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San Mateo County, CaliforniaSan Mateo County, California
NIATx Summit and SAAS National ConferenceNIATx Summit and SAAS National ConferenceBoston, MABoston, MAJuly 2011July 2011
NIATx-SI: Business Practices for the NIATx-SI: Business Practices for the Future Learning CollaborativeFuture Learning Collaborative
San Mateo CountySan Mateo CountyLearning CollaborativeLearning Collaborative
Designing a fee for service Designing a fee for service billing system for a new low billing system for a new low
income health programincome health program
Our Primary Aim (Plan)Our Primary Aim (Plan)
Establish a Low Income Health Program/Medicaid Establish a Low Income Health Program/Medicaid Coverage Expansion (LIHP/MCE) for County Coverage Expansion (LIHP/MCE) for County residents with a substance use services benefit.residents with a substance use services benefit. Acquire knowledge of all billing system functions, Acquire knowledge of all billing system functions,
requirements from Medicaid requirements from Medicaid Treatment providers will screen for health coverage, Treatment providers will screen for health coverage,
facilitate enrollment and secure service authorizations, facilitate enrollment and secure service authorizations, and provide and document services.and provide and document services.
Providers will have a paper fee for service (FFS) billing Providers will have a paper fee for service (FFS) billing process in place to bill for LIHP/MCE substance use process in place to bill for LIHP/MCE substance use servicesservices..
Our Secondary Aims (Plan)Our Secondary Aims (Plan)
Support Treatment providers to bill private Support Treatment providers to bill private insurance /third party payers.insurance /third party payers.
Explore the feasibility of cross provider Explore the feasibility of cross provider sharing of billing functions sharing of billing functions
Set the groundwork for electronic health Set the groundwork for electronic health record and electronic billing system record and electronic billing system design.design.
Change (Do)Change (Do)
System systems changes to increase enrollment in System systems changes to increase enrollment in LIHP/MCE coverageLIHP/MCE coverage County streamlined application and enrollment process, County streamlined application and enrollment process, County obtained provider input into removing enrollment County obtained provider input into removing enrollment
barriers, revised application, barriers, revised application, Provided 3 trainings to program staff on processProvided 3 trainings to program staff on process Provider staff now screen for health coverage, verify Provider staff now screen for health coverage, verify
eligibility, and assist clients with benefits application.eligibility, and assist clients with benefits application. Increase treatment authorizationsIncrease treatment authorizations
Trained provider staff on effective ways to request Trained provider staff on effective ways to request treatment authorizations and demonstrate medical treatment authorizations and demonstrate medical necessity and provided technical assistance tailored by necessity and provided technical assistance tailored by levels of care.levels of care.
Change (Do)Change (Do)
Trained provider staff on treatment planning and Trained provider staff on treatment planning and clinical documentation requirements for clinical documentation requirements for Medicaid.Medicaid.
Established a paper billing system for LIHP/MCEEstablished a paper billing system for LIHP/MCE Service and billing codes determinedService and billing codes determined Service packages and bundled services identifiedService packages and bundled services identified County designed scantron form for provider billingCounty designed scantron form for provider billing
• Services billed by minute, bundled services billed by dayServices billed by minute, bundled services billed by day• Service Tracking and billing (beginning July 1)Service Tracking and billing (beginning July 1)
Change (Do)Change (Do)
Trained provider staff on CPT codes commonly Trained provider staff on CPT codes commonly used with other 3used with other 3rdrd party insurers. party insurers.
Technical support provided to treatment Technical support provided to treatment programs to develop a local network to:programs to develop a local network to: share information about lessons learned and share information about lessons learned and
strategies to increase 3strategies to increase 3rdrd party insurance revenues party insurance revenues to obtain 3to obtain 3rdrd party insurance contracts as a network of party insurance contracts as a network of
treatment service providers.treatment service providers. Established workgroups for provider input into Established workgroups for provider input into
development of electronic health record and development of electronic health record and electronic billing system electronic billing system
Results (Study) Results (Study) Increased LIHP/MCE ApplicationsIncreased LIHP/MCE Applications
0
10
20
30
40
50
60
70
80
Oct.2010
Nov.2010
Dec.2010
Jan.2011
Feb.2011
Mar.2011
Apr.2011
Number of Applications Received from Treatment Programs
Results (Study) Results (Study) LIHP/MCE Clients Enrolled in Care LIHP/MCE Clients Enrolled in Care (as of 6/14/11)(as of 6/14/11)
512
2310
415
3042
184
813
18
Number of LIHP/MCE Clients Enrolled in Treatment, by Provider
Results (Study) Results (Study) Projected Annual Revenue IncreasesProjected Annual Revenue Increases
$1,960,000
$3,921,000
$0
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000
$3,000,000
$3,500,000
$4,000,000
Pre LIHP/MCE Post LIHP/MCE
Projected Annual Revenue
Next StepsNext Steps
In-person site visits for T/A and feedback on In-person site visits for T/A and feedback on documentation for medical necessity, service documentation for medical necessity, service tracking, coding and billing.tracking, coding and billing.
Continued learning collaborative meetings Continued learning collaborative meetings Support ongoing systems change and process Support ongoing systems change and process
improvements,improvements, 33rdrd party billing information sharing and exploration of party billing information sharing and exploration of
contracts with 3contracts with 3rdrd party payers as a provider network, party payers as a provider network,
Use FFS knowledge to inform development Use FFS knowledge to inform development billing workflow and design of new electronic billing workflow and design of new electronic health record and billing system.health record and billing system.
ImpactsImpacts
Increased number of residents can access Increased number of residents can access treatment (estimated 800 / year).treatment (estimated 800 / year).
Increased revenue and financial stability of Increased revenue and financial stability of treatment programs. treatment programs.
Enhanced partnership and collaboration among Enhanced partnership and collaboration among providers (history of competition for clients and providers (history of competition for clients and limited resources).limited resources).
Greater readiness for Health Care Reform.Greater readiness for Health Care Reform. Increased ability to work with 3Increased ability to work with 3rdrd party payers as party payers as
a health care service provider and to do FFS a health care service provider and to do FFS billing.billing.
Many Thanks toMany Thanks to NIATx and their awesome staff and guest presenters,NIATx and their awesome staff and guest presenters, Don Holloway, our irresistibly influential coach, Don Holloway, our irresistibly influential coach, ……and of course, our San Mateo County treatment and of course, our San Mateo County treatment
providers:providers: Asian American Recovery ServicesAsian American Recovery Services El Centro de LibertadEl Centro de Libertad Free at LastFree at Last Latino CommissionLatino Commission Hope HouseHope House Horizon ServicesHorizon Services Project NinetyProject Ninety Pyramid AlternativesPyramid Alternatives Sitike Counseling ServicesSitike Counseling Services StarVistaStarVista Women’s Recovery AssociationWomen’s Recovery Association
A brighter future…A brighter future…
For more information, contactFor more information, contact
Clara Boyden, Program ManagerClara Boyden, Program Manager
Alcohol and Other Drug ServicesAlcohol and Other Drug Services
San Mateo County Behavioral Health & Recovery ServicesSan Mateo County Behavioral Health & Recovery Services
Phone: 650-802-5101Phone: 650-802-5101
Email: [email protected]: [email protected]
