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San Mateo County, California NIATx Summit and SAAS National Conference Boston, MA July 2011

San Mateo County, California NIATx Summit and SAAS National Conference Boston, MA July 2011. NIATx-SI: Business Practices for the Future Learning Collaborative. San Mateo County Learning Collaborative. Designing a fee for service billing system for a new low income health program.

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San Mateo County, California NIATx Summit and SAAS National Conference Boston, MA July 2011

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  1. San Mateo County, CaliforniaNIATx Summit and SAAS National ConferenceBoston, MAJuly 2011 NIATx-SI: Business Practices for the Future Learning Collaborative

  2. San Mateo CountyLearning Collaborative Designing a fee for service billing system for a new low income health program

  3. Our Primary Aim (Plan) • Establish a Low Income Health Program/Medicaid Coverage Expansion (LIHP/MCE) for County residents with a substance use services benefit. • Acquire knowledge of all billing system functions, requirements from Medicaid • Treatment providers will screen for health coverage, facilitate enrollment and secure service authorizations, and provide and document services. • Providers will have a paper fee for service (FFS) billing process in place to bill for LIHP/MCE substance use services.

  4. Our Secondary Aims (Plan) • Support Treatment providers to bill private insurance /third party payers. • Explore the feasibility of cross provider sharing of billing functions • Set the groundwork for electronic health record and electronic billing system design.

  5. Change (Do) • System systems changes to increase enrollment in LIHP/MCE coverage • County streamlined application and enrollment process, • County obtained provider input into removing enrollment barriers, revised application, • Provided 3 trainings to program staff on process • Provider staff now screen for health coverage, verify eligibility, and assist clients with benefits application. • Increase treatment authorizations • Trained provider staff on effective ways to request treatment authorizations and demonstrate medical necessity and provided technical assistance tailored by levels of care.

  6. Change (Do) • Trained provider staff on treatment planning and clinical documentation requirements for Medicaid. • Established a paper billing system for LIHP/MCE • Service and billing codes determined • Service packages and bundled services identified • County designed scantron form for provider billing • Services billed by minute, bundled services billed by day • Service Tracking and billing (beginning July 1)

  7. Change (Do) • Trained provider staff on CPT codes commonly used with other 3rd party insurers. • Technical support provided to treatment programs to develop a local network to: • share information about lessons learned and strategies to increase 3rd party insurance revenues • to obtain 3rd party insurance contracts as a network of treatment service providers. • Established workgroups for provider input into development of electronic health record and electronic billing system

  8. Results (Study) Increased LIHP/MCE Applications

  9. Results (Study) LIHP/MCE Clients Enrolled in Care (as of 6/14/11)

  10. Results (Study) Projected Annual Revenue Increases

  11. Next Steps • In-person site visits for T/A and feedback on documentation for medical necessity, service tracking, coding and billing. • Continued learning collaborative meetings • Support ongoing systems change and process improvements, • 3rd party billing information sharing and exploration of contracts with 3rd party payers as a provider network, • Use FFS knowledge to inform development billing workflow and design of new electronic health record and billing system.

  12. Impacts • Increased number of residents can access treatment (estimated 800 / year). • Increased revenue and financial stability of treatment programs. • Enhanced partnership and collaboration among providers (history of competition for clients and limited resources). • Greater readiness for Health Care Reform. • Increased ability to work with 3rd party payers as a health care service provider and to do FFS billing.

  13. Many Thanks to • NIATx and their awesome staff and guest presenters, • Don Holloway, our irresistibly influential coach,  • …and of course, our San Mateo County treatment providers: • Asian American Recovery Services • El Centro de Libertad • Free at Last • Latino Commission • Hope House • Horizon Services • Project Ninety • Pyramid Alternatives • Sitike Counseling Services • StarVista • Women’s Recovery Association

  14. A brighter future…

  15. For more information, contact Clara Boyden, Program Manager Alcohol and Other Drug Services San Mateo County Behavioral Health & Recovery Services Phone: 650-802-5101 Email: cboyden@co.sanmateo.ca.us

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