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TMHP Billing Solutions for Texas

While many billing companies are focused on hospital billing, physician practices billing, surgical billing, and other specialties, few billing companies have given the necessary attention to health and human services billing including Intellectual and Developmental Disability (I/DD) services and behavioral health.  

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In the Texas Medicaid system, Millin discovered a gap in the industry as Home and Community-based services (HCS) transitioned to bill through TMHP. The basic MMIS system the State pushed out did barely enough for program providers to get claims out the door for Texas Medicaid services and Millin recognized the need for a solution that focused strictly on the billing process for HCS and TxHmL (Texas Home Living) providers that serve people with disabilities. Being that most Texas Health and Human services long-term care agencies and community services, including developmental disability services, are generally reimbursed by Medicaid, there are many specific regulations associated with this type of billing, and program rules associated with submitting claims through TMHP that providers must remember. Not only is it critical to get paid in full on all I/DD claims but ensuring that all TxHmL and HCS program billing rules and regulations are being followed is just as important to avoid recoupment of payments and penalties upon audit. Most recoupments are not due to fraud but simply due to human error and lack of following certain regulatory requirements that could have been avoided with the right system in place. Fortunately, Millin has developed a solution for submitting Texas Medicaid billing through TMHP that drastically mitigates these errors. 

whyMillinFinal
Some Texas Medicaid healthcare programs billed through TMHP are billed monthly, while others are billed daily, or by number of units. Units of time can also vary from one program to another. Some programs have 15-minute units while other programs have 1-hour units.
In some cases, you can combine the minutes within a day to capture as many billable medicaid services as possible while in other...
Read More
Some Texas Medicaid healthcare programs billed through TMHP are billed monthly, while others are billed daily, or by number of units. Units of time can also vary from one program to another. Some programs have 15-minute units while other programs have 1-hour units.
 
In some cases, you can combine the minutes within a day to capture as many billable medicaid services as possible while in other instances you may not be able to do so. Then there are rules as to when you can round up the minutes and when you need to round them down. This can also vary by program.
 
The Texas Medicaid and Healthcare Partnership does not house all these intricate billing rules in their system and without knowledge of how TMHP works or years and years of TxHmL or HCS billing expertise, these long-term care billing rules can be easily overlooked. The billing rules for intellectual and developmental disabilities services are just the starting point and for a system like TMHP that requires a lot of getting used to, this can result in many denied claims and decreased cashflow. Controls like this are built into the billing logic of MillinPro, whereas in TMHP, these types of rules may require general knowledge to manually manipulate a claim.
 
In addition, there are several States that are already contracted with Managed Care Organizations (MCOs) to be the payer for intellectual and developmental disabilities and behavioral health providers. This also means that not only do I/DD and behavioral health providers need to keep track of the nuances for each program, but each payer may have their own billing rules as well.
 
For these, and many other reasons, having a system like MillinPro that replaces a large chunk of the TMHP billing process is critical and Millin's expertise is invaluable. The MillinPro software for TMHP has a sophisticated rules-engine that is updated on an ongoing basis as Texas Medicaid rules and regulations change. Millin has business analysts on staff that continuously track any new or updated TMHP information to incorporate revisions into the MillinPro billing system. The billing logic can keep track of rules by program, payer, and individuals served. This ensures claims are submitted correctly the first time around. This will not only increase your cash-flow but ultimately increase your overall collection rate and decrease time spent managing I/DD billing as well.
 
In addition, MillinPro has a proprietary issue tracker that ensures you are able to track and follow up on all issues that occur within TMHP without having claims fall through the cracks. Millin alerts for issues that occur pre-billing in TexMedConnect and MeSAV or after the claim is submitted through TMHP. Many agencies have recognized value in outsourcing the billing process to Millin so we can help identify any issues within Texas Medicaid that come up with TMHP. This allows you to better focus on the medical services and care options that you provide. We manage the TMHP billing process for small, medium, and large agencies. Some of our clients process less than one million dollars in claims annually while others process a few hundred million dollars, and everything in between.
 
