Business Practices for the Future Learning Collaborative

Fee-for-Service, Cohort II

This Learning Collaborative was developed for the Substance Abuse and Mental Health Services Administration (SAMHSA) by the University of Wisconsin through JBS International, Inc., under contract numbers HHSS283200700003I/HHSS28300002T, with SAMHSA, U.S. Department of Health and Human Services (HHS). “The contents of this presentation do not necessarily reflect the views or policies of SAMHSA, or DHHS.” Kim Plavsic served as the Government Project Officer.

(Title)

Name(s) of presenter(s)Organizational Affiliation

New Jersey Learning Collaborative

NIATIx-SI: Business Practices for the Future Learning Collaborative

Fall 2012

Goal:

To provide New Jersey substance abuse providers with the opportunity to improve their capacity to meet Fee-for-Service contract performance targets and to provide technical assistance that will prepare agencies to compete in a changing public healthcare financing environment

* Providers have also voiced interest in increasing third-party commercial payment

• Objectives for Participant Agencies

– Review agency specific business processes and identify necessary changes that will improve prior authorization and billing practices to increase fee for service revenue

– Establish agency policies and procedures that reinforce efficient and effective business process that maximize revenue opportunities

““Utilization Rate” Utilization Rate” was identified in was identified in June 2011 as a performance measure June 2011 as a performance measure for agencies contracted with the for agencies contracted with the Division of Mental Health and Division of Mental Health and Addiction to provide services in the Addiction to provide services in the New Jersey Fee for Service network New Jersey Fee for Service network

Agencies Claims Paid Summary

Why was Utilization Rate identified as a Performance Indicator

It is a performance indicator which mirrors the clinical events of successful engagement and retention in treatment

Research has shown that high engagement and retention rates are strongly correlated with positive treatment outcomes

Participation in the NIATX process improvement collaborative provided the ideal opportunity for agencies to review provider service delivery and claims submission processes

Utilization Rate

• Next Steps – Expand NIATX opportunity for New Jersey Substance

Abuse and Mental Health providers

– Provide opportunity for NIATX participants to offer Peer to Peer technical assistance and/or recommendations to other New Jersey providers as well as state representatives

– Develop process to address barriers to billing New Jersey’s Medicaid system for Addiction Services

– Establish state mental health and addiction stakeholder group focused on process improvement practices