Clara Boyden, AOD Program Manager Behavioral Health & Recovery Services San Mateo County

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

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

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

Contracts with Payers Collections Process Improved Billing System Design and Implementation NIATx System Improvement Learning Collaborative

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.

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.

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

NIATX Survey Results Number of Contracts with Insurers None46.2% One to Two38.5% Two-Five7% More than Five7% Claim Rejection Rate Less than 20% 62.5% Between 20-40%12.5% Greater than 60%25.0%

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

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

Provider Staffing Questionnaire Conducted in October 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

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

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

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

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

Challenges Program Design Organizational Culture Philosophy Policies & Procedures Business practices & tools Staff competencies and credentialing

Clara Boyden