The NIATx Learning Collaborative Developing a Billing System

1. The NIATx Learning CollaborativeDeveloping a Billing System Clara Boyden SMC BHRS Regional Kick-off Meeting November 8, 2010

2. What is NIATx? • Network for the Improvement of Addiction Treatment • NIATx works to improve access to and retention of individuals in treatment • Launched in 2003 with funds from RWJF and SAMHSA • Based out of University of Wisconsin • Designed a process improvement model to use in AOD settings (Plan-Do-Study-Act)

3. NIATx System ImprovementLearning Collaborative

4. NIATx Learning Collaborative • SMC to focus on how to set up a billing system. • Providers to work on paper billing processes • BHRS to design electronic billing system (Avatar) to bill other health care (OHC) insurers • NIATx to provide T/A on process improvement, coaching support, and access to subject matter experts through monthly webinars.

5. 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

6. BHRS 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

9. AOD Staffing Survey • 10 of 13 providers responded to date • 90% have at least one licensed staff already working within the Agency. • 80% have at least one licensed staff already working within the AOD program area.

10. NIATX Survey Results • No SMC AOD providers bill MediCal (MediCaid); two non-NIATX participant providers do bill DMC, • No SMC AOD providers use an electronic billing system to bill MediCal or other insurance, • 83% of SMC AOD providers maintain their own financial system.

11. NIATX Survey Results Number 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%

12. BHRS Goals and Objectives • Complete an analysis of current billing system capacity including staff knowledge, skills, and ability and infrastructure. • Identify billing system specifications, including requirements to ensure compatibility with BHRS electronic health record used by mental health providers.

13. BHRS Goals and Objectives • Acquire knowledge of all billing system functions, requirements from Medicaid and OHC providers. • Determine the feasibility of cross provider sharing of billing functions and develop a business plan to implement (if feasible). • Identify viable plans to fund the development, implementation and maintenance of a billing system.

15. Getting Started Objective: Each provider will send at least one bill through their billing system. • Initial emphasis with providers will be to verify health coverage and facilitate enrollment into ACE, MediCal, etc. • Start small, test on just a few clients • Refine and adapt as you learn

16. San Mateo County NIATX Learning Collaborative provider participants • AARS - El Centro • Horizon Services - Latino Commission • Project Ninety - Pyramid • Service League - Sitike • WRA - YFES