The MESAV reconciliation report that MillinPro has built into its workflow is a huge part of staying on top of claims that have potential to be rejected or denied before they're even sent through the TMHP billing system for processing. Rather than logging into MESAV or other Texas Medicaid sites and manually checking available units and service authorization by hand, Millin has launched a report that pulls all the data residing in MESAV into MillinPro. The Medicaid billing software then cross references the unit authorization and utilization with the services an eligible individual received. If there are any discrepancies at all, MillinPro will hold the claim back and alert you immediately via the issue tracker so you can resolve the issue. Once fixed, you can put the claim back in the queue to be sent out and only then will the system allow you to submit it to TMHP.
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whyMillinFinal
Some Texas Medicaid healthcare programs billed through TMHP are billed monthly, while others are billed daily, or by number of units. Units of time can also vary from one program to another. Some programs have 15-minute units while other programs have 1-hour units.
In some cases, you can combine the minutes within a day to capture as many billable medicaid services as possible while in other...
Read More
Some Texas Medicaid healthcare programs billed through TMHP are billed monthly, while others are billed daily, or by number of units. Units of time can also vary from one program to another. Some programs have 15-minute units while other programs have 1-hour units.
 
In some cases, you can combine the minutes within a day to capture as many billable medicaid services as possible while in other instances you may not be able to do so. Then there are rules as to when you can round up the minutes and when you need to round them down. This can also vary by program.
 
The Texas Medicaid and Healthcare Partnership does not house all these intricate billing rules in their system and without knowledge of how TMHP works or years and years of TxHmL or HCS billing expertise, these long-term care billing rules can be easily overlooked. The billing rules for intellectual and developmental disabilities services are just the starting point and for a system like TMHP that requires a lot of getting used to, this can result in many denied claims and decreased cashflow. Controls like this are built into the billing logic of MillinPro, whereas in TMHP, these types of rules may require general knowledge to manually manipulate a claim.
 
In addition, there are several States that are already contracted with Managed Care Organizations (MCOs) to be the payer for intellectual and developmental disabilities and behavioral health providers. This also means that not only do I/DD and behavioral health providers need to keep track of the nuances for each program, but each payer may have their own billing rules as well.
 
For these, and many other reasons, having a system like MillinPro that replaces a large chunk of the TMHP billing process is critical and Millin's expertise is invaluable. The MillinPro software for TMHP has a sophisticated rules-engine that is updated on an ongoing basis as Texas Medicaid rules and regulations change. Millin has business analysts on staff that continuously track any new or updated TMHP information to incorporate revisions into the MillinPro billing system. The billing logic can keep track of rules by program, payer, and individuals served. This ensures claims are submitted correctly the first time around. This will not only increase your cash-flow but ultimately increase your overall collection rate and decrease time spent managing I/DD billing as well.
 
In addition, MillinPro has a proprietary issue tracker that ensures you are able to track and follow up on all issues that occur within TMHP without having claims fall through the cracks. Millin alerts for issues that occur pre-billing in TexMedConnect and MeSAV or after the claim is submitted through TMHP. Many agencies have recognized value in outsourcing the billing process to Millin so we can help identify any issues within Texas Medicaid that come up with TMHP. This allows you to better focus on the medical services and care options that you provide. We manage the TMHP billing process for small, medium, and large agencies. Some of our clients process less than one million dollars in claims annually while others process a few hundred million dollars, and everything in between.
 
The MESAV reconciliation report that MillinPro has built into its workflow is a huge part of staying on top of claims that have potential to be rejected or denied before they're even sent through the TMHP billing system for processing. Rather than logging into MESAV or other Texas Medicaid sites and manually checking available units and service authorization by hand, Millin has launched a report that pulls all the data residing in MESAV into MillinPro. The Medicaid billing software then cross references the unit authorization and utilization with the services an eligible individual received. If there are any discrepancies at all, MillinPro will hold the claim back and alert you immediately via the issue tracker so you can resolve the issue. Once fixed, you can put the claim back in the queue to be sent out and only then will the system allow you to submit it to TMHP.
Read Less
Some Texas Medicaid programs billed through TMHP are billed monthly, while others are billed daily, or by number of units. Units of time can also vary from one program to another. Some programs have 15-minute units while other programs have 1-hour units.
 
