance company – NO response from insurance company – Recovering $ sent by the insurance company directly to insured members – Collecting co-pays from insured members

CHANGES Ask if clients have insurance. Verify coverage. Get pre-authorization. Match clients with credentialed therapists. Use Availity to verify coverage and to know status of billing. Customize billing software to submit bills for substance abuse treatment (previously thought not to be covered). Train staff to provide correct dates and modifiers on bills and bill within required time frame, including modifying management info system. OP clinics send clinical notes to Billing; created tracking system to ensure that they’re sent in a timely manner. Develop collections procedure and script for staff to use to request co- pay from clients. Collect payment from clients prior to session, for clients for whom insured member will be reimbursed. Require existing staff to become licensed and credentialed within 2 years; new hires must be licensed.

RESULTS Increased revenue from $2,623 to $3,206/mo Increased revenue from $232 to $774/6 mos. Increased revenue from $100 to $2,800/6 mos. Anthem Denial Rate

RESULTS Cumberland River Eliminated top 3 reasons for Medicaid denials Chrysalis House They now ask if clients have insurance (but residential treatment is typically not covered). They will try billing anyway. Transitions Created billing process to bill one new third party payor (Anthem)

How was the NIATx Way incorporated? Understand and involve the customer – Client: Walk-through as a client with insurance – Third Party Payor: Attend Anthem training/Invite Anthem to train staff to understand their perspective Focus on ONE aim, ONE third party payor, ONE population (clients with insurance), at ONE location Pick a powerful Change Leader from financial staff Change Teams included financial AND clinical staff Use PDSA cycles to test changes

WHAT NEXT? SUSTAIN the changes by having a Sustain Leader who will track collection rate relative to target sustain level Providers will SPREAD improved billing processes to: – Other locations – Other third party payors, including Medicaid MCO’s Convener will SPREAD at meetings with – CEOs of publicly funded Behavioral Health Centers – KY Division of Behavioral Health staff

IMPACT Increased revenue More efficient billing processes for for for both provider AND payor Financial staff are better prepared to use the Process Improvement approach to face future challenges