THIRD PARTY INSURANCE BILLING THE JOURNEY OF IMPLEMENTING INSURANCE BILLING at NORTH CAROLINA STATE UNIVERSITY

Question Everything

Driving Factors  Affordable Care Act  Access to Care (out of network)  Decreased Utilization of Services  Student Demand  Parent Requests  Student Health Fee

PROCESS How do we get there from here?

Strategy by Design The Fishbowl Phenomena… new initiative = all eyes on you! What do we want to accomplish? What is our Current State ? How do we Plan for our Future State?

GOALS ■Implement Billing by Fall 2016 ■Improve Access to Care for Students ■Improve Patient / Parent Satisfaction ■Demonstrate Additional Value to Campus ■Maintain and Grow Customer Base ■Grow Revenue

ASSESSMENT

Assessment Current State ■Hard Waiver ■SHIP Billing ■Courtesy Billing/Bursar Balance ■Not in network with major plans ■Providers lack of coding/billing experience ■Paper Reimbursements ■Manual adjustments & posting ■Unknown student plan participation Future State ■Hard Waiver ■Continue SHIP ■Reduce/Eliminate Courtesy Billing ■Become In-network with major plans ■Transition ICD 9 to ICD 10 ■Electronic Reimbursements ■Auto adjudication ■Knowledge of student’s plan participation

CONTRACTS

Consultants

Our Road to Contracting ■Collection of insurance information – orientation is a great time ■Identification of major plans in the area – know your market ■Leveraging negotiating power – springboard off of others ■Contracting process is lengthy – days not unusual –Health services review –Purchasing review –Legal review ■Jurisdiction for arbitration or suit(s) – can be a deal breaker with state entities ■Key verbiage: “ organization name will be suppressed in provider network publications” or “services available to eligible members (students/campus community) only” ■Reimbursements – based off Medicare allowable – negotiate everything! ■Using Consultants – helpful or not? –For negotiating contracts –For service provision

Health Fees vs Insurance Health FeeCovers ■Most Primary Care Visits including Initial Well Visit (community charge $125) ■Two Nutrition/Dietitian Visits ■Two Psychiatry visits and all Counseling visits ■Wellness Outreach Events ■Health Education Programming Diabetes Asthma Sexual Health Insurance is Billed ■Laboratory ■Pharmacy OTC and RX ■Radiology ■Physical Therapy ■Procedures ■Supplies ■Specialty Office Visits

Timelines ■2008 Courtesy filing ■2014 Assessment / consultant; review of charges; pro-forma ■2015 Hired coder; contracted with BCBS; trained providers in ICD 10; trained staff; ■2016 Continue contracting with Cigna, United, and Aetna. Not accepting Medicaid. ■Over the past two years, we have funded a Student Medical Emergency Fund through donations to assist students with demonstrated financial need thus eliminating financial barrier to needed care.

STAFFING AND TRAINING

Staffing and Training Needs ■Staffing Considerations Billing submission Coding specialist Referrals and approvals Accounts Receivables Resubmissions Reconciliations Cross-training of staff ■Training Considerations Providers and Staff ICD coding Charges Referrals Plan differences Documentation expectations Students and Parents In network status Billing: Copays, deductibles

IMPACT

Students & Parents Students (parents) are excited to be able to use insurance at health center Convenient In-network Continuity of care Specialist care (on site specialists bill their own – some confusion) Health Center Health center has experienced Increased utilization of services Incremental increase in revenue Process changes to accommodate insurance filing and plan requirements Lab did not suffer lost revenue like we expected One additional FTE (referral/coding specialist)

LESSONS LEARNED

Take Away Messages ■Plan Well in Advance – Stick to your Plan ■Create a Pro-forma on financials to predict impact ■Engage: Students, Parents, Administrators ■Understand your Market (population served, major health plans, and community climate) ■Evaluate often – create a dashboard for reference ■Think BIG, Start small…if you need to ■Maximize resources at all levels ■Use technology whenever possible ■Plan for a future with reduced / no health fees…seriously.

Questions? Please feel free to contact us: Leah Arnett Director, Student Health Denise Joshua Assistant Director Business and Finance