In some cases, you can combine the minutes within a day to capture as many billable medicaid services as possible while in other instances you may not be able to do so. Then there are rules as to when you can round up the minutes and when you need to round them down. This can also vary by program.
 
TMHP does not house all of these intricate billing rules in their system and without knowledge of how TMHP works or years and years of TxHmL or HCS billing expertise, these long-term care billing rules can be easily overlooked. The billing rules for intellectual and developmental disabilities services are just the starting point and for a system like TMHP that requires a lot of getting used to, this can result in a lot of denied claims and decreased cashflow. Rules like this are built into the billing logic of MillinPro, whereas in TMHP, these types of rules may require general knowledge to manually manipulate a claim.
 
In addition, there are several States that are already contracted with Managed Care Organizations (MCOs) to be the payer for intellectual and developmental disabilities and behavioral health providers. This also means that not only do I/DD and behavioral health providers need to keep track of the nuances for each program, but each payer may have their own billing rules as well.
 
For these, and many other reasons, having a system like MillinPro that replaces a large chunk of the TMHP billing process is critical and Millin’s expertise is invaluable. The MillinPro billing system for TMHP has a sophisticated rules-engine that is updated on an ongoing basis as Texas Medicaid rules and regulations change. Millin has business analysts on staff that continuously keep track of new and updated TMHP information to incorporate them into the MillinPro billing system. The rules-engine can keep track of rules by program, payer, and individuals served. This ensures claims are submitted correctly the first time around. This will not only increase your cash-flow but ultimately increase your overall collection rate and decrease time spent managing the developmental disabilities billing as well.
 
In addition, MillinPro has a proprietary issue tracker that ensures you are able to keep track and follow up on all issues that occur within TMHP without having claims fall through the cracks. Millin alerts for issues that occur pre-billing in TexMedConnect and MeSAV, including Medicaid eligibility, or after the claim is submitted through TMHP. Many agencies have recognized value in outsourcing the billing process to Millin so we can help identify any issues that come up with TMHP. This allows you to better focus on the services that you provide. We manage the TMHP billing process for small, medium, and large agencies. Some of our clients process less than one million dollars in claims annually while others process a few hundred million dollars, and everything in between.
 
The MESAV reconciliation report that MillinPro has built into its workflow is a huge part of staying on top of claims that have potential to be rejected or denied before they’re even sent through the TMHP billing system for processing. Rather than logging into MESAV and manually checking available units and service authorization by hand, Millin has launched a report that pulls all the data residing in MESAV into MillinPro. The software then cross references the unit authorization and utilization with the services an individual received. If there are any discrepancies at all, MillinPro will hold the claim back and alert you immediately via the issue tracker so you can solve the issue. Once the issue is fixed, you can put it back in the queue to be sent out and only then will the system allow you to submit it to TMHP.

Electronic Health Record & Electronic Visit Verification Systems Integration

Most I/DD agencies are already using an electronic health record (EHR) system and/or an electronic visit verification (EVV) system. The MillinPro solution can integrate with all EHR and EVV systems which is important so all information for all HCS or TxHmL services (or any other info that resides in the Texas Medicaid systems) can flow to and from the documenting system of choice to Millin to TMHP with the click of a button. The following are some of the most common systems Texas Health and Human Services long-term care providers and service coordinators use to connect with MillinPro but there are many others.

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The MillinPro billing system can integrate in several ways depending on the EHR and EVV capabilities. 

