When a clinician at the nonprofit Huther-Doyle addiction treatment organization in Rochester, N.Y., creates a progress note, the action automatically generates a file in the billing system with all the information that has been gathered for clinical purposes populating fields in the billing system. “There used to be much greater room for error and inefficiency,” says Sharon DeLeo, Huther-Doyle's director of client accounts.

While generally acknowledged as lagging behind the rest of the healthcare industry in technology adoption, addiction treatment centers are starting to take advantage of electronic health records to automate some steps on the clinical side of their operations. Perhaps getting less attention are the gradual but important advances addiction professionals also are making on the financial and billing side to match their software to staff workflow in order to reduce coding errors, speed insurance billing and ease regulatory reporting.

Many treatment centers also are taking advantage of the integration between clinical and financial systems to cut down on data entry and to use quality-reporting tools to analyze their trends and improve business processes. The transition to new systems can be painful, and the goal of an entirely paper-free system an elusive one. Nevertheless, the following stories of efficiencies gained could inspire others just starting down the path.

Huther-Doyle, which has four locations in the Rochester area and sees about 750 clients per day, began working with software vendor Sequest Technologies in 2003 on electronic billing. But the agency only recently upgraded its Sequest TIER (Totally Integrated Electronic Record) software to tie the patient medical record and billing modules in a workflow process.

“Previously nothing was connected,” DeLeo explains. “A progress note was entered, then the medical records department would have to go through those records and re-enter data by hand into the billing system. It was a huge job. Now all those systems are connected.”

The integration also helps when the state licensure authority conducts an audit. “They are able to look at charges and see the clinical documents directly attached to them,” says Joyce Mitchell, Huther-Doyle's director of health information and data management. “Those audits now go much quicker. In the old days, they would pore over lots of paper documents.”

The agency is planning to take advantage of a few more features the software offers, including electronic download of insurance payments and batch eligibility checks for Medicaid. “Currently we have to do those one at a time,” DeLeo says, “and we do several hundred a week.”

Mitchell notes that Huther-Doyle is not yet 100 percent paperless. “We are working toward getting signature pads to get electronic signatures from clients and clinicians, so we won't have to store any paper records at all,” she explains. “And we will have document scanning, so that if people bring paper records from other providers, those can be scanned in and made part of the records we keep.”

The need for customization

The biggest challenge for treatment centers is that private insurers, Medicaid and Medicare all require a facility to bill differently, says Brad Ewalt, president and founder of software vendor ClaimTrak Systems Inc. in Gilbert, Ariz.

“If you are moving to automation, you have to understand how the billing is taking place and translate that into a system that follows that workflow about documenting what the insurers want,” says Ewalt, who started out as a consultant with a handful of behavioral health customers and then saw a need for customizable claims processing and client management software.

The biggest challenge for treatment centers is that private insurers, Medicaid and Medicare all require a facility to bill differently.

Vendors such as ClaimTrak build core systems but as they move from state to state, they need the flexibility to customize for customers' needs. “For instance, in Rhode Island, there are certain treatment programs in which providers can charge per-diems if they meet certain thresholds in a given month and if not, they have to bill fee for service,” Ewalt says. “They even have to look over a three-month period to make some of the determinations. So we develop a rule-based program that makes that determination for them about which way to bill.”

Ewalt sees many treatment centers that are still completely paper-based, and others that are electronic on the billing side but still use paper charts on the clinical side. “Some of those are now moving to a complete system,” he says, “because they realize they are losing efficiency because all that data has to be re-entered.”

Web-based solutions

Some smaller operations are finding that web-based “software-as-a-service” solutions fit their needs. The Center for Solutions is a 24-bed residential facility in a rural setting in Cando, N.D. As chief of operations Bob Spencer explains, the center was founded as a subsidiary of a nearby nonprofit medical center, which handled the billing. “Addiction treatment billing requires some additional expertise they did not have,” he says. “Things were not being billed appropriately, and the follow-up was not being handled properly.”

In October 2008, as the center sought another billing solution, it also separated from the medical center and became an independent, for-profit business. After interviewing several software vendors, Spencer chose an application service provider (ASP) solution from Valley Hope Association, the nationally known nonprofit addiction treatment service organization with facilities in seven states.

“We liked Valley Hope's approach that is to build a longer-term relationship and really hold your hand. As the transition took place, they had the depth and experience to help us,” Spencer recalls. “If we had tried to do that transition ourselves with software we had purchased, I think we would have failed miserably.”

The center is responsible for entering all billing information and keeping patient information current and correct, while Valley Hope submits claims to third-party payers and maintains the center's accounts.

“They double-check our work and can catch it if we forget a charge,” Spencer says. “We are able to handle the billing now with only one staff person.”

The Center for Solutions pays monthly fees for the billing and EHR software and another fee for Valley Hope to handle the billing services. When the medical center did the billing, Spencer knew he was losing out on revenue. “With the conversion to Valley Hope, we are capturing revenue that was leaking out, so it has more than paid for the expense involved.”

Customization also is important to Tarzana Treatment Centers in California, according to director of information technology Jim Sorg. His organization has used the RADplus (Rapid Application Development) feature of Netsmart Solutions' Avatar product suite to build customized screens.

“We have sought to push for better collection of co-pays and deductibles,” Sorg says. In Los Angeles County, providers can collect a therapeutic admission fee for public-sector patients, so Tarzana has developed a series of screens to help staff in the collections.

“We are also able to generate automated e-mail reminders to staff to pursue collections,” Sorg adds. “It is quite flexible in allowing us to generate e-mail notifications to particular staff, for instance about billing Medi-Cal for patients who enter a detox unit.”

The agency is now working on implementing a patient portal called ConsumerConnect that will eventually include a way for patients to see and pay bills online.

The next step for many providers is to take advantage of quality-reporting features both internally and externally. “I am convinced that data can be the key to the success of a facility,” ClaimTrak's Ewalt says. “Agencies that can take data to payers about their outcomes and their spending often get more money and more contracts because they can justify their productivity levels.”