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Western_Montana_Addiction_Services-Niatx_2011

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									    Western Montana Addiction Services


   Provides Substance Abuse Treatment and
    Prevention Services in Missoula, Ravalli,
    Mineral and Lake Counties.
   State Approved Provider
   Annual Operational Budget = $4,578.900
   106 Employees
   8 Sites of Operation
   Highly diversified funding base
Teen Recovery Center

   8 Bed Residential Facility for Adolescents
   Annual Budget = $483,150
   Highly structured level 3.5 treatment (35
    days)
   Integrated into Adolescent Program
   Referrals taken statewide (1 of 2 State
    programs)
TRC Funding Sources and %

   Client Pay: 10%
   State Block Grant: 14%
   Medicaid: 63%
   3rd Party Insurance: 13%
Problem

   3rd Party Reimbursement accounts for only
    12% of funding in FY ‘10.
   Average reimbursement rate varies greatly
    among funders ($120 - $450 per day).
   Billing process differs greatly among funders.
   Denials rate too high (34.6%)
Change Team

Kathy Ratlaff - 3rd Party Billing Coordinator
Miranda House - Contract Manager/Fiscal
Lilly Gervais – Financial Eligibility Coordinator
Cinna Boyle – TRC Program Manager
Skip Rosenthal – Executive Sponsor
Aim

   Increase average daily reimbursement rate
    among 3rd party insurance providers.
   Decrease denials from 35% to 20%.
   Improve overall revenue generated by the
    program.
Changes Made

   Negotiate “all-inclusive” bundled rate for TRC
    services with largest 3rd party provider
    (BCBS of MT).
   Submit TRC bills on both UB-4 and HCFA
    formats as negotiated with insurance
    providers.
Results (as determined on monthly billing and financial reports)

   Denials as total % of Total Billed decreased
    by 7.4%.
   Increase of 18.8% in 3rd party reimbursement
    as proportion of overall program funding. We
    achieved the target payer mix
    (State/Medicaid vs. 3rd Party) during the 3rd
    quarter.
   Overall revenue increased from – $21,778 to
    $15,424 in 3 months (Jan – March).
What we learned / Problems

   We gained a great deal of applicable knowledge
    from the discussions and webinars.
   We determined the Rapid Cycle process was not
    really applicable to the process since changes were
    already in process and due to the time required to
    determine outcomes.
   Our current accounting system did not provide the
    level of detail required to evaluate project. We need
    to track detail better to determine what we did that
    worked.
   Changes being made relied on outside sources
    (insurance companies) that take their time in
    approving and/or implementing changes we come up
    with.
Future Plans / Sustainability

   Continue to work with insurance providers to
    maximize reimbursement.
   Negotiate bundled rate with BCBS of MT and
    then others.
   Monitor payer mix to diversify and adapt to
    changes in healthcare.

								
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