For example, Therap has a Millin report in their suite of reports that an agency can request. Clients that use Therap as their I/DD EHR system will upload that report into MillinPro for billing purposes. This ensures your service level info gets into Millin before it gets to TMHP, ensuring you are using the best available solution for your Texas Medicaid billing. The process takes about one minute and includes a reconciliation process within MillinPro confirming all the claims that were transferred from Therap. In addition, if there are any new individuals in the Therap system, those will automatically be set up in MillinPro, once again eliminating the need to constantly log into TMHP to confirm demographic data or program eligibility. With each transfer of data from Therap, MillinPro will also confirm how many new individuals are being set up in the system. 

This process and reconciliation is also available with Netsmart, Welligent, Focus, TaskmasterPro, MITC, and any others whose systems support Texas long-term care.

There are a few EHR and EVV systems that integrate with MillinPro via API. For example, Evero and Precisioncare have an API integration with MillinPro. So, with a click of a button in Evero or Precisioncare, the billing data is transferred into the MillinPro system. It's that simple. Once again, using a HCS or long-term care focused EHR in conjunction with the best-in-class TMHP billing vendor ensures that everything is submitted correctly the first time. 

The same process applies to Accumedic and a number of other systems that aid in reimbursement or payment for services rendered. 

Most of the electronic health records and EVV systems that I/DD organizations use have a Medicaid billing module, however it's generally not up to par with the agency's needs, especially when it needs to be flexible enough to integrate with a new, complex system like TMHP and the nuances within Texas Medicaid. Using a TMHP billing expert like MillinPro allows healthcare providers to collect on all eligible claims and employ a billing process that's the most efficient and effective. 

That is why hundreds of agencies choose to use the MillinPro billing system. That's also why Millin has become the preferred vendor to contract with for all IDD services that must be billed through TMHP. 

For an agency to improve their TMHP billing process, they do not need to switch out from their EHR or EVV system, which can be a considerable undertaking, disruption, and significant cost. All a Texas HCS or TxHmL program needs to do is integrate the MillinPro billing software with their documenting system. Generally, this doesn't affect more than a handful of people and those are the people that are thrilled to switch to MillinPro as it makes their lives much easier and more efficient. 

General Ledger System Integration

One of the many notable features in MillinPro is the ability to have a custom general ledger (GL) report based on the way your organization captures data in your general ledger system. Since all of the billing and claims data reside in MillinPro instead of TMHP, this data can be mapped with the cost centers in your GL system. Regardless of which general ledger system you use for your I/DD agency, you will be able to upload the GL report from Millin. Countless long-term care providers that have this custom cost reporting have told us this saves them many hours of tedious work every month that existed when they were trying to extract data from TMHP. By doing it through Millin, it also eliminated any human error. This is a customizable report and Millin's staff will work closely with you to create this report exactly the way you need it.

 

Reports 

We can certainly create other custom reports for you in addition to the GL report, but it is most likely that all reports your organization may need throughout the year are already available in our reporting module with endless filtering capabilities. All reports can be exported in excel. In TMHP many reports come over through PDF and this is a massive waste of time. You can't filter anything, and it takes hours of double data entry to be able to manipulate these reports. On top of that, some of the most popular, important reports such as the R&S reports contained in TMHP are bare-bones, non-filterable, and incomplete. In MillinPro, you can report on any remit, payor, denial, claims status, with a range of dates of service. These can all be exported to Excel.

 

No two States I/DD Billing are the same 

Millin understand that each State has its own unique enrollment process, payers, billing procedures, and compliance documentation requirements for intellectual and developmental disabilities programs and all other long-term care programs. The Texas Medicaid system is no different. Therefore, Millin configures the MillinPro billing system according to each State's process and regulatory requirements. However, the MillinPro system has one source code for all clients that use the system. This gives us a huge advantage as it provides Millin with the ability to make changes very quickly when there are new rules and standards or payer changes. When long-term care programs first switched to TMHP this was a common theme as new rules for submission and new technical criteria seem to be at the forefront every week. We have heard many times IDD providers complain that they are waiting for TMHP to get back to them on a basic workflow problem so they can relay to their vendor how to best fix the issue. Their vendors may not be as proactive as Millin in demanding an answer to the problem from TMHP. This can affect the cash-flow and reimbursement method in a drastic way when not addressed promptly. By using the MillinPro billing system, I/DD providers mitigate this risk.

