State behavioral health agency cites billing overhaul and client-enrollment work as drivers of $17.2 million projected revenue gain

Laura Anderson, policy director for the Behavioral Health Division at the North Dakota Department of Health and Human Services, told the Appropriations Committee the division has reorganized billing and related functions and is projecting higher reimbursement as a result. "Our rev cycle director was hired about 11 months ago," Anderson said, and the work since then has focused on client access, coding, credentialing and timely filing to increase billable revenue.

The division said the policy and administration team now includes a revenue cycle and a quality and technical services vertical totaling about 100 positions; many were moved into the team from other HHS units. Those positions handle tasks ranging from billing and coding to client access and credentialing. Anderson said one newly hired client-access staff member helped sign up 20 individuals for insurance coverage, a change she called illustrative of the expected gains from targeted enrollment work.

Why it matters: The division presented charts showing combined revenue for the clinics and state hospital. Anderson said the current biennium’s actual-plus-projected revenue totals about $43.6 million and the division is projecting roughly $60.8 million for the next biennium, a projected increase of about $17.2 million tied largely to improved billing, higher utilization of insurance, and process changes.

Division leaders gave examples of the work underway: establishing workload standards for billing staff; creating a client-access team that enrolls patients in Medicaid or commercial plans where appropriate; addressing credentialing and accounts-receivable delays; and aligning the electronic health record (EHR) workflows to support billing and clinical documentation needs. Anderson said the EHR is shared by clinics and the state hospital and that some one-time funding requests on the agency’s list would support data migration or backup solutions for the record system.

The committee asked how durable the revenue gains are and whether growth will continue beyond the next biennium. Representative Steven and Representative Murphy asked whether the projected increases reflect steady growth or one-time recoveries; Anderson replied that the improvements target systemic issues—credentialing, enrollment and billing workflows—so some increase is expected in the next biennium but slower growth thereafter as the team “realizes national best practices.”

The presentation noted vacancies and recent position shifts into the new revenue-cycle team; Anderson said about 31 vacancies listed at the time of the report had been or were being filled and that many new positions were requested through the FTE block-grant process.

The department did not present a final, binding revenue guarantee and staff said questions about specific claim-level recovery (for example, where third-party billers may have been responsible) would require follow-up with the revenue-cycle director and finance staff.

Looking ahead: Committee members asked for follow-up details including (1) examples of claims where an outside payer was available and the voucher or state funds were used instead, (2) breakdowns of productivity expectations for billing staff, and (3) confirmation of the EHR migration and redundancy plans included among the division’s one-time requests. Anderson said staff would return with additional documentation and that the rev-cycle team would continue to track and report measurable gains.

Ending: The division emphasized that the revenue-cycle effort is intended to strengthen long-term billing practices, not to substitute for other funding, and that it supports the larger policy goals of improving access and quality across clinic and hospital services.