MEET RUTH

CRISIS SERVICES

Ruth, a 71 year old female, was brought to Mobile Crisis by the local police department in response to a call from a concerned family member after Ruth expressed suicidal ideation. Ruth was assessed by a Mobile Crisis Team clinician and a Peer Support Specialist who determined that she was not at immediate risk but would likely need a high level of support to follow up and engage in services.

Ruth was provided with a next day appointment with the Behavioral Health Crisis Treatment Center. Upon presenting to the Crisis Treatment Center, she was assessed by a Crisis Treatment Center case manager and APRN, who recognized that she had some physical symptoms that were complicating her overall presentation and recommended she obtain medical clearance at Concord Hospital before further treatment.

INPATIENT SERVICES

Over the course of the next two weeks, the Crisis Treatment Center team worked tirelessly with Riverbend Emergency Services staff and primary care to coordinate the client’s movement through medical hospitalization, discharge, Crisis Treatment Center engagement, and returns to the ED.

Ruth had great difficulty with regulating her symptoms and struggled to organize tasks and follow up with providers. Team members provided regular check ins with Ruth over the next two months to navigate medication management, engagement with community support services, and bridge primary care and behavioral health service delivery until longer term services became available.

COMMUNITY BASED SERVICES AND PREVENTION & EDUCATION

Ruth was then connected to the Referral, Education, Assistance and Prevention Program (REAP), and to the Community Support Program where she met with a Clinician for intake. Ruth was found eligible for Community Support Program services but required support getting connected with Medicaid to pay for the services she needed. Staff from the Crisis Treatment Center continued to team with her new Community Support Program providers - a Case Manager, Nurse, and Doctor - to support continuity of care while she established services.

proclaimed “nerd who likes spreadsheets”, supervises a team of eight who handles the billing process from collecting, batching and sending incoming charges to the insurance companies, receiving and applying incoming payments, handling client statements and incoming payments, and dealing with denied claims.

“Fortunately, the vast majority of our work can be done from home,” Holland shared. “Overall things have been pretty stable in our department. Under the Public Health Emergency, things have been put into place making it easier for clients to maintain their benefits, meaning our team is not required to constantly check a client’s benefits status.”

Using the start of Covid as a marker of time passed can sometimes feel as if we’ve been living in a black hole wherein no time has passed, yet so much has happened. Over these last two years though, the Facilities, Administrative Operations and Accounts Receivable teams have been hard at work.

Aside from ensuring the buildings are kept safe and clean and sanitized, Nelson’s team can be found working on capital projects at any given time.

“Essentially, I’m working on tightening up efficiencies across my department,” Nelson explained.

With ten different locations to manage, finding ways to consolidate work flows and minimize unnecessary trips to buildings across town is key. Nelson’s most recent projects have involved getting his department technologically up to speed. Recently, he implemented an online ticketing service for maintenance tasks.

“I wanted to make it easier for everyone to be able to request something, and I also wanted to create a paper trail for accountability. I’m trying to create a better customer service platform. I want to be transparent with everything we do,” Nelson said.

Nelson is also exploring other cloud-based services to allow certain functions to be viewed and controlled from anywhere.

“We’re currently bidding proposals for building automation for the HVAC systems. They become computer controlled which opens up the possibility of being able to access them from anywhere. It also includes alarms if there’s loss of heat, or it’s too hot, or the water flow is too high indicating a leak - things that will save our department time and money while also tightening up that energy envelope,” Nelson explained.

For O’Connell, the past two years have allowed her staff to grow professionally.

“It’s put us in a position where it’s allowed us to identify opportunities for things like cross-training, so we’ve been able to develop folks and utilize them across departments in a way that

we haven’t before which has been really beneficial for staff-satisfaction and meeting the needs of the

FINANCE STAT

MONTHLY AVERAGE NUMBER INSURANCE CLAIMS

PROCESSED: 18,000 60 BILLING CODES OVER 20+ MAJOR INSURANCE

PROVIDERS NUMBER ACTIVE VENDORS: (AWAITING NUMBER)

FACILITIES*

>2,545.75 HOURS OF OVERTIME 20 AIR PURIFIERS INSTALLED

600 LIGHTBULBS CHANGED *SINCE MARCH 2020

agency,” O’Connell reflected.

Additional projects for O’Connell’s team have included collaborations with outside agencies like Concord Hospital and the Department of Health and Human Services (DHHS). Sixteen Riverbend staff have been certified by the State to determine an individual’s eligibility for Medicaid benefits, allowing the client to receive limited benefits for up to two months. This is critical in allowing clients to be enrolled at programs that require Medicaid benefits in order to be accepted, and also grants clients the ability to fill their prescriptions as soon as they’re discharged from hospitals.

Another key project that her team has been working on is preparing for the Public Health Emergency (PHE) Unwind.

“The public health emergency is going to end at some point, and there’s a lot of concern about clients’ Medicaid benefits closing once that happens. Because DHHS has not been closing cases as they normally would, despite the fact that clients may not be providing the level of detail and documentation that Medicaid would normally require of them, once the PHE unwinds lots and lots of cases are going to get closed. The concern is that we’ll have a large group of clients that are going to be in that situation which is going to cause strain on us, on DHHS - the entire system. What we’ve really done is try to work with DHHS to develop new communication pathways to ensure that we are identifying cases that need addressing to prevent those closures from occurring,” O’Connell explained.

O’Connell’s team also has been working closely with Concord Hospital’s revenue cycle team to create streamlined processes to receive data elements that support documentation and billing processes for services rendered on-site at the hospital. They’ve also identified opportunities to improve cross-communication between benefit specialists at Riverbend and Concord Hospital to reduce dropped information or duplication of work efforts in shared clients.

Additionally, O’Connell facilitated the implementation of electronic forms and signatures that allows the capacity for forms to be sent and signed electronically, which has been key when clients haven’t been able to come into the office.

For Holland’s Accounts Receivable team, they’re constantly working to meet the ever-changing requirements of insurance providers. A Statewide mobile crisis initiative that rolled out on January 1 of 2022 named “Rapid Response” has caused Medicaid to issue completely new billing guidance and different billing codes. This requires Holland’s team to work closely with Riverbend’s Information Technology department to get the proper codes put into place in their billing system.

“We’ve also been working a lot on cleanup of old balances and tightening up the way the insurance plans are entered into our system. By doing this we are consolidating and combining steps to make it easier

QUALITY ASSURANCE

AUDITS FOR COMPLIANCE, QUALITY, AND PRIVACY:

- 100 STAFF AUDITS PER MONTH, FOCUSING ON QUALITY OF DOCUMENTATION

- 110 CLIENT CHARTS PREPARED/PROCESSED FOR INSURER REVIEWS IN 2021

- 78 MONTHLY TARGETED MEDICAL CHART AUDITS OF RIVERBEND’S ELECTRONIC

MEDICAL RECORD TO MONITOR PRIVACY, ACCESS, AND ACTIVITY

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