Overview NIATx-SI Business Practices for the Future Learning Collaborative Fee-for-Service Cohort II Informational Call Jeanne Pulvermacher, Project Director Funding provided by: CSAT

Fee-for-Service Cohort II November 2011-October 2012 Develop the capacity to bill third-party payers.  Training on the core components of implementing third-party billing systems  Identify common areas where billing systems function poorly  Learn improvement techniques that work  Know and understand The NIATx Third-party Billing Guide

Six regional teams will be chosen and will be assigned to one of two levels in the NIATx Fee-for-Service Capacity Pyramid: Ideally each provider in a team will fit in the same level.

Regional Team A Convener – someone from the state, county, provider association, health system, or intermediary 10 to 12 local non-profit, community-based addiction treatment providers Coach – NIATx Process Improvement expert NIATx staff – liaison and support for each team Jeanne Pulvermacher, Project Manager Amy McIlvaine, Educational Services Director

Expected Outcomes Each team will gain a greater understanding of the changes anticipated with healthcare reform. Coaching and monthly calls will help teams develop or improve their systems for billing third-party payers. Treatment providers within each team will develop or improve their collections performance. Conveners will build their teams’ capacity for peer-to-peer mentoring and sharing best practices. Each team will achieve locally specific milestones to build better and more robust business models.

Level I Aim = Design a third-party billing system Routinely request insurance cards and verify coverage Request prior authorization and document authorization limits Provide and document services using correct billing codes and amounts Submit at least six invoices for payment, noting if bill was paid, denied or no response given Make corrections and resubmit Document the billing procedure for those steps and write up a policy and procedure to be included in the agency billing manual

Level II Aim = Improve Collections Perform a walk-through of their billing process Create a flow chart and assign staff to each process Work to improve at least one step in their process (utilization review, accuracy of record keeping) and increase collections Increase collections by a specified amount (will vary by provider) Document the billing procedures and include all policies and procedures in a billing manual

Who should apply Each of these providers must complete an on-line survey describing their need to implement and/or improve their third- party billing system. Providers Each convener must also recruit 10 to 12 local non-profit, community-based addiction treatment providers Convener States, counties, provider associations, health systems, or intermediaries can apply to participate as a convener.

Timeline DatesActivityFormatWho participates? August-September 2011Announcement, Informational call, Application Processing, Collection, and Review Conference call/WebinarConveners, NIATx September 14, 2011Application Deadline 5:00pm CST Conveners October 1, 2011Announcement of Selected Organizations Conveners, NIATx October 2011Convener Pre-work and Orientation to Collaborative WebinarConveners, NIATx

Timeline DatesActivityFormatWho participates? November-December 2011 Coaches Pre-work and Orientation to Collaborative WebinarCoaches, NIATx November 2011Kick-Off MeetingFace-to-face in each region Coaches, Conveners, Providers, NIATx November 2011-August 2012 Demonstration PeriodMonthly Interest Circle Calls. Coaching Assistance, Skill Building Calls Coaches, Conveners, Providers, NIATx

Timeline DatesActivityFormatWho participates? April 2012Mid-Project ReviewWebinarCoaches, Conveners, Providers, NIATx August 2012Wrap-UpWebinarCoaches, Conveners, Providers, NIATx September 2012Conclusion MeetingFace-to-face meeting, location TBA Coaches, Conveners, NIATx

1.5 day Kick-Off Meeting November 2011 Meetings typically take place at a convener’s or provider’s office building. Convener responsible for securing the meeting space and other local costs associated with the meeting. NIATx staff, coaches, conveners, and providers will attend Providers will learn: –NIATx Process Improvement 101, –system design and change strategies –review the NIATx Third-party Billing Guide. Each team will develop an organization-specific “Business Practice Implementation Plan.”

Demonstration Period November 2011-August 2012 Monthly Interest Circle Calls for Level 1 and 2 NIATx will provide content experts for these calls. Coaching: each region is assigned a NIATx coach to –Facilitate monthly calls to review each provider’s progress –Participate on monthly interest circle and skill builder calls –Attend the face-to-face meetings –15 days of technical assistance allowed NIATx will facilitate Level I and Level II monthly project review and skill-building calls with coaches and conveners.

Mid-Project Review Webinar April 2012 Two people from each local project, their coach, and NIATx staff will attend a mid-project review webinar check-in and review of project outcomes to date identifying timelines and milestones needed to achieve project goals.

Close Out Meeting & Sustainability August-September 2012 Each convener will present their change project story at an in-person closeout session. (Place TBD) Each local convener and key providers from the regional team will present their change projects during one of two scheduled webinars for all members of the collaborative. Each convener will submit a completed project charter of outcomes and outline next steps for sustainability and dissemination to at least five additional provider sites.

Questions?

Contact Information Jeanne Pulvermacher