Today's questions on the call
Where are clients getting stuck or falling out of care?
What are the most common points where people disengage?
What are the biggest barriers to moving to the next level of care?
Where is capacity insufficient—and where is it mismatched?
What levels of care have the longest waitlists?
Are there services that exist but are underutilized?
What populations are hardest to serve?
Who requires the most coordination but has the least support?
Where do current models fail complex or high-acuity clients?
What operational barriers affect care delivery?
How do authorizations, billing systems (e.g., CMBHS), or contracts slow care?
Where are providers spending time that should be spent on clients?
What actually improves outcomes?
What practices lead to retention, engagement, and long-term recovery?
What’s working that isn’t being funded or scaled?
What operational barriers affect care delivery: Our biggest barrier is the Medicaid billing process. The process is very time consuming and requires multiple phone calls, emails and coordination between billing clerk, counselors, and to Medicaid. Often times, Medicaid will deny claims due to admit dates verses pre-authorization dates, not receiving justification documentation but have proof of emailing required documents. Another recent issue that has come up is Medicaid saying they have paid for a claim but we have not received payment for the claim. Recently, we have issued 3 check traces that can take 30 to 45 days. Clients Medicaid Eligibility Verification on CMBHS does not reflect what private or Medicaid coverage they currently have, one month it may show no coverage and we bill HHSC and the next month it may show that they have Medicaid coverage pre dating our state funding date. Billing Clerk, Clinical Director, Director of Operations, and Counselors spend time every week to ensure we get paid for services provided. Chris Logan.