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Using the NIATX Billing Guide. 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. - PowerPoint PPT Presentation
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Clara Boyden, AOD Program ManagerBehavioral Health & Recovery Services
San Mateo County
Pigeon Point Lighthouse San Mateo County
A little about San Mateo County…
Purpose of TodayTo 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 zeroStrategies to build and keep momentumChallenges…more than just a new process
Context of our NIATX effortsPatient Protection and Affordable Care ActWellstone/Domenici Mental Health Parity and
Addiction Equity ActLocal opportunity through California’s 1115
Medicaid waiver & County ACE ProgramSMC Providers have limited experience or
infrastructure for billing outside Federal Block Grant
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 ObjectivesDetermine 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 StartedSelf Assessment
NIATX Survey and Walk Through Pilot Test SMC Health Insurance Coverage SurveySMC Provider Staffing QuestionnaireAssess Current Billing System/Infrastructure
Provider Interviews Interest-Public billing vs. Private billing
NIATX Survey ResultsNumber of Contracts with Insurers
None 46.2% One to Two 38.5% Two-Five 7% More than Five 7%
Claim Rejection Rate Less than 20% 62.5% Between 20-40% 12.5% Greater than 60% 25.0%
BHRS Health Insurance StudyPurpose: to obtain a snapshot of current
BHRS clients in relation to:Current health insurance coveragePotential eligibility for health insuranceHealth service utilization in prior 12 months
Conducted in summer 2010Providers 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 programs58% of respondents currently had health
insurance coverage18% currently receiving disability income83% with annual income less than $20 K
Provider Staffing Questionnaire
Conducted in October 2010
10 of 13 providers responded90% 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 frequencyGreater Accountability Drive the process
Workplan Design
Easy Does it!Use the Billing Guide to plot your courseMap out “micro steps”Start smallDual focus (FFS public vs private)Workplan flexibility
Strategies to Build MomentumConnect to other effortsIn person conveningsEstablish Change Leaders and Change
TeamsShared workplanRegular callsProvider liaisons/partner
More Strategies for Success
Establish workgroups as neededConsider Site visitsTrainings & RoleplaysNIATX webinars, site, toolsBring in subject matter expertsConsider provider networks
Challenges
Program DesignOrganizational Culture Philosophy Policies & ProceduresBusiness practices & tools Staff competencies and credentialing
