Reduce Waiting & No-Shows  Increase Admissions & Continuation Overview Iowa Fee For Service Project

Reduce Waiting & No-Shows  Increase Admissions & Continuation Who’s on First – Partners Iowa Department of Public Health Iowa Behavioral Health Association NIATx Compass Point Pathways SASC CADS UCS Heartland SEIDA MECCA Zion YSS Prairie Ridge ADDS CFR

Reduce Waiting & No-Shows  Increase Admissions & Continuation What were our goals? Assist providers in securing new contracts. Create a financial dashboard

Reduce Waiting & No-Shows  Increase Admissions & Continuation DASHBOARD RESULTS Responses from all providers Not easy to collect some of the data Surprises lead to changes in at least two providers Iowa State 2010MedianOPOP and Res Financial Indicators Denials as % of Total Billed16.36%16.18%16.36% % of Collections of Net Revenue28.99%28.00%29.97% % of Accounts Receivable Greater than 90 days24.00%18.00%11.00% Days In AR Current Ratio Days Cash on Hand Admin Exp as % of Total Exp15.64%15.60%18.00%

Reduce Waiting & No-Shows  Increase Admissions & Continuation Insurance contracts Submitted 21 total contracts

Reduce Waiting & No-Shows  Increase Admissions & Continuation Contract process Sought contracts from 21 different insurance product Submitted requests for twenty-eight contracts for a specific insurance product Six more contracts are under consideration, or in process but not yet submitted

Reduce Waiting & No-Shows  Increase Admissions & Continuation Contracting Results

Reduce Waiting & No-Shows  Increase Admissions & Continuation Costs Lessons Learned Know your cost basis Use cost knowledge to help negotiate Don’t be afraid to ask for a rate change If you don’t get the desired contract (e.g., out- of-network), set up system to track for future negotiations

Reduce Waiting & No-Shows  Increase Admissions & Continuation General Lessons Learned Helped with organizational focus Keep a copy of the contract paperwork Insurance is important but so is maximizing 3 rd party billing New contract may equal new billing process Pay attention to internal billing & 3 rd party billing processes Patience, persistence, frequent follow-up & communication are all crucial

Reduce Waiting & No-Shows  Increase Admissions & Continuation Staff Lessons Learned Hire employees with finance, healthcare & insurance backgrounds Knowledgeable staff about credentialing/contracting can make a huge difference in your contracted reimbursement. Credentialing is important, staff needs to have the correct licensing/certification for payment of individual services verses IOP.

Reduce Waiting & No-Shows  Increase Admissions & Continuation Market Lessons Learned Know your market and understand who needs services in the area? How does that play into our strengths? Learn what type of contract to seek out (individual vs. facility) Getting together the relevant information Some processes are more streamlined than others While your process may be quick, insurance companies take their time in responding

Reduce Waiting & No-Shows  Increase Admissions & Continuation Organizational Changes Collect fees at beginning of group Understand and learn –New billing procedures –How claims are processed –How to use HCFA vs. UB forms Track clients with high deductibles & no coverage –9% increase in client fee payments –9% increase in 3 rd party billing –200% increase in out-of-state billing (approx 4 to 5K)

Reduce Waiting & No-Shows  Increase Admissions & Continuation Organizational Changes Trained counselors to –Complete the forms and –Talk to their clients about money. Develop a uncollectible accounts write-off policy with our accountant. Implemented pre-authorization for Medicaid and all insurances. Hired a new person with a focus on marketing.

Reduce Waiting & No-Shows  Increase Admissions & Continuation Collaborative Benefits Sharing and mentoring within the collaborative –Sending contract links –Connecting key staff –Learning from others Better understanding how insurance companies think Learn how to present our case to them for a fair rate.

Reduce Waiting & No-Shows  Increase Admissions & Continuation Future Challenges With health insurance exchanges being created, is there any where to create a single process of credentialing with the HIE? How can the process be used to negotiate successfully as a group with Magellan?

Reduce Waiting & No-Shows  Increase Admissions & Continuation Photo courtesy of Iowa Tourism Office Wisconsin + Iowa + NIATx = Win