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Billing for Services Kim Johnson, MBA Deputy Director

Billing for Services Kim Johnson, MBA Deputy Director. Reduce Waiting & No-Shows  Increase Admissions & Continuation. www.NIATx.net. Reduce Waiting & No-Shows  Increase Admissions & Continuation. Myth #1. I have to have an electronic system to bill. www.NIATx.net.

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Billing for Services Kim Johnson, MBA Deputy Director

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  1. Billing for Services Kim Johnson, MBA Deputy Director Reduce Waiting & No-Shows  Increase Admissions & Continuation

  2. www.NIATx.net Reduce Waiting & No-Shows  Increase Admissions & Continuation

  3. Myth #1 I have to have an electronic system to bill www.NIATx.net Reduce Waiting & No-Shows  Increase Admissions & Continuation

  4. Myth #2 I need a contract to get paid www.NIATx.net Reduce Waiting & No-Shows  Increase Admissions & Continuation

  5. Myth #3 I can’t bill with existing staff www.NIATx.net Reduce Waiting & No-Shows  Increase Admissions & Continuation

  6. Myth #4 Nobody will pay for the services we provide www.NIATx.net Reduce Waiting & No-Shows  Increase Admissions & Continuation

  7. Patient Flow Billing starts with your first interaction with the patient and ends when all possible payments have been posted and any balance has been written off. Everybody in the organization plays a role. Gervean Williams, National Association of Community Health Centers www.NIATx.net Reduce Waiting & No-Shows  Increase Admissions & Continuation

  8. Where to start?

  9. www.NIATx.net Reduce Waiting & No-Shows  Increase Admissions & Continuation

  10. Start at the Beginning • Do a pilot test: • Start with asking patients if they have insurance • When someone says yes, make a copy of their card and either call provider relations or look them up on line • This will let you know what services may be billable www.NIATx.net Reduce Waiting & No-Shows  Increase Admissions & Continuation

  11. Billing Forms • There is a standard set of billing forms • Most payers still accept paper forms or have web enabled forms • You will usually find information on the payer provider relations web site www.NIATx.net Reduce Waiting & No-Shows  Increase Admissions & Continuation

  12. www.NIATx.net Reduce Waiting & No-Shows  Increase Admissions & Continuation

  13. Coding • Often the most difficult part of billing process • Codes changing in 2014 • Matching procedure codes and diagnostic codes common reason for denials www.NIATx.net Reduce Waiting & No-Shows  Increase Admissions & Continuation

  14. It is ok to contract out the billing process especially if you are a small agency www.NIATx.net Reduce Waiting & No-Shows  Increase Admissions & Continuation

  15. www.NIATx.net Reduce Waiting & No-Shows  Increase Admissions & Continuation

  16. AIM Increase Medicaid third party payments from 0 to 15 by March 31, 2011 Muskingum Behavioral Health Zanesville, Ohio Current Billing or Baseline = 0 or $0.00 Target = 15 clients with Medicaid $1000.00 billed and received.

  17. Plan Muskingum Behavioral Health - Zanesville, Ohio Having no experience with Third Party billing, work with change team and billing person on familiarizing ourselves with the NIATx billing Guide Start Documenting our process for third party billing information Ask each person who calls if they have any insurance Record results on a tally sheet

  18. Results Muskingum Behavioral Health - Zanesville, Ohio • The first step was to establish a process and being to document each step. • Ask everyone who came in if they had insurance? • Copy the insurance card when they arrived • Document coverage using the NIATx pre-authorization template • Work with one clinician for one month to begin to track each service and match authorization and billing codes for that treatment plan • Not everyone was willing to ask for insurance cards. • Needed to train staff, create a tally sheet, • Educate customers about insurance - understand if they had possible insurance coverage • Practice by role playing • and then documenting the process and the results. Not everyone verified insurance every time. • Worked on establishing and improving process for 3 months. Kept working with the one clinician • In April of 2011, we had 15 clients who were covered by Medicaid. • In 5 months we collected $1,875 in Medicaid revenue. Though this may not be a large amount of money, it is for a small organization. That’s $22,500 . per year more than we were getting before the project started! • Clients with third party payers have gone from zero to 10 per month.

  19. Next Steps Muskingum Behavioral Health - Zanesville, Ohio Make the current billing processes more formalized Continue to foster relationships with third party payers. Establish protocols for addressing denials Increase marketing effort to people who have third party reimbursement.

  20. Important Considerations • Know your costs • Document, Document, Document • Learn insurer speak • Persistence is the most important trait www.NIATx.net Reduce Waiting & No-Shows  Increase Admissions & Continuation

  21. Questions? www.NIATx.net Reduce Waiting & No-Shows  Increase Admissions & Continuation

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