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The Ohio Council Fee for Service Project

The Ohio Council Fee for Service Project. Making Third Party Payers Pay. Take Aim. What are the third party pay issues? Who knows – we never billed them Who knows – we never tracked them once billed High denial rate

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The Ohio Council Fee for Service Project

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  1. The Ohio Council Fee for Service Project Making Third Party Payers Pay

  2. Take Aim • What are the third party pay issues? • Who knows – we never billed them • Who knows – we never tracked them once billed • High denial rate • Increase Insurance Collections by Reducing Third Party Payer Denial/Billing Error Rate by 30% • Increase revenues through Appropriate Co-payment and Client Balance Collections • Proactively Managed the Billing Process

  3. Changes Made • Front Door Changes • Check-in tied down – insurance info/co-pay/pre-auth • Information collected up front • Appropriate counselor assigned • Proactive Clinical Preparation • CAQH Registration • Create a list of insurance providers and requirements for easy access • Tracking Billing Process • Studying results and working with insurance clearinghouse on errors

  4. Results • Went from an average loss of $11,500 per month to an average loss of $3,672

  5. Contact Info

  6. What Stuck? • Formalized Process for Denial Management • Changes in Up Front Information Gathering • Proactive Clinician Assignment • CAQH Registration • Council on Affordable Quality Healthcare • https://upd.caqh.org/oas/Default.aspx

  7. Impact – What did we learn? • Decreased Denial Rate • Increased Staff Sensitivity • New ways to analyze operations • Created a viable new revenue stream

  8. Contact Info • Pat Bridgman, MA, LICDC, Associate Director • The Ohio Council of Behavioral Health and Family Services Providers • 614.228.0747 • Bridgman@theohiocouncil.org

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