NIATx-SI Business Practices for the Future
Learning Collaborative
Fee-for-Service Cohort II
Informational Call
Overview
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
Convener
States, counties, provider associations, health systems, or intermediaries
can apply to participate as a convener.
Providers
Each convener must also recruit 10 to 12 local non-profit, community-based
addiction treatment providers
Each of these providers must complete an on-line survey
describing their need to implement and/or improve their thirdparty billing system.
Timeline
Dates
Activity
Format
Who participates?
August-September 2011
Announcement,
Informational call,
Application Processing,
Collection, and Review
Application Deadline
5:00pm CST
Announcement of
Selected Organizations
Convener Pre-work and
Orientation to
Collaborative
Conference call/Webinar
Conveners, NIATx
September 14, 2011
October 1, 2011
October 2011
Conveners
E-mail
Conveners, NIATx
Webinar
Conveners, NIATx
Timeline
Dates
Activity
Format
Who participates?
November-December
2011
Coaches Pre-work and
Orientation to
Collaborative
Kick-Off Meeting
Webinar
Coaches, NIATx
Face-to-face in each
region
Monthly Interest Circle
Calls. Coaching
Assistance , Skill Building
Calls
Coaches, Conveners,
Providers, NIATx
Coaches, Conveners,
Providers, NIATx
November 2011
November 2011-August
2012
Demonstration Period
Timeline
Dates
Activity
Format
Who participates?
April 2012
Mid-Project Review
Webinar
August 2012
Wrap-Up
Webinar
September 2012
Conclusion Meeting
Face-to-face meeting,
location TBA
Coaches, Conveners,
Providers, NIATx
Coaches, Conveners,
Providers, NIATx
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
Jeanne.pulvermacher@chess.wisc.edu
608-513-9430