 

So, you wonder how different can the billing process be from one State to another? Quite different. 

In Texas long-term care, all Medicaid I/DD billing needs to be submitted through the TMHP system. It can be quite cumbersome submitting claims through TMHP if you don’t have a billing system like MillinPro that integrates directly with TMHP. While the same file type (837) is used in Texas and most other States, the information required on this file is quite different from one State to another. If any piece of information that Texas Medicaid requires, is not reported on the file or is reported in the incorrect loop and segment, the claim may be rejected or denied. An even worse scenario is when claims are missing information on the 837 file and make it through the system for payment, only to be recouped years later upon audit.

There are several States that are already contracted with Managed Care Organizations (MCOs) for long-term care and IDD services and the claims need to be submitted to those MCOs via a clearinghouse. In such cases, you are likely to encounter that different MCOs will require different information on the claims that are being sent. This is one of the many reasons why having an I/DD billing system like MillinPro is so critical. The MillinPro billing system has a rules engine incorporated in its system that can ensure all claims submitted are in accordance with each State and payer requirement and ensures only the correct information is transmitted onto the 837 billing file when submitting claims to Medicaid or the clearinghouse.

Experts at I/DD Billing Management

Millin keeps its offerings simple. You can license the MillinPro billing system and manage the TMHP billing process internally at nursing facilities, intermediate care facilities, or your applicable agency. That's right, your billers no longer need to log into TMHP to do anything manually. Everything can be done with a few clicks of the button through MillinPro....

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Experts at I/DD Billing Management

Millin keeps its offerings simple. You can license the MillinPro billing system and manage the TMHP billing process internally at nursing facilities, intermediate care facilities, or your applicable agency. That's right, your billers no longer need to log into TMHP to do anything manually. Everything can be done with a few clicks of the button through MillinPro. The second option is to outsource the TMHP billing process to the expert billing agents at Millin. Should you choose to outsource the process, you will have full, real-time access to the MillinPro system for tracking and reporting just as if you manage the billing process internally. The following are some of the many reasons why agencies choose to outsource to Millin:

  • The TMHP billing process has become too complicated for the staff to handle, and too little resources are available
  • Too much money is being left on the table year after year that should have been collected
  • Too much billing staff turnover
  • Hard to find the necessary billing expertise to maximize revenue
  • Millin keeps track of all the industry regulatory and payer changes that affect the TMHP billing process
  • Millin can quickly identify provider specific issues vs. global Texas Medicaid issues affecting all providers
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Experts at I/DD Billing Management

Millin keeps its offerings simple. You can license the MillinPro billing system and manage the TMHP billing process internally at nursing facilities, intermediate care facilities, or your applicable agency. That's right, your billers no longer need to log into TMHP to do anything manually. Everything can be done with a few clicks of the button through MillinPro....

Read More

Experts at I/DD Billing Management

Millin keeps its offerings simple. You can license the MillinPro billing system and manage the TMHP billing process internally at nursing facilities, intermediate care facilities, or your applicable agency. That's right, your billers no longer need to log into TMHP to do anything manually. Everything can be done with a few clicks of the button through MillinPro. The second option is to outsource the TMHP billing process to the expert billing agents at Millin. Should you choose to outsource the process, you will have full, real-time access to the MillinPro system for tracking and reporting just as if you manage the billing process internally. The following are some of the many reasons why agencies choose to outsource to Millin:

  • The TMHP billing process has become too complicated for the staff to handle, and too little resources are available
  • Too much money is being left on the table year after year that should have been collected
  • Too much billing staff turnover
  • Hard to find the necessary billing expertise to maximize revenue
  • Millin keeps track of all the industry regulatory and payer changes that affect the TMHP billing process
  • Millin can quickly identify provider specific issues vs. global Texas Medicaid issues affecting all providers
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Some of Millin's clients provide I/DD and behavioral health services and use multiple different EHR systems. Those agencies can incorporate billing related data from multiple EHRs (Electronic Health Records) into one MillinPro system for billing, tracking, and reporting across all programs. 

Accessing MillinPro 

All you need to easily access MillinPro is internet connectivity. Millin uses Microsoft Azure to store all your data, redundancies, and backups. This also ensures that your data is secure and compliant with all the necessary Federal, State, and local regulations. Millin also uses Multi-Factor Authentication (MFA). In addition to each user having a unique user id and password to access the MillinPro software, they also have a secondary verification method that is required to access data. 

Return on Investment (ROI) 

By now you probably have a good grasp as to why so many I/DD providers and other long-term care providers within the Texas Medicaid system turn to Millin for their billing that currently resides in TMHP. In a perfect world you would want one system that does it all; EHR, EVV, Billing, Accounting, Payroll, HR. In reality, you are much better off working with vendors that specialize in one particular area but can integrate with other systems. That is why best-of-breed systems will provide you with so many more advantages and have become so popular with I/DD providers that are going through this Texas Medicaid transition through TMHP. 

Long-term care agencies that use the MillinPro billing system tend to have an ROI north of 10x what they pay for the system when compared to the collection rate prior to using MillinPro and the number of hours spent on the billing process prior to using MillinPro, not to mention the added I/DD billing compliance they now have in place. The value-add proposition of Millin’s TMHP billing service is equally impressive. By outsourcing the billing process, I/DD providers are able to better focus on growing the programs and provide the best possible quality of service for the individuals in need of long-term care.

Contact Millin for I/DD Billing
We are looking forward to having the opportunity to schedule a call or demo with you to discuss the TMHP billing at your agency and show you how Millin can be of assistance to you and your team.
Frequently Asked Questions

Most EMR companies do not focus nearly as much on the billing module compared to the EMR system itself. The difference between using MillinPro vs. the TMHP billing module in your EMR system can be tremendous. By contracting with a vendor that eats, sleeps, and breaths Texas Medicaid, and more specifically Texas HCS and TxHmL billing, an agency immediately recognizes a decrease in claim mismatches, a higher collection rate, better reporting, and better cash flow. This often results in increased revenue in the hundreds of thousands of dollars or even in the millions with some agencies. 

Extraordinarily little. This is another big differentiator with some of the other vendors. Millin will set up the entire system with all the necessary information for your organization. This includes anything that resides in the Texas Medicaid system; provider contact information, locations, basic unit rates, services, clearinghouse integration, TMHP integration, TexMedConnect integration, and MeSAV integration along with the rules engine, consumer demographic information, etc. By having Millin's experts configure the system for your agency, you do not need to worry about errors and claim mismatches that can affect payments, reimbursement checks, and cash flow.

The fee schedule is based on the number of claims and types of services provided by the agency. The monthly fee includes access to the system including the reporting module, updates and upgrades, hosting, backups, redundancies, and security.

Rather than update the system quarterly or annually, Millin continuously updates the system as soon Texas Medicaid releases new billing guidance, as new features are tested, when new programs/services are introduced, or when there are new rules and regulations that can be incorporated into MillinPro's billing system's rules engine. All the updates to your MillinPro system are done by Millin associates and do not interfere with your daily work within the billing software system. TMHP has been pushing a ton of updates over the last few months and these changes are immediately reflected in the MillinPro software.

Absolutely. We can even have this automated to occur daily, weekly, or any interval that works for your organization.

No. The fee is flat rate based on the workload it takes to get you paid on all your claims. Whether you collect $50 a service or $500, the workload is often the same and there is no reason for you to pay a premium on high-value claims.
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