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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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