Fee For Service Project 2012

1. Fee For Service Project 2012 Convener: Lynn Posze Coach: Elizabeth Strauss Participating Providers: Adanta, Inc. Communicare, Inc. Cumberland River Comprehensive Care Center Kentucky River Community Care Mountain Comprehensive Care Center Chrysalis House, Inc. Pathways Transitions, Inc.

2. AIM • Increase collection rate from Anthem Blue Cross/Blue Shield (4 providers) • Reduce denial rate • from Anthem Blue Cross/Blue Shield (1 provider) • from Medicaid MCO’s (1 provider) • Create billing process to be capable of billing one third party payor (2 providers)

3. Why focus on Collection Rate rather than Denial Rate? • Reducing denials is one strategy to increase collections… however, focusing only on denials does not address the following: • Bills NOT sent to insurance company • NO response from insurance company • Recovering $ sent by the insurance company directly to insured members • Collecting co-pays from insured members

4. CHANGES • Ask if clients have insurance. • Verify coverage. • Get pre-authorization. • Match clients with credentialed therapists. • Use Availity to verify coverage and to know status of billing. • Customize billing software to submit bills for substance abuse treatment (previously thought not to be covered). • Train staff to provide correct dates and modifiers on bills and bill within required time frame, including modifying management info system. • OP clinics send clinical notes to Billing; created tracking system to ensure that they’re sent in a timely manner. • Develop collections procedure and script for staff to use to request co-pay from clients. • Collect payment from clients prior to session, for clients for whom insured member will be reimbursed. • Require existing staff to become licensed and credentialed within 2 years; new hires must be licensed.

5. RESULTS Anthem Denial Rate Increased revenue from $2,623 to $3,206/mo Increased revenue from $232 to $774/6 mos. Increased revenue from $100 to $2,800/6 mos.

6. RESULTS Cumberland River • Eliminated top 3 reasons for Medicaid denials Chrysalis House • They now ask if clients have insurance (but residential treatment is typically not covered).  They will try billing anyway.  Transitions • Created billing process to bill one new third party payor (Anthem)

7. How was the NIATx Way incorporated? • Understand and involve the customer • Client: Walk-through as a client with insurance • Third Party Payor: Attend Anthem training/Invite Anthem to train staff to understand their perspective • Focus on ONE aim, ONE third party payor, ONE population (clients with insurance), at ONE location • Pick a powerful Change Leader from financial staff • Change Teams included financial AND clinical staff • Use PDSA cycles to test changes

8. WHAT NEXT? • SUSTAIN the changes by having a Sustain Leader who will track collection rate relative to target sustain level • Providers will SPREAD improved billing processes to: • Other locations • Other third party payors, including Medicaid MCO’s • Convener will SPREAD at meetings with • CEOs of publicly funded Behavioral Health Centers • KY Division of Behavioral Health staff

9. IMPACT • Increased revenue • More efficient billing processes for for for both provider AND payor • Financial staff are better prepared to use the Process Improvement approach to face future challenges