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Oct. 10, 2013
TOPEKA A new pilot program aimed at improving billing and collections at local health departments is beginning at a critical time: just as tens of thousands of Kansans are expected to get insurance coverage under the Affordable Care Act (ACA).
Currently, billing errors are costing many local health departments when it comes to collecting payments from private insurance companies and the Medicaid program. But that cost isn’t as significant as it could be because the lion's share of those now being served by health departments are uninsured and so pay their bills directly.
However, the payer mix is expected to change as more Kansans obtain private coverage through the new online marketplace healthcare.gov, assuming federal officials are able to solve technical problems that have plagued the website since its Oct. 1st launch.
Further, a decision by Gov. Sam Brownback and the legislature to expand eligibility for the state’s Medicaid program – known as KanCare — also would substantially increase the pressure on local health departments to improve their billing procedures. For the time being, though, neither Brownback nor the Republican-controlled legislature appear poised to authorize that expansion.
Photo by Karrey Britt
The pilot — spearheaded by the Kansas Foundation for Medical Care (KFMC), a Quality Improvement Organization — is beginning in this month in Douglas, Harper, Reno and Sumner counties.
Each of the four local health departments (LHDs) will receive up to $1,360 to train staff members on billing techniques intended to maximize reimbursement for services provided to covered clients, said Stephanie Lambert-Barth, manager for KFMC's Immunization Billing Project.
“Training of LHD billing staff will streamline the billing processes and improve billing outcomes, resulting in a return on the training investment. Demonstrating this return on investment may help other Kansas LHDs make the case to fund training for their billing staff,” she said.
The Lawrence-Douglas County health department is one of the largest and best funded in the state. Nevertheless it only has one office assistant working two days a week on billing, said director Dan Partridge.
"For us billing has been a challenge because our capacity to dedicate and train staff has been limited," Partridge said.
Currently about 3/4 of his department's revenue comes from clients who pay their bills directly. The agency has an 85 percent collection rate among those clients. However, it collects only 57 percent of the amount it bills to Medicaid and only 20 percent of what it bills to clients covered by private insurance.
"Most of it is coding errors," Partridge said. "We feel confident our participation (in the pilot) will lead to improved collection rates. We also want to be prepared for whatever shift the ACA will create within our revenue streams as private insurance coverage increases."
KFMC’s Lambert-Barth said that, while the project is focused on improving reimbursement rates for immunization services, the plan is to evaluate all claims billed by participating health departments, including family planning services for example.
"Our project's final product is a strategic plan report, which will include recommendations for how to move forward. It is not yet clear what those specific recommendations will be, but if the pilot goes well then expansion (of the pilot) would make sense,” she said.
The pilot project’s website contains links to billing resources, tools, project updates and other related information.
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