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Using the NIATX Billing Guide

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.

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Using the NIATX Billing Guide

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  1. Using the NIATX Billing Guide Clara Boyden, AOD Program Manager Behavioral Health & Recovery Services San Mateo County

  2. Pigeon Point Lighthouse San Mateo County A little about San Mateo County…

  3. Purpose of Today To 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 zero • Strategies to build and keep momentum • Challenges…more than just a new process

  4. Context of our NIATX efforts • Patient Protection and Affordable Care Act • Wellstone/Domenici Mental Health Parity and Addiction Equity Act • Local opportunity through California’s 1115 Medicaid waiver & County ACE Program • SMC Providers have limited experience or infrastructure for billing outside Federal Block Grant

  5. NIATx System ImprovementLearning Collaborative

  6. 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.

  7. BHRS Goals and Objectives • Determine 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.

  8. Getting Started Self Assessment • NIATX Survey and Walk Through Pilot Test • SMC Health Insurance Coverage Survey • SMC Provider Staffing Questionnaire • Assess Current Billing System/Infrastructure Provider Interviews • Interest-Public billing vs. Private billing

  9. 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%

  10. 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

  11. BHRS Health 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

  12. Provider Staffing Questionnaire Conducted in October 2010 • 10 of 13 providers responded • 90% 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

  13. Designing our Learning Collaborative • Use of NIATX processes & tools– establish change team & other resources • Incorporate learning from previous “learning collaborative” • Build Momentum-contact frequency • Greater Accountability • Drive the process • Workplan Design

  14. Easy Does it! • Use the Billing Guide to plot your course • Map out “micro steps” • Start small • Dual focus (FFS public vs private) • Workplan flexibility

  15. Strategies to Build Momentum • Connect to other efforts • In person convenings • Establish Change Leaders and Change Teams • Shared workplan • Regular calls • Provider liaisons/partner

  16. More Strategies for Success • Establish workgroups as needed • Consider Site visits • Trainings & Roleplays • NIATX webinars, site, tools • Bring in subject matter experts • Consider provider networks

  17. Challenges • Program Design • Organizational Culture • Philosophy • Policies & Procedures • Business practices & tools • Staff competencies and credentialing

  18. Questions?

  19. Thank you! Clara Boyden650-802-5101cboyden@co.sanmateo.ca